Wednesday, July 22, 2009

Lord of the ... card

Having returned to the land of the concious after a sjhort bout of flu (Tamiflu is wonderous stuff - but you need to take it early - so do see your doctor as soon as symptoms develop), I was pleased to find a story on a health related matter.

The story relates to a paper by Jennifer Doggett for the Centre for Policy Development. In a Tolkien-esque kind of way the paper calls for "one card to rule them all" - it is a health payment card that works as both an access to the underlying funds (e.g. Medicare and any private health fund) as well as creating acess to a kind of Health Loan system (like HECS) and to a single Safety Net regime to limit payments.

Actually it all sounds tremendously sensible. We could do with some other changes too though. These include eliminating the idea that the Medicare rebate amount is the "scheduled fee" and noting instead is simply the amount that Medicare has agreed to pay, removing the idiotic logic that "bulk-billing" meant the doctor had to take a fee cut (though that goes anyway) and finally requiring doctors to advertise their fees in a "meaningful" way. The last part could be by way of an index across a weighted range of typical consultations and procedures and state that the Doctor charges xxx% of the standard Medicare rebate. It probably needs to be matched with the existing quotation of basic consultation, and perhaps an indication of what the maximum mark-up might be.

But the biggest stumbling block for the innovative idea is the simple IT challenge. As a report in Saturday's SMH made clear, even getting agreement to implement a common health identifier is a challenge!

Finally, how long can it be before we decide the simplest way of dealing with both the health identifier and the credit card idea is to simply microchip us all. It works as a technology perfectly well for pets and livestock. What could be simpler for fronting to the receptionist at your doctor or arriving on a slab in an ambulance than having a microchip that can be wanded to provide your health ID and then full acess to your health record.

Privacy groups will start howling at this point but, heck, it only improves the ability to identify who I am. The number itself is no use to anyone - plus the chip itself should not contain the number but an encrypted version of it. It could be made relatively secure. If it were a voluntary option to have a microchip with your health ID on it would you have one - my answer is absolutely.

But the biggest problem in all this still remains the supply and demand side economies of scale. The costs become low and the benefits high only once you get a very large base of users of the health ID.

There is a long way to go - but some serious opportunities exist.

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