SALMAN KHAN: Andthen correct me Expose my ignorance So clearly you have your suppliers Those would be your nurses and doctors and all of the rest LAURENCE BAKER: Hospitals drug stores all forms of human beings are your providers SALMAN KHAN: OK so definitely each whos providing fitness care So thats right over there So thats healthcare facilities medical doctors drug stores all the rest And then they might be supplying the healthcare to somebody So the ones would be the clients Let me attempt this in every other color, LAURENCE BAKER: Call them patients Yeah from time to time you get the details like people grow to be sufferersafter they need health care But some humans simply have a concern Theyre not virtually victims theyre just asking SALMAN KHAN: okay What might you call them then?
SALMAN KHAN: OKI dont need to get too into– LAURENCE BAKER: We can kindof consider it with in the manner in which youre speaking around it So an HMO might have a list of doctors that youre supposed to see And youll need to pass see the medical professionals on that list And a stereotypical one if you dont see the doctors on that listing the insurer not going to pay for you care youre going to spend for yourself And in the stereotypical HMO theres going to be a fairlytight management between the protection corporation and the docs about whats going to be performed what sallowable and so on SALMAN KHAN: And inside the most firmly associated case theyll be the sameThey docs will behired via the business Thats like Kaiser.
SALMAN KHAN: Right That makes complete sense And then with in this environment– we focus loads roughly HMOs My perception is thats amixture of the insurance coverage company and the provider Its type of in one plan, LAURENCE BAKER: Right So through the years the United States has actually had unique varieties of insurance company sout there In the private market specifically theres been many innovation inside the final 30 forty years in forms of insurance providers which can be out there So we have specific insurance companies that have behaved in one of a kind approaches as weve gone through the one sevolutionary cycles So one model of this is what we call an HMO– a health upkeep organization And thats true ly merely jargon You should dig into it to recognize out what it implies But in plenty of cases what that isis an organization enterprise that sacting as insurance So you pay a top class to them if youre a client or a person and also you buy a couple of protection And then they llcover your care But they ll attempt this by means of attempting to integrate them selves with the providers And so the corporations either are integrated due to the reality the HMO employs physicians directly or possibly owns the health centers– like Kaiser Permanente for instance Or in a couple of cases its acontractual relation shipIts now not precisely the very same.
LAURENCE BAKER: Call them population SALMAN KHAN: Population So simply the population of the world or of the united states of america or something– people And then someone has to spend for this And so for the most aspect that is insurance companies LAURENCE BAKER: Yup Insurance companies In the olden days– like in case you return 100 years– we didnt surely have insurers We had providers and patients And patients could– in the event that they hada concern they had a scenario they go to the supplier Theyd make some deal pay them a few money do a little provider for them and work it out We were offered coverage groups actually only in the remaining 100 years may be Really beginning inamerica in may be 19301940 they started to grow to be popular So thats type of a brand-new restoration And the ones three matters paintings to gether
SALMAN KHAN: And the protection companies them selves theyre no longer doing this out of the goodness in their heart Someone is paying them And for the most part with in the United State sit has a propensity to be employers LAURENCE BAKER: So ideal So if we made some othe rarrow for your diagram right here it would be from the population– or perhaps from the patients– to the protection business that supplies the cash for the insurance provider to utilize to spend for the supplier So patients might buyan coverage corporation– or not an insurance coverage company buy a coverage policy.
SALMAN KHAN: And the difference– I assume that is some thingall individuals faces after they signup with insurance with their corporation– I needed to do it these days– is– all of them state you have to select HMO versus PPO And theyre inside the same policy And so my perception is HMO is you have actually set list of physicians that they probable pre-negotiated rates with, LAURENCE BAKER: Yeah So the distinction among PPOs and hmos gets a little bit in to the information.
LAURENCE BAKER: And whos in it? SALMAN KHAN: I believe I might offer a cross at it, LAURENCE BAKER: Go for it.
SALMAN KHAN: Your copay is type of there just in order that– it sort of makes the insurance coverage organization feel great that youre no longer just making use of it willy-nilly– that you have to pay your $10 or $50, LAURENCE BAKER: Absolutely So insurance companies understand that after they start paying the business for the care and the affected individual states its totally loose people may uses tuff that mightbe well worth a bit little bit but it fees lots for everyone to spend for So if you placed aco-payment on there it makes human beings presume two times about using things that they do not clearly require.
