Saturday, March 29, 2008
  Almost as good as French

A new old idea for medical care is spreading in this state. A company with the clumsy name of Qliance is implementing the idea, which comes pretty damn close to the French flavor of medical care. I call it 'new old' because it's based on the ancient Chinese tradition of paying the doctor when you're well, not when you're sick. (Actually I'm not sure if this was ever a real Chinese tradition, but it's often cited as such!)

Qliance works like this: you pay a standard monthly fee, which runs from $39 to $79 according to age. For this fee, you get to use the Qliance clinic and doctors as often as you need, and the doctor promises to be available when you need him. Clinical services like blood tests and X-rays are part of the package, but some services incur extra charges. These extra charges are strictly at cost, unlike the $100 aspirin you get at the hospital. Major surgery is still done elsewhere, under the existing system.

What's the key to the cheapness? Half is "French", half is "Chinese". The French half: Qliance doesn't handle insurance at all. If you can get your insurance to pay you, that's fine, but you have to do the paperwork. The Chinese half: If the Qliance doctor does the human side of his job properly ... advising, counseling, providing common sense, helping you control your diet, stress and exercise ... then you won't have to use the costly part of the service nearly as much or as often. Not precisely the same as the legendary method; but Qliance has to work harder for the same payment when you get sick, so their incentive is to keep you well.

The head of Qliance, Dr Garrison Bliss, is a great explainer. In this presentation, he describes exactly how and why the current system fails, and how Qliance breaks out of the failure. His conclusion: The current system serves nobody but the insurance companies. Doctors and hospitals spend most of their time and money doing paperwork to "confuse and confound" the insurance companies, because that's the only way they can get any payment at all. The insurance companies are "running blind", so they can't figure out how to make things better.

The Qliance model still doesn't solve the litigation problem, though I suspect patients who feel that the doc is actually listening to their needs and serving their purposes will be less likely to sue.

= = = = =

Footnote: Found the ancient Chinese tradition, and it's even closer to the Qliance idea than I thought. From here:
Historically in China, each village was under the care of one doctor. In return, they took care of him (fed him, clothed him, etc.). What's so different about this from the exchange that goes on in modern healthcare? The traditional Chinese doctor's job was to keep the village from getting sick in the first place. Once people got sick, they were unable to support the doctor. It made more sense for him to keep them well than to wait until they were sick.

 


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Polistra was named after the original townsite of Manhattan (the one in Kansas). When I was growing up in Manhattan, I spent a lot of time exploring by foot, bike, and car. I discovered the ruins of an old mill along Wildcat Creek, and decided (inaccurately) that it was the remains of the original site of Polistra. Accurate or not, I've always liked the name, with its echoes of Poland (an under-appreciated friend of freedom) and stars. ==== The title icon is explained here. ==== Switchover: This 2007 entry marks a sharp change in worldview from neocon to pure populist. ===== The long illustrated story of Polistra's Dream is a time-travel fable, attempting to answer the dangerous revision of New Deal history propagated by Amity Shlaes. The Dream has 8 episodes, linked in a chain from the first. This entry explains the Shlaes connection.

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