Dr.. Bassam Darwish
Health media and medical development consultant
Healthcare systems around the world are complex, and inefficiencies often arise from the interaction between different actors, including insurance companies. Although insurance is essential to reduce financial risks for patients, its current role and structure in healthcare needs major reform.
Below we review the most important reasons that call for insurance companies to transform their approach to health care:
1. Incompatible stimuli
Insurance companies mainly aim to maximize profits, often at the expense of patient care. This drive for profits can lead to cost-cutting measures that negatively impact the quality of care. Therefore, insurance practices must be reformed to give priority to patient outcomes rather than profits, so that incentives are consistent with the reminder that the overall goal of health care services is to improve the health of patients, promote health, prevent diseases, reduce their complications, and improve the quality of life.
2. Administrative burden
The current model of insurance introduces a significant administrative burden. Healthcare providers spend significant time and resources dealing with insurance claims, coding, and approvals. Streamlining these processes through reforms can reduce administrative costs and allow health professionals to focus more on patient care.
3. Access to care
Insurance companies often limit acceptable services and denied services, limiting patients’ access to necessary care. This control can delay treatment and worsen the condition. Reforms must therefore ensure that insurance coverage is more comprehensive and patient-centred, giving better access to essential healthcare services.
4. Transparency of costs
Patients often face unexpected medical bills due to a lack of cost transparency in insurance policies. Requiring insurers to provide clear pricing and coverage information upfront can empower patients to make informed decisions about their health care, which may reduce overall costs.
In addition, insurance companies’ pricing of services prompts some doctors to request radiological tests or investigations or other tests without any reason or indication, and this reflects negatively on the quality of health care services and the safety of patients and is inconsistent with the ethics of the humane medical profession.
5. Preventive care
Insurance models typically focus on treating diseases rather than preventing them. It is known that the shift towards a preventive care approach contributes to reducing health care costs in the long term and improving patient outcomes and quality of life. This is why insurance companies must incentivize preventive measures, such as regular check-ups and vaccinations, to enhance the health of the population.
6. Chronic disease management
Managing chronic diseases is expensive and complex. Current insurance practices often fail to provide adequate support for chronic disease management, resulting in frequent hospitalizations and high costs. By reforming their approach, insurers can offer better chronic disease management programs, reducing long-term costs and improving patients’ quality of life.
7. Innovation and flexibility
Strict insurance plan requirements stifle innovation in health care delivery. Adopting more flexible models and encouraging the adoption of new technologies and treatment approaches can lead to more effective and efficient health care delivery. Insurance reforms should support telemedicine, personalized medicine, and other innovations that enhance patient care.
8. Parity in mental health
Mental health is often not adequately covered in insurance plans, despite its great importance to overall well-being. Ensuring parity in mental health insurance coverage is key. Reforms should mandate equal coverage of mental and physical health services, promoting universal health care.
9. Patient support
Insurance companies have significant power in determining patient care. Shifting toward a model in which insurers serve as patient advocates rather than gatekeepers could transform the healthcare experience. These changes will focus on patient needs and improving satisfaction and outcomes.
10. Impact on public health
The broader impact of insurance practices on public health cannot be ignored. By reforming insurance policies to be more inclusive, we can address health disparities and promote a healthier society. Insurers can play an important role in public health initiatives, such as vaccination campaigns and health education programs.
Sustainable health
Insurance companies are an essential part of the health care system, but their current practices often undermine the primary goal of health care: improving patients’ health. By reforming their approach, insurers can help create a more efficient, fair, and patient-focused health care system. These changes will not only benefit patients but will also contribute to a more sustainable and effective healthcare system overall.