SALMAN KHAN: Only if theyre effectively healed LAURENCE BAKER: Some of them buy the entire thing But they just might purchase their own policy Go purchase an insurance coverage policypay them a premium without delay the insurance enterprise gathers that cash Or for a lot of individuals theywork for a company The organisation makes the arrangement to buy that insurance coverage and after that implicitly charges the population the clients for that Maybe right away by utilizing having them contribute some of their wage Maybe implicitly through just reducing the amount of money they provide everymonth and rather providing this insurance plan So people do that And the opposite piece that sfloating round in here is that in a couple of instances the population can pay taxesto the government thatthen capabilities essentially as an insurer like the Medicare program in which theres insurance coverage provided to people thats paid for by means of taxes So theres some remarkable financial resources streams walking around right here nevertheless constantly money going from patients to insurance companies through companies from taxes by means of direct payments Those insurers accumulating the cash and then purchasing abunch of the care thats supplied by the suppliers And thats the basic plan Theres one greatertiny piece whichis that now and once again patients pay the medical physicians or the health centers straight You move youve gota $20 co-payment And so theres a small price that is going back and forth.
LAURENCE BAKER: As you observed approximately it as a spectrumif you move a bit bitfar from that to a PPO Whats taking place in a PPO is youre still going to get a list so youre going to be backed to see the ones doctors but possibly itll be alittle more versatility Like if you made a decision now notto see someone at the listthe strategy might still pay some quantity May be not as a bargain as they couldin case you noticed a person on a listing however something Where as in an HMO might be absolutely nothing And the strategy will in all like lihood work a little less hardat handling what the ones medical professionals are doing to attempt to limit access to say high fee services HMO will generally tend to work harder PPO tends to work alittle less difficult So its a bitlittle bit of a spectrum Youre sort of moving from greater extra and regulated focused to a touch less managed but never theless more so than the system we had state in the 50s or 60s where in definitely everybody went to any doctor and any medical doctor did whatever they desired And the insurance enterprise just paid the invoiceand there has been no integration So its a little bit of a–.
SALMAN KHAN: And the fashion able time duration– and this is a phrase Ive noticeable alot and from time to time its a little complicated becauseits really close to payer you take note of those payors And that might betoge ther with anybody whos procuring the purchasing the service And protection companies might be included there LAURENCE BAKER: Right So weve got– we call them payors Sometimes we call them fitness plans since they set up for a few of the care that people get And payors can be non-public protection businesses or they can be government payors– government insurance coverage business like Medicare
SALMAN KHAN: So no longer they allis firmly connected as a Kaiserin which its like you pass to this structure that states Kaiser on it And thats where your physician is It might be physicians merely have their practices however they re firmly related to a– I believe thats how what Blue Shield? Or among those, LAURENCE BAKER: Yeah Blue Shield or Aetna or a number of thes especific business And you might begin to go into the information sand every one could be a touch bit one of a kind from the option however theyre legal relation ships.
SALMAN KHAN: So thats the primary motivation why insurance coverage organizations are attempting to get greater integrated with the carriersis due to the truth– similar to youstated in the 50s and 60s youve got the business imparting a service And obviously the impacted person like the service And then you have a third celebration purchasing it And so theres no have a look aton– the male or woman choosing and the person getting it says yeah we could get higher service And somebody else is– right, LAURENCE BAKER: So we produced a large concern Insurance businesses are type of a thrilling thingin a physical fitness coverage world Because we ought to have them We need to have them to control the possibility related to getting ill You get weak today and get a huge expense And so we cant leave humans on their individual for that We were offered to have insurance coverage companies But as quickly as you develop insurance coverage companies and I will have implicitly all my neighbors pay for the health care that I require thenI may begin the use of matters that become an effective And so you got to have them– insurer But you obtain to control whath appens when you have them also And so thats the combination among providersor co-payments and utilization evaluation and all these thing sare basically triesvia protection companies to try to manage what economic experts would call the ethical hazard The the usage of extra services that you dont necessarily require since all individuals else is going to pay for it for you, SALMAN KHAN: It makes complete sense Well thanksThat makes a lot of sense.
SALMAN KHAN: Yeah and whos in it? LAURENCE BAKER: And whos in it? SALMAN KHAN: I believe I might offer a cross at it, LAURENCE BAKER: Go for it.