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Risk sharing versus Risk shifting

October 15, 2015

Are you ready and prepared yet? The risk is being shifted and being ( dumped) on the consumer , that is what is happening and became official. It is seen in many cases whether with the new credit card machines , if you do not update your machine, the risk will be shifted from the financial institution literally to become laid on your shoulder, similarly if you do not ( code it right ) referring to the ICD 10 coding  system , you will be delayed and denied payment for your professional medical services even in some cases with hiring professional billers that are well trained in this transition , turning again all the responsibility on the provider who are most likely will have most of the denials and delays in payment!

Similarly , with subprime mortgage crisis , when someone who may not qualify brought home or property and then the bubble burst , and the economy went into a recession, then millions of Americans lost their homes and properties with foreclosures that devastated millions  of families and businesses with effects of which still being felt throughout the nation!

So many people struggle to make ends meet and good luck jumping those hoops to make it on a day by day basis, with a significant crunch in the cash flow cycle which is going to impact so many industries , for example the medical offices give business to many suppliers of medical equipment and supplies, hires staff , pay taxes and contribute to overall economy. But those small entities that contribute up to 84% of the total engine of the economy , may come to full stop as the cycle of business is not moving and forcing so many to early retirement or bankruptcy! On the contrary the bigger providers are merging together( for example Anthem merger with Cigna and Humana merger with Atena insurance companies) to get stronger and richer with stronger control of the market leaving consumer with less options and more risk shifting on the patients with more out of pocket expenses , co payments for office visits, testing , deductibles to the point that people are refusing the coverage simply when they add up what they have to pay on top of their insurance ,they will not have enough left to feed their families or pay bills .

The rising trend of risk shifting is not good for consumers as there is no balance and sense of security left anymore . Everyone is afraid to loose their shirt if they get sick !. This is unsustainable and is bound to fail. We have to restore a well balanced model when we all enter into a fair and transparent partnership with all our providers and go back to fair risk sharing rather that devastating and stiffing risk shifting to the consumer with more options. That is why we advocate direct care model to cut unnecessary cost of third party involvement and advocate on patient behalf to put patient first rather that send them to the cleaners!

Dr Adel Eldin,MD, FACC,FACP
Board Certified Cardiologist
President, Clinical Appeals Services
Founder, CEO
Affordable Quality Healthcare Program
Founder, CEO
Wesley Chapel , Florida
President ,Society of Physician Entrepreneur, Tampa Bay Chapter

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Florida Medical Tourism is a unique global service in medical care. It was originally designed to offer special medical services to global customers, specifically from the Middle East (Arabic speaking areas). The program was founded in the spring of 2012 to offer culturally sensitive medical services with emphasis on universal values and compassionate care.
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