Abstract:
A system for management of public health care where participating entities consume and purchasing health care services. Entities contribute to a health care fund and insurance account, both managed and supported by government. Personal physicians enroll participating entities until a maximum enrollment is reached, and the physicians are compensated from the fund per enrollment, the physicians see enrolled entities and recommend medications/treatments. Wellness maintenance providers enroll participating entities until maximum enrollment is reached, providing preventive medical services to entities, and compensated from the fund per enrollee. WMPs pay all costs of medications prescribed by physicians, WMPs pay 80% for recommended treatments. Pharmacies accept prescription orders from physicians and dispense directly to participating entities or their WMPs, receiving payment from the WMPs. Curative and specialty service providers provide treatments and services recommended by physicians, CSSPs paid by WMPs and insurance on a 80/20 split.

Description:
FIELD OF THE INVENTION 
       [0001]    This invention relates to public health care and insurance systems, and more specifically, an improved public medical health system focusing on cost effectiveness, preventive measures and general public&#39;s well being. 
       BACKGROUND OF THE INVENTION 
       [0002]    The health and medical care industry is one of the biggest industries in the US, and is worth billions of dollars. According to the US Census Bureau, the percentage of people in the US without health insurance was 15.3 percent in 2007 and the number of uninsured was 45.7 million. With the aggressive push for universal health care of the current Obama presidency, it is imperative to develop a more cost effective, patient oriented and streamlined health care system. 
         [0003]    With billions of dollars at stake, there have been observations that pharmaceutical companies strive to design medications to “contain” an ailment, instead of finding a cure, and fewer companies have been going into the vaccine business. Then there are also those who seek to defraud the healthcare system, like a doctor in south Texas who replaced perfectly good teeth in poor children just to claim money from Medicaid. 
         [0004]    The public health care includes but is not limited to Medicare, Medicaid, Veterans Health Administration, Military Health System/TRICARE, Indian Health Service, State Children&#39;s Health Insurance Program (SCHIP), and Federal Employees Health Benefits Program. The private health care system includes insurance companies such as Blue Cross/Blue Shield, and other Preferred provider organizations (PPOs) and Health maintenance organizations (HMO), etc. 
         [0005]      FIG. 1A  (prior art) describes one of the most common existing health care models  90 . As shown in  FIG. 1A , insurance buyers&#39; and/or tax money is injected into the PPO and Government Health Care Fund periodically. Money from these sources in addition to insured patients&#39; co-payments will be paid out to independent service providers on a pay per service basis. The PPO has the main objective to control and reduce payment to ISPs by measures such as rigid price control, high co-payment or delay or denial of service. To attain more money from the funds and co-payments, ISPs seek to provide services could be beyond actual need. There are also potential problems such as: 
         [0006]    Rigid price control discourage new ISPs 
         [0007]    ISP and patients conspire to commit fraud again PPO 
         [0008]      FIG. 1B  (prior art) describes another one of the most common existing health care models  92 . As shown in  FIG. 1B , insurance buyers&#39; and/or tax moneys are injected into the HMO and Government Health Care Fund periodically. Money from these, in addition to insured patients&#39; co-payments, will be paid out to subsidiary service providers and/or public medical facilities. HMO has the main objective to control cost by limiting capital investment, imposing high co-payment, adopting complex process, or delay or denial of services. 
         [0009]    There are also potential problems such as: 
         [0010]    Inadequate service capacity and service quality 
         [0011]    Patients are not given full range of treatment options 
         [0012]    Patients avoid system unless/until conditions become serious 
       ADVANTAGES AND SUMMARY OF THE INVENTION 
       [0013]    The present invention is an improved medical health care system that focuses on preventive services over curative treatment, cost efficiency, patient choice and free market operations. 
         [0014]    The present invention is an improved health care system designed to develop a system with professionals who have a financial incentive to keeps subscribers happy, healthy and productive and not just an incentive to sell subscribers services to make higher profits. 
         [0015]    The objective of the present invention is to encourage the use of preventive services before serious conditions develops, to create a group of professionals whose sole financial interest is the patients&#39; health and well being, to create a group of market players whose will work hard for preventive and curative solutions in order to contain health care cost, to create a vibrant market of all types of treatments and services and to minimize government intervention in the application of medicine. 
