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Americans pay multipes more for healthcare than other countries. Here in France, the government is considerng a proposal to increase the share paid by patients (via their private, typically employer-paid insurance) for routine medical visits, so as the shore up the budget for "la Sécu," the national Healthcare system. A routine check-up currently costs French patients 23 €, some part of which is reimbursed by private insurance ("une mutuelle"). In today's Le Monde, a group of doctors suggests a better solution : let the government manage the administration of both la Sécu and les mutuelles. To an American, this might seem counter-intuitive. For France, it seems obvious. Private, complementary insurers pay €7.7 billion on administration, while covering 13% of healthcare expenses, the doctors write. The government pays €7.5 billion to manage 80% of healthcare costs (which amount to 11.9% of GDP). Put otherwise, they write, 75% of euros collected by les mutuelles gets spent on actual healthcare. For La Sécu, it's 96%. In the US, healthcare represents 17.3% of GDP at last count, and administrative costs eat up 25% of the total expenses. It seems to me that the French doctors are dead right, and that Americans still have a thing or two to learn about healthcare delivery.

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Is PMI the new CIC? And are there too many TLAs in our world? Thought-provoking insights from Cameron Roberts and experts about the demise of our public health sector and relationship with PMI demand. There's no overnight fix to the state and performance of the NHS, and if it ever recovers, there's the important matter of choice that PMI offers. I agree with Kyle Godden that we may (and should) end up with a three tier system, there is certainly room and need for lower-cost, more targeted PMI solutions (focusing on diagnostics and core benefits). But this also highlights the importance of advice for PMI too - with so many choices and the beartaps of moratoriums - there's a strong case for an advised broker model vs direct insurer. Consumer Duty anyone? LifeSearchAlan Richardson Dip CII Christopher Paul Mooney Poonam Khan Alastair Smart Paula Bertram-Lax Ricky Butler Debbie Kennedy Rose Howarth #healthmatters #protectingpeopleproperly #refreshingprotection #privatehealth

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🔍 Understanding the Medical Preauthorization Process Medical preauthorization is a key step in ensuring patients receive the care they need, while keeping costs transparent and under control. Here are the essential steps involved: 1️⃣ Request Submission: The healthcare provider submits a detailed request to the insurance company, including patient history, diagnosis, and recommended treatment. 2️⃣ Review Process: The insurer evaluates the request against their coverage policies, guidelines, and medical necessity criteria. 3️⃣ Clinical Validation: Medical professionals may be consulted to verify if the proposed treatment is the most appropriate course. 4️⃣ Decision: The insurance company approves, denies, or requests further information to make an informed decision. 5️⃣ Notification: Both the patient and provider are informed of the outcome, and next steps are taken accordingly. Efficient preauthorization helps balance medical necessity with financial sustainability, ensuring patients get timely, necessary care. 🏥 #MedicalPreauthorization #Healthcare #PatientCare #Insurance #MedicalApprovals #HealthManagement

Payers can leverage Payer Initiated Reduction (PIR) as a tool to control costs, ensure appropriate use of healthcare services, and maintain the financial sustainability of their insurance plans. Here are some ways payers can use PIR effectively. #payers #payer #PIR https://lnkd.in/gGrCbcnA

Renewed CMS exemption paves the way for extended sale of primary healthcare policies. The Council for Medical Schemes (CMS) has extended by one year the exemption that allows companies to sell insurance policies that cover primary healthcare services provided by private practitioners. Read full article for more information: https://buff.ly/43NGv3q Reminder to share, like, and subscribe to stay informed! #CouncilforMedicalSchemes #DemarcationRegulations #healthinsurance #lowcostbenefitoptions #MedicalSchemesAct #moonstoneinfo #moonstoneupdate #industrynews

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