Health care can‘t keep surviving on unlimited credit cards, even though the role of health funders, both public and private, has shifted from providers to financiers.
There needs to be an alternative method for funding our health microenvironment and microservices.
The only way for funders to balance their books these days is to restrict services and increase patients’ out-of-pocket expenses.
Private health insurance companies learned that lesson long ago. They now function as catastrophic illness subsidisers. Like most insurance, plans are designed to target low- frequency, high-value services in order to contain costs, such as subsidising expensive drugs for very rare conditions.
Other services are essentially blocked by high deductibles, co-payments or restrictive reimbursement criteria. In Germany, for example, the average deductible on private health insurance is around 600 euro, nearly one tenth of the price of the plan. In the USA, where the cost of an initial consultation with a doctor in hospital is roughly equivalent to Germany, 13% of enrolees are in plans with an annual out-of-pocket maximum of $6,000 or just under one third the cost of the plan.
There is not much we can do to change the global environment. As patients and clinicians, we know very little about how finances for health services are mobilised, prioritized and allocated to meet our needs – especially where the health problems may be vague and outcomes are difficult to quantify, for example in the area of pain relief.
It is virtually impossible to see a standardised way forward for all. It also makes it very difficult for us to have a say in service provision or funding on our own frontlines. We are bombarded with stories of inadequacies but have little power to effect local change.
There needs to be an alternative method for funding our health microenvironment and microservices. A microservice can be anything that is too small for a full clinical service or only a small part of an ongoing care plan such as short term post surgical follow-up in the community. Microfinancing can be the answer. After all it has revolutionized another impoverished industry, for example agriculture, with the rolling out of rural banks.
Microhealth banks could also provide us with small amounts of affordable credit and other financial services to help us keep on contributing to our communities even though there may be irrevocable changes in our circumstances, for example after a major stroke. Microfinancing arrangements operate most effectively when they are organised in small groups or communities and the group takes collective responsibility. An effective lending-repayment system is especially important for women who are less likely to have disposable financial resources, are more likely to be designated carers and are less likely to have people to care for them.
With the introduction of microfinancing, this could ease the burden of national health care costs, and alleviate the uncertainty of adequate health care on an individual level. Small amounts of incremental financial support can have a major impact on not just our financial security, but on our health security as well.