         [0016]    The medical health care system of the present invention calls for a unified plan within which each consumer will need to make three independent yet interconnected decisions. These decisions are rooted in the principles of free market. Each consumer will be able to choose the provider best suited to their unique needs. Each provider can tailor their services to target general or specific niche markets to attract customers. It also takes a lesson from the US constitution. Each choice consists of a group of private sector professionals designed to check and balance the influence and power of another group of private sector operators. Most importantly, these choices foster a matrix that steers the financial incentive decidedly in favor of prevention instead of treatment, cure instead of containment. 
         [0017]    One advantage and object of the present invention is to provide universal access of health care without excessive bureaucracy and inconvenience to consumers. 
         [0018]    Another advantage and object of the present invention is to provide community pooling of risk in a competitive health care market with input by consumers. 
         [0019]    Yet another advantage and object of the present invention is to provide a foreseeable and predictable public health care budget and manage those budget by encouragement of preventive and curative medicine. 
         [0020]    Another advantage and object of the present invention is to provide a large number of professionals who&#39;s own financial interest has a direct link to the general public&#39;s health and well being. 
         [0021]    Further details, objects and advantages of the present invention will become apparent through the following descriptions, and will be included and incorporated herein. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0022]      FIG. 1A  (prior art) is a flowchart describing one of the most common existing health care models  90 . 
           [0023]      FIG. 1B  (prior art) is a flowchart describing another one of the most common existing health care models  92 . 
           [0024]      FIG. 2A  is a representative flowchart showing the medical health care system  100  of the present invention in the perspective of cash flow. 
           [0025]      FIG. 2B  is a representative flowchart showing the medical health care system  100  of the present invention in the perspective of consumer choices. 
           [0026]      FIG. 3  is a chart illustrating the supply and demand relationship between WMPs  106  and CSSPs  110 . 
           [0027]      FIG. 4  illustrates how medical health care system  100  of the present invention works in three different demands from insured consumers  102 . 
           [0028]      FIG. 5  describes the approval process of new services and drugs. 
           [0029]      FIG. 6  describes a fast track process for new service and drug approval. 
           [0030]      FIG. 7  illustrates optional measures to further strengthen the medical health care system  100 . 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0031]    The description that follows is presented to enable one skilled in the art to make and use the present invention, and is provided in the context of a particular application and its requirements. Various modifications to the disclosed embodiments will be apparent to those skilled in the art, and the general principals discussed below may be applied to other embodiments and applications without departing from the scope and spirit of the invention. Therefore, the invention is not intended to be limited to the embodiments disclosed, but the invention is to be given the largest possible scope which is consistent with the principals and features described herein. 
         [0032]    It will be understood that in the event parts of different embodiments have similar functions or uses, they may have been given similar or identical reference numerals and descriptions. It will be understood that such duplication of reference numerals is intended solely for efficiency and ease of understanding the present invention, and are not to be construed as limiting in any way, or as implying that the various embodiments themselves are identical. 
         [0033]      FIG. 2A  is a representative flowchart showing the medical health care system  100  of the present invention in the perspective of cash flow. As shown in  FIG. 2A , the medical health care system  100  consists essentially of insured consumers  102 , public health care funding  114 , supplemental medical insurance provider (SMIP)  112 , personal physicians  104 , Wellness Maintenance Providers (WMP)  106 , pharmaceutical vendors  116  and Curative and Specialty Service Providers (CSSP)  110 . 
         [0034]    As shown in  FIG. 2A , insured consumers  102  will pay their insurance premium periodically to the public health care funding  114  in which the federal and state governments will also provide funding. And from the public health care funding  114 , money will be paid to personal physicians  104  and Wellness Maintenance Providers (WMPs)  106 , solely based on the number of enrollment they have and a fixed amount is paid for each enrollment. The purpose of fixed WMP  106  payment is to create market vibrancy with competition and WMP&#39;s  106  competitive in global capital market. The payment rate is adjusted every 5 years base on the P/E ratio of the most profitable WMP  106  in that period. Periodic adjustments are however limited to a fix percentage point to avoid destabilizing the market and scaring off potential investors. Also, newly introduced treatments should come with reasonable corresponding raise to WMP  106 . 
         [0035]    The core of the present medical health care system  100  is the creation of WMP  106 . The WMP  106  keeps overall health care cost down by encouraging the use of preventive services before serious conditions develops among insured consumers  102 . 
