Why shouldn't communities be allowed to opt out of Medicare?

Consumer intermediaries working within a framework of pre-paid budget-capped health care management would be the only structural entities in the health system with a financial incentive to monitor the outcomes of care of their pools of patients and tailor their practices to objectives such as improved pre-admission and post-discharge reviews, reduced infection rates, fewer post-surgical complications, and lower readmission rates. Their aim would be to develop marketable health value advantages around these outcomes to attract more members, thus creating competition among intermediaries for consumer allegiance.

This is an opt-in strategy. In the spirit of competition, intermediaries would be obliged to engage with consumers and communities about health-outcome advantages. If consumers were not convinced, they could remain within the old regime. Unlike the current pseudo-competition among health insurers or medical practitioners (which avoids any reference to health outcomes), competition between consumer intermediaries would have to trade in measurable health outcomes and performance.

Some existing health funds, professional associations, credit unions and consumer co-operatives already undertake, in a limited form, some intermediary functions such as aggregated purchasing benefits or preferred provider arrangements in selected health areas. These could be readily expanded in anticipation of public policy changes to enhance the role of health intermediaries.

State or Commonwealth governments could recognise these intermediaries and encourage their development by introducing (without major public policy change) a fee payable to the intermediary for every enrolled consumer or family (the fee being risk-rated for age and health status to discourage selective enrolment of the young and healthy). The development of competing intermediaries would be the first step towards enhanced competition and a functioning market in health care.

For marketing purposes, I would present this approach as the introduction of Family Health Brokers to assist families access the best health care and home supports.