I suspect we could do decently by requiring insurance to purely reimburse the patient (possibly without the patient needing to pay first). If an insurer pays up to $1k for an MRI, and a hospital charges $15k but an outpatient imaging center charges $700, there will be a strong incentive for patients to stop using the hospital’s MRI.
Combining this with an auto-service requirement for a binding estimate before services are rendered would be amazing.
(Dealing with actual emergencies in this model may be hard.)
Which isn’t necessarily a problem because of insurance. If insurance reimburses $500, than that $700 MRI costs $200. If insurance reimbursed $800, then the $700 MRI is free. (Presumably the rules should be that providers may not discriminate on price except for genuine charity and that insurers must advertise the extent to which their coverage is sufficient for, say, the lower 40% percentile costs in the area.
The goal here is to remove incentives for various forms of corruption:
Providers (especially pharmaceutical companies) to charge outlandish amounts and then reimburse copays.
Providers to optimize pricing to extract money from insurers, when insurers have very little say as to where patients go.
Patients to simply not care what procedures cost at different places (right now, patients often can’t even find out).
Providers to invent charges after the fact. (If a patient gets a binding estimate in advance with a line item that makes so sense, the patient will argue. If a patient’s insurance is billed for nonsense, there may not be anyone paying attention who knows better.)
Combining this with an auto-service requirement for a binding estimate before services are rendered would be amazing.
(Dealing with actual emergencies in this model may be hard.)