Method of eliminating malady in society _1

[Wang_Feng]

------If West countries impose Recycle-Tax (describe in Chapter 6) on merchandise, East country (China) will become difficult to dump cheap merchandise into Europe and American. In this way, West World can give full play to their advantage in high technology and science, and can radically solve the problem of overproduction and unemployment.
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[Wang_Feng]

-- - The goal of Medical Care system designing is prevent health person become patient, reduce the burden for whole society.

_ _It is better that Medicare be running by commercial insurance company, for it will lower medical cost by market effect. Insurance company shall determine annually the list of hospital that he promises to pay the medical bill. The hospital with high medical cost will be eliminated from the list.

Principle 1: Regard “a policy holder become patient” as a failure of insurance company, like a bacteria penetrated immune defense.

　 Principle 2: Government ought to “purchase health” which produced by hospital and insurance company. If government promise purchasing medical service, that mean in market there are limitless purchasing power for medical service, in naturally, pharmacy factory and hospital would provide limitless medical service, and force patient and government to buy. On the other hand, we can easily evaluate health by “ill-risk”, and measure it by premium.

_ _ Specialize medical insurance company include 2 types:
(1), "LOW insurance company" does only accept health (low ill-risk) people. Government must confine its premium in lower level.
(2), "HIGH insurance company" does accept sub-health (high ill-risk) people. This kind company possess own sanatorium and convalescent home.

_ _ The contract of LOW insurance company is long-term one, or even through lifetime if its policy holder maintain health. So LOW insurance company will obtain profit by invest in preventing disease.

_ _ In Chapter 3 <Reform education system> of <Method of eliminate malady in society>I have wrote: “We could collect together income tax, retirement insurance and medical insurance, and pay it immediately to the schools that taxpayer has been educated. After several decade, central government shall pay old people pension and medical insurance premium according their past tax payment record.”

_ _ In detail, only LOW insurance company’s health people can contribute most part of medical premium to their Alma Mater. LOW insurance company actually receives small part of medical premium. This regulation will spur college and high school teach student sanitary knowledge and beyond smoking, maintain right life style. The schools will obtain extra profit if their students stay in LOW insurance company for many years. It follows principle 1 hereinabove: “purchase health” which produced by schools.

_ _ If LOW insurance company discover one of his policy holder’s health out of condition and the low premium can’t bear high probability of ill. The LOW insurance company will transfer this policy holder to a HIGH insurance company.

_ _ Of course policy holders must have freedom of selecting: They shall determine annually the Blacklist of “refuse LOW insurance company and HIGH insurance company”.

_ _ A professional judge will preside at the process of sub-health policy holder transfer from LOW insurance company to HIGH insurance company. It like “public sale”. Every HIGH insurance company (not on Blacklist) offer their own premium, then select out 3 or 5 company who offer lower premium, and eventually decide by lot (avoid cheat). If so many insurance company in the Blacklist that the number of bidders less than 3, the professional judge will make determine by himself. Maybe the judge would invite the policy holder for 1000m jog before physical check-up, and then evaluate probability of ill.
_ _ It needs not to use auction in another situation: If a HIGH insurance company “capture” sub-health policy holder from a LOW insurance company, and apply to judge.

_ _ It is important that little part of high medical premium does come from policy holder’s own income. It will spur him obedience to suggestion made by HIGH insurance company and change his live style, for return back health people group sooner. The rest part of medical premium does come from the part “original be send to school” (describe hereinbefore).

_ _ It is different from LOW insurance company’s long-term contract; the HIGH insurance company’s contract is short-term (3 year). After 3 year, the original judge will preside at second auction process. This time, both LOW insurance company and HIGH insurance company will attend. There are 2 results.

Result (1): This sub-health policy holder can come back a LOW insurance company (forbidden original one). It indicates that this HIGH insurance company has eliminated successfully the ill-risk and stop this sub-health policy holder became patient. Then the LOW insurance company (which the policy holder original belonging) must give money to this HIGH insurance company as “bonus of eliminating risk”. The sum must equal or more than high-risk premium determine by first “public sale” process hereinabove. In other words, HIGH insurance company obtain profit by the work of eliminate the ill-risk. It follows principle 1 hereinabove: “purchase health” which produced by hospital and insurance company. For LOW insurance company, it follows principle 2: “pay for his one failure of defending disease”. Further more, if this sub-health policy holder does being “captured” by HIGH insurance company, the LOW insurance company (who failure to find out its sub-health policy holder) will pay higher “bonus of eliminating risk”. The purpose of this regulation is: 1, make LOW insurance company check policy holder’s physical condition in 2nd process of “public sale” for avoid cheat. 2, spur LOW insurance company do more medical-care work for prevent his policy holders become patient.

Result (2): If this sub-health policy holder only be accepted by a HIGH insurance company (forbidden original one), then they must sign a further short-term (3 year) medical insurance contract. After 3 year, the original judge will preside at third auction process, and so on. It indicates that it is difficult to eliminate this ill-risk. Eventually, LOW insurance company (which the policy holder original belonging)will pay small part of “bonus of eliminating risk” to HIGH insurance company. The rest part of “bonus of eliminating risk” will pay by federal government.

_ _ We need to set different premium for different age person, in order to make LOW insurance company’s medical-care service not only cover young people, but also cover old people. So we need to define “health”(or ill-risk) for different age: An 80 year old person is health if he doesn’t need nurse’s help; a 60 year old person is health if he never visits doctor in past 3 year; a 20 year old person is sub-health if he often coughs and cold. Federal government does pay the premium for retirement people according different age.

_ _ The process is similar with hereinabove while a policy holder (belong LOW insurance company or HIGH insurance company) been sent to hospital. According the bill made by hospital, we divide the medical cost into 3 parts.
_ _The first part includes the part paid by patient himself. Insurance company must pay the first part according hospital’s bill in any condition. If (LOW or HIGH) insurance company detect policy holder’s disease and send him to hospital on their own initiative, they will receive Federal government’s subsidy.

_ _ The payment of rest 2/3 part of bill will depend on hospital’s treatment effect.

Result (1): If the disease can’t be cured and transfer the patient to another hospital, insurance company need not to pay this 2/3 part.

Result (2): If patient leave hospital, a professional judge will preside at a (first) auction process. Every HIGH insurance company and LOW insurance company (not on patient’s Blacklist) offer their own premium, then select out 3 or 5 company who offer lower premium, and eventually decide by lot. If the patient be accepted by a LOW insurance company (forbidden original one), it indicates that he has get well (The criterion of health depend on age, according hereinabove). HIGH insurance company or LOW insurance company (which the patient original belonging) will pay the rest 2/3 part of medical bill to hospital. It follows principle 1 hereinabove: “purchase health” which produced by hospital and insurance company.

Result (3): If the patient has not healed up. In future, it is high possible that he need further medical treatment. Then the patient will be accepted by a HIGH insurance company. HIGH or LOW insurance company (which the patient original belonging) only pay the rest 1/3 part of medical bill to hospital. The last 1/3 part (the hospital has lost) will become premium or “bonus of eliminating risk”, and be paid to HIGH insurance company in next 3 year.

Wang Feng
/Luoyang city/Henan province/China
99peak88@163.com
02 June 2010