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National Health Insurance

�?National Health Insurance�

â??Yesterday, the president signed a bill passed by Congress establishing universal-comprehensive health insurance. It will cover all U.S. residents for medically necessary hospital inpatient and outpatient services, physician and other licensed independent practitioner services, and nursing facility care. The National Health Insurance (NHI) program becomes effective 12 months from yesterday. Funding for the NHI program will be through a national value added tax. All residents, whether employed or unemployed, from birth to death (â??womb to tombâ??) are covered by the NHI program, and there are no beneficiary deductibles or co-payments. State government State Health Insurance Boards (SHIBs) will be the fiscal intermediaries. Private health insurance for covered services will be barred when the NHI program takes effect.

Delivery of services will be private, as before, and will be done through existing providers (eg. hospitals, nursing facilities, private practitioners). Institutional providersâ?? services and capacities will be frozen in place the day the NHI program begins. They may only be changed (added to or deleted) subject to SHIB approval based on the SHIBâ??s assessment of area needs. Start-up and facility expenditures for approved expansions in services and capabilities will be fully funded by the federal NHI board through the SHIB.

Amounts paid to all independent providers, such as physicians for care rendered to beneficiaries, will be fee-for-service. National rates for all services will be determined by the federal NHI board and will vary in amount only by geographic area based on a market-basket consumer price index. Institutional providers will not be reimbursed on fee-for-service but will receive annual global budgets that are fixed. These budgets will be determined by each SHIB and will be largely based on capacity, such as type and number of beds. Providers will not be allowed to balance bill patients. Because uninhibited access is an objective of the NHI program, all providers will be required to serve all people who present themselves.�

-Is this NHI program a threat or an opportunity for healthcare organizations?

-If you were a hospital CEO, how would you respond? How would you want your organization to respond before the program is implemented? How would you want to respond after the program begins?

-How would you expect your relationships with your stakeholders to change after the program is implemented?

Solution Summary

National Health Insurance programs' benefits and drawbacks are brainstormed.

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