Abstract
The assumption that private and public programs will fail in the foreseeable future to provide benefits that are close to the total health care expenditures for most individuals has fostered the proposal for coverage. An organization providing postpayment protection would pay for all of at least certain health care expenditures, with the portion thereof not covered by traditional prepayment coverage being considered as a loan to the insured. In addition to considering certain aspects of post-payment coverage, the article evaluates the implications associated with post-payment being offered by various types of organizations, including health insurers, credit card companies and providers of health care. In the Summer of 1968 the author proposed in an article, subsequently published,1 a new arrangement for health insurance under which health insurers wvould expand the objectives and scope of their coverages to include responsibility for the payment of virtually all health bills incurred by a policyholder. The essence of the proposal was an arrangement called In the intervening year, at least three organizations announced intentions of providing protection resembling certain facets of post-payment. Thus, this article will: (1) compare the proposals and announced programs involving what may be called and assess the implications associated with different types of sponsorship; (2) evaluate certain possible aspects of the coverage itself; and (3) analyze the potential for Robert D. Eilers, Ph.D., C.L.U., is Associate Professor of Insurance and Executive Director of the Leonard Davis Institute of Health Economics. He was formerly Executive Director of the S. S. Huebner Foundation for Insurance Education. This paper was presented at the A.R.I.A. 1969 Annual Meeting. I Robert D. Eilers, Mledical Expense Coverage: A Proposed Salvation for Insured and Insurer, Medical Care (May-June, 1969), Vol. 7, No. 3, pp. 191-208. the proposed coverage and tlhe impact it could have on various interested parties. The Post-Payment Approach Under post-payment, responsibility for initial payment of most medical expenses of covered persons would be assumed by the organization issuing the coverage. The original post-payment proposal anticipated that the issuing organization would be a health insurance company or Blue Cross-Blue Shield plan, but other types of sponsoring organizations are possible. Having obtained post-payment coverage, possibly as an addition to group or individual health insurance, an insured would be given a post-payment coverage card to be submitted to liospitals, physicians, dentists, nursing homes, pharmacies and others which would provide health care services and products. The post-payment card would furnish the identification needed by health care providers to send bills to the insurer issuing the coverage, wvhich would then make direct payments to the providers for the covered services and products received by the insured. If post-payment coverage were issued by a health insurer, the insurer would
Published Version
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