Thursday, February 22 , 2018, 5:04 am | Fair 37º


Ali Javanbakht M.D.: H1N1 Is a Case Study in the Need for Reform

For-profit insurance companies are missing the real opportunity in this crisis

Let’s pretend you’re the CEO of a for-profit health insurance company. Here are the facts:

Ali Javanbakht M.D.
Ali Javanbakht M.D.

This could be a tough flu season with two strains of the viral infection: the seasonal flu and H1N1.

Each year, 200,000 people are hospitalized with the flu and 36,000 die. That number could be double this year because we have two flus.

For a patient to spend a day in a regular hospital ward (not the Intensive Care Unit) costs about $1,000 a day. That does not include meals, medications, procedures, IV fluids, injections, doctors’ evaluations or physical therapy.

There are vaccines available that could stop someone from getting either flu. The vaccines cost around $20 to $30 per dose.

The Centers for Disease Control and Prevention and local public health agencies, aka the government, will handle acquiring and delivering the vaccines to local health-care providers.

Knowing all that, what do you do? If you’re the CEO of a for-profit health insurance company in America, the answer is: nothing. And who takes over educating providers and patients? The CDC and local public health agencies. In other words, the government.

My wife is a pediatrician. Her clinic got a call from the Public Health Department informing her that it had not received an order for H1N1 vaccines from her clinic. The boarding school at which I work has its own special liaison at the Public Health Department to help with acquiring and delivering the vaccines.

How much does the government stand to make from its involvement? Close to nothing. How much does the for-profit health insurance industry stand to make from people getting vaccinated? Potentially, millions of dollars.

So why haven’t for-profit insurance companies contacted their high-risk patients more aggressively? Why do they still charge their patients a co-pay for the vaccine? Why not do a reverse co-pay, i.e. pay the patients who get the vaccine? Why not offer transportation to those who need it? Where are their advertisements encouraging people to get vaccinated? All of these efforts would cost a fraction of a CEO’s bonus, could potentially save the company millions, and would dramatically improve the company’s public image at a time when they need it most.

And still, there are those who argue the merits of a for-profit system.

— Ali Javanbakht M.D. is a family physician in Santa Barbara.

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