Under the inadequate coverage of medical insurance, there is no place for the hundreds of billions of medical bills in the United States

At the end of the movie I'm not the God of medicine, officer Cao takes Cheng Yong out of prison and tells him that there is no market for India's Lenin now, because Switzerland's Lenin has been included in the medical insurance Art into reality In 2013, Jiangsu Province included anti-tumor drugs such as Lenin in the payment scope of medical insurance fund, so that the annual medical expenses of CML patients dropped from more than 70000 yuan to less than 20000 yuan An expert in gateways In "I'm not the God of medicine", the life-saving drug of CML, Lenin, is too expensive for patients to afford People who go to extremes even take suicide as the final solution The story happened in 2002 At that time, it was nearly 4 years since the establishment of basic medical insurance for urban employees in China, which has covered most urban families After the movie ended, the author fell into deep thought In China, health insurance coverage should never be just a matter of breadth, and the difficulty of depth is even more difficult to solve In fact, the same problem exists in the United States Different from the "strong welfare" of the old European countries and the "big government" of the rich Southeast Asian countries, the American health insurance system operates in a market-oriented way, and a "broad and shallow" health insurance network is spread in each state Under the Internet, there are hundreds of billions of US dollars of medical bills This paper will first discuss the problem of insufficient coverage of health insurance in the United States At the end of this paper, we will introduce some beneficial attempts of innovative enterprises to compress the bill of network leakage In 2010, the United States began to implement the "Affordable Care Act" (ACA), the so-called "Obama medical administration" Former President Barack Obama fulfilled his campaign promise to the poor The ACA personal enforcement clause states that all U.S citizens are required to purchase medical insurance or will be subject to a fine unless exempted for religious or economic reasons As a result, 30 million uninsured U.S citizens have also been covered by health insurance In fact, ACA is only a supplement to the US healthcare system In the United States, most people work to take part in unit collective health insurance On this basis, the medical insurance system in the United States has set up Medicare, Medicaid and chip specifically for the elderly over 65, the poor and the disabled, and children The complex health insurance system basically covers all people in the United States, and there are few missed fish The burden of American medical treatment is still very heavy However, a data from the U.S bankruptcy court breaks the calm Every year, nearly 1.2 million families in the United States seek bankruptcy protection, 62% of which are due to medical expenses It is worth noting that 60% of medical bankruptcy applicants have private medical insurance, and only 22% of them are uninsured In the United States, the insured need to pay thousands of dollars of insurance every year When the medical expenses occur, they also need to bear the deductible, CO payment, quota fee and other out of pocket expenses This is an important source of inadequate coverage Take a 50 year old American man Assuming an annual income of $46100, he pays an annual premium of $10585, or 22.9% of his annual income In case of medical expenses, he will also have to bear the self payment of up to $6250, thus increasing the medical expenses to 36.5% According to ACA, 100% - 400% of the federal poor can enjoy tax credits and health insurance subsidies According to the 2018 federal poverty line standard, this person is eligible Even so, the medical burden of this low-income person is still 18.6% In statistics, there are some quantitative standards for "insufficient coverage of medical insurance" One of them is that the ratio of individual out of Pocket Medical Expenses per year exceeds 10% of family income According to the National Health Expenditure Survey (NMES), between 1996 and 2003, the proportion of individuals participating in group health insurance increased from 14.2% to 18.2% According to the Commonwealth Fund Survey, in 2010, the under coverage rate of non elderly people in the United States was 32% According to NMES data, in terms of income level, low-income groups have the highest proportion of under insurance coverage, which is about 33.3%; in terms of health status, the under insurance coverage rate of those with poor health is 32.3% Specifically, 39.1% of diabetic patients, 30.9% of hypertensive patients and 29.2% of psychiatric patients are not covered by adequate medical insurance These diseases are the most common chronic diseases in the United States According to NMES data, the research shows that the insurance coverage is not only financial, but also health, even life In the RAND Health Insurance randomized trial, under coverage increased the risk of death by 21% for low-income seriously ill participants In addition, a 2007 U.S survey found that 29% of high deductible participants and 16% of low deductible participants delayed or gave up care because of costs ACA is still in a state of turmoil, and it is difficult to solve the problem of the depth of health insurance coverage The ACA mentioned at the beginning of this article helps Americans effectively solve the problem of uninsured and uninsured, but it aggravates the lack of insurance coverage objectively On the one hand, the regulatory authorities allow ACA to claim co payment and deductible from the insured who receive medical insurance subsidy On the other hand, the percentage of coverage under the ACA scheme itself is low For example, the bronze scheme covers 60% of the average medical expenses, the silver scheme covers 70%, and the gold scheme, with the largest proportion of coverage, covers only 80% of the average medical expenses ACA is regarded as the most powerful health care reform bill in history Because of the increased financial pressure of federal and state governments, it has been opposed in many aspects from the beginning In June 2012, the Federal Supreme Court ruled in a Republican case against ACA for unconstitutional conduct Although it supports most of the content of ACA, it is unconstitutional for the federal government to require states to expand the coverage of Medicaid under the threat of Medicaid funding In 2017, after Trump came to power, he advocated the abolition of "Obama medical administration" In May of the same year, the U.S House of Representatives passed a new bill, the U.S health care act 2017 (ahca), which replaced the "Obama medical administration" Fortunately, in the Senate vote, ACA's alternative bill was not passed "Obama medical administration" has been implemented so far The US media has made a statistic that if ahca replaces ACA, the number of uninsured people in the US will increase by 23 million by 2026 The picture comes from KFF official website How to place the hundreds of billions of leaked bills? These attempts deserve attention to the arterial network for a rough statistics In 2018, for example, there are about 130 million working staff in the United States, with an average wage of $43460 Assuming that the proportion of medical expenses that need to be borne by individuals is 10% after population structure weighting, the amount of medical insurance bill missed in one year in the United States is more than 560 billion The figure is rough, but large enough to attract attention In fact, some companies in the United States are trying to reduce this bill Advocatia solution: link more people to insurance coverage recently, at the "health: US 2018 plan" jointly organized by Caesar medical and village capital, two start-ups won in the final stage, one of which is advocatia, headquartered in Chicago Arterial network learned that the "health: US 2018 plan" is a special venture capital plan aimed at cultivating early companies that solve key problems of population aging Advocatia provides hospitals with tools to help them with uninsured and underinsured patients, such as making them aware of their financial assistance policies Laura Robbins, co-founder of advocatia, believes that more than 28 million people are not adequately insured, of whom 11.7 million are eligible for health care plans, but they are not aware The latter is the target population of advocatia Advantia's solution consists of three modules: benefit triage, benefit text and inturnav Benefit triage is a SaaS financial advisory platform, which can be used to help identify the financial assistance of patients' medical insurance options, optimize workflow and improve the reimbursement efficiency of services provided Text is a decision-making engine, which communicates with the uninsured or under covered people in the form of text messages, so that they can actively screen available projects; InsurNav will be embedded in the hospital website, so that doctors and patients can better understand the resources around them Tcare: evidence based solution for family caregiver tcare is another enterprise that has entered the final circle of "health: US 2018 plan" with advantia Headquartered in Madison, Wisconsin, tcare provides intelligent management to tens of millions of family caregivers in the United States Tcare's solution divides family care into two parts, i.e identifying problems and providing resources, and optimizes this free medical treatment behavior through six steps The picture comes from tcare official website The most important step is to determine the best treatment goal, community support strategy and priority service list of professional medical personnel through special algorithm after the assessment of family care personnel, so that professional medical personnel can better locate medical needs and integrate resources >>>>Mdsave: the medical care version of Expedia, headquartered in Nashville, was founded in 2011 by Paul Ketchel, a technical systems administrator at lobbyist, a former Capitol professional, and Bill Frist, a former senator from Tennessee In 2013, mdsave's website was officially launched, with functions similar to Expedia's health care version, allowing patients to compare medical procedures and guarantee nearly immediate payment to medical providers What the patients need to do is to input their location, find the treatment method they need, and choose the most suitable treatment scheme according to the price, proximity and doctor's score For ease of use, all costs are tied together, so patients don't receive a large number of bills with unexpected costs In international trade, independent monetary policy, fixed exchange rate system and free flow of capital can not happen at the same time, which is called "Impossible Triangle", or "ternary paradox" In the supply of medical services, "Impossible Triangle" also exists, that is, improving the quality of medical services, increasing the accessibility of medical services and reducing the price of medical services From the perspective of finance, medical insurance has increased the accessibility of medical services, but it has created a "broad and shallow" problem In the future, only technological innovation can break the "Impossible Triangle" of medical treatment In the above three cases, we see that innovators try to use Internet technology and artificial intelligence algorithm to reduce the cost of medical insurance network leakage Although the effect is not so significant, but after all, in addition to the policy, it opens a new way for the supply of medical services for low-income people.