         [0036]    WMP  106 , in short, is a place designed where a healthy insured consumer  102  go to stay healthy, hence lower the health care cost by prevention of more serious diseases. WMP  106  builds wellness centers in the community, where healthy insured consumers  102  come regularly for preventive treatments such as vaccinations, body check up, etc. without fear of getting infected by people who may have contagious diseases. Upon requests or pre-arrangement, WMP  106  may even provide services directly at insured consumers&#39;  102  home. WMP  106  may contract out services such as dental, medical testing, and addiction treatment and it may provide additional psychological counseling and preventive screening. Since WMPs  106  are funded by public health care funding  114 , they must accept all applicants and are forbidden to adopt geographical skimming by enforcing geographic pairing. 
         [0037]    The operation of WMPs  106  is completely funded by public health care funding  114  by receiving fixed payment from government per patient  102  enrollment and its only source of income is the fixed payment from member enrollment (insured consumers  102 ). Any form of cash back for enrollment is strictly forbidden. Advertising &amp; sales budget per WMP  106  is limited and not linked to the number of enrollment of individual WMPs  106 . 
         [0038]    WMPs  106  must provide recurring care (Wellness Care) as defined by the Public health authority. They pay for 80% of the cost of emergency or specialty care (i.e. curative actions) and necessary medication. With those measures in place, WMPs  106  have high incentive to seek curative measures instead of depending on chronic medicines. WMPs  106  also do not have the veto power for treatment, meaning they cannot deny or delay treatment when personal physicians  104  and patients (insured consumers)  102  agree on particular treatments. WMPs  106  must also provide unhindered information for personal physicians  104  of insured consumers  102  and provide accurate aggregate enrollment/health status data to the public in order to help them select their WMPs  106 . 
         [0039]    As shown in  FIG. 2A , WMPs  106  will pay for 80% of the entire cost of treatment of each enrolled insured consumer  102  to CSSPs  110  and the entire cost prescription to pharmaceutical vendors  116 . To become financially competitive, WMPs  106  must increase the number of enrollment while keeping its expenses down. Since they cannot deny treatment requests from members  102  through their personal physicians  114 , it is to their benefits to keep the insured members  102  healthy to minimize curative costs. In so doing, preventive measures are provided to insured consumers  102  to prevent more serious conditions from developing. WMPs  106  also compete for enrollment with each other with extra treatment options, better performance, or/and improved service quality and they may also target niche markets with enhanced services. They may also form consortium to negotiate pharmaceutical pricing (group pricing) to reduce costs. WMPs  106  could also limit executive pay package to a reasonable level to stay competitive. 
         [0040]    The objective of fixed payments to personal physicians  104  is to give a newly starting physician a reasonable income and an established physician a respectable income in their community. The calculation is based on a reasonable number of patients  102  a physician  104  might have and also on community income and living expenses where the physicians  104  are located. For example, in rural areas, a base stipend should be considered for physicians  104  willing to locate there. Since the only income for each personal physician  114  is from the fixed payments paid based on member  102  enrollment and the number of enrollment for each physician  114  is fixed, the only way to maximize income is to have the maximum enrollment allowed and keep them for as long as they could by keeping them healthy. Personal physicians  114 , unless the enrollment cap is reached, are not allowed to turn away patients  102 . Also by focusing on preventive measures, they can limit efforts/time spent on each insured consumer  102 . Any form of cash back as reward for enrollment is strictly forbidden and advertising/promotion budget is again limited and the same amongst physicians  114 . In short, there is a huge incentive for personal physician  114  to provide quality, cost effective, preventive treatments so they recruit as many as possible enrollments and keep them as healthy and as long as they could. 
         [0041]    It is imperative to ensure that personal physicians  104  recommendations for or against any service or treatment gets them any financial gain/loss to keep those decisions as neutral and patient oriented as possible. They are not allowed to accept financial incentive from WMPs  106 , CSSPs  110  and pharmaceutical vendors  116  for recommending for or against certain treatment and brands of medication prescribed. They are, however, able to order any testing and those tests will be paid by WMPs  106 . Personal physicians  104  may organize into clinics with multiple practicing physicians  104  so new physicians can get insured consumers  102  and establish physicians can have a balance work load. They can even refer patients  102  to other physicians  104  with expertise with revenue sharing agreement. 
         [0042]    There are three types of prescription medication provided by the pharmaceutical vendors  116  under the system: 
       Type A—Vital Medication: 
       [0043]    Such as vaccine or drugs for internal organ illness 
         [0044]    Fully paid for by WMPs  106   
       Type B—Elective Medication: 
       [0045]    Medicines that alleviates non-fatal conditions such as for cold or dermatological ailments 
         [0046]    Small fixed out of pocket cost 
       Type C—Optional Medication: 
       [0047]    Such as ED medications or supplements 
         [0048]    Supply by WMPs  106  at cost: wholesale+relevant cost 
         [0049]    Individual WMPs  106  may choose to cover them 
         [0050]      FIG. 5  describes the approval process of new services and drugs. Firstly, medical trial is conducted by reputable institutions or foreign real-world application and then the new service and drug must be recommended by WMPs  106 , Personal Physician Association (PPA) or Government. It is followed by a vote of all currently active personal physicians  104 . Then it should be approved by a majority vote by all insured consumers  102 . A 3-Year real world trial with payment raise to WMPs  106  would be conducted. The final step is the final approval by a second majority vote. 
         [0051]      FIG. 6  describes a fast track process for new service and drug approval. Proposed services and drugs are recommended by WMPs  106 , PPA and the government. The approval should be confirmed by a over 80% vote by all practicing personal physicians  104 . A neutral auditor is then brought in to determine whether WMP  106  payment should be adjusted. However, fast track approval should be restricted to urgent situations and to inexpensive treatment, treatment well-proven abroad, to those related to society-wide medical emergency and political consensus. 
         [0052]    CSSPs provide treatment services to insured consumers  102  when such services are requested by consumers  102  and/or their personal physicians  104 . As best shown in  FIG. 2A , services provided by CSSPs  110  are paid for by WMPs  106  and SMIPs  112  at a 80/20 split. The selection of particular CSSPs  110  is determined by the free market where WMPs  106  will make the decisions based on service quality, level of technology, reputation, and/or cost. Since rules governing free markets apply, price fixing and monopoly is unlikely to happen. There will be no hard price cap and modular growth can quickly meet gaps in treatment and supply. 
         [0053]    SMIPs  112  account for 20% of all CSSPs  110  charges. As shown in  FIG. 2A , in the medical health care system  100  of the present invention, on top of the public health care funding  114  every insured consumer  102  also pays a percentage of income into an individual SMIP  112  account until the total amount paid on account reaches a preset balance. The payment must be compulsory to avoid skimming. Money in every SMIP  112  account earns interest. When a medical cost arises, SMIP  112  pays CSSPs  110  and deducts that amount from individual account. When an account reaches zero, the individual pays up to annual deductible set by government. Any cost beyond that is paid by SMIP  112  without affecting any other individual accounts and to ensure CSSPs  110  always get compensated. At death, the account balance will be refunded to the designated heir untaxed. 
         [0054]    In the case of families, every family pays a percentage of income into an individual SMIP  112  account until account reaches the preset balance. The payment must be compulsory to avoid skimming. Money in every SMIP  112  account earns interest. When a medical cost arises, SMIP  112  pays CSSPs  110  and deducts that amount from individual family account. When an account reaches zero, the family pays up to annual deductible set by the federal government. Any cost beyond that is paid by SMIP  112  without affecting any other individual account and to ensure CSSPs  110  always gets paid. When the account grows to twice the preset balance amount, additional interest will be refunded to families. 
         [0055]    Every 3 years, US government offers a hidden bid to choose one provider, in an effort to avoid collusion, based on interest rate, for example Prime+1%, and SMIP  112  will pay all funded accounts that interest rate. SMIPs  112  makes profit by investing the money from funded accounts at a rate higher than the agreed upon rate which is adequate to cover medical costs to CSSPs  110  from other accounts with zero balance. Optionally, SMIPs  112  may audit any WMP and CSSP for fraud. These measures help SMIP  112  to be profitable for a financial institution to undertake the task of the operations. 
         [0056]      FIG. 2B  is a representative flowchart showing the medical health care system  100  of the present invention in the perspective of decision making and interaction. Each insured consumer  102  will need to make three independent yet interconnected decisions. The first decision is the most intimate decision of them all, the selection of a personal physician  104 . In the present invention  100 , consumers  102  can see their personal physicians  104  anytime without a co-payment for the visit as their personal physicians  104  are compensated as described above. This arrangement would permit even those consumers who are in tight financial situations