Health Insurance System Regulations, Claims & Programs

Part 1: The Basic Tools, Chapter 1: The Health Insurance Maze Page 7

Continued from Previous Page

Once a computerized, electronic claim-filing and claim-processing system is established, a consumer could simply present his electronic card to the doctor or hospital whenever treatment is provided. The information could then be scanned into a computer, and the claim could be automatically filed electronically. Payment could be made electronically, as well. A comparison of the systems makes the benefits of an electronic system obvious (See Table 2).

Studies are now being conducted by both private insurers and government agencies on the question of whether a computerized, electronic claim-filing and claim-processing system should be established in the United States. Given the enormous potential benefits that the development of such a system could offer, perhaps those studies should be made a national priority.

In the meantime, the health insurance system and the regulations under which it operates seem to grow more complex each year. A great deal of that complexity could probably be eliminated fairly easily. That's unlikely to occur in the immediate future, however, since Americans seem to be caught in a continuing philosophical debate about health care and health insurance.

The main issue in that debate revolves around the question of whether health insurance problems are best solved by government regulation or by the free market system. Instead of making a choice between these two approaches -- each of which, I think, could work effectively, if properly designed and administered -- we seem instead to allow the pendulum to swing back and forth between the two different views.

Continued on Next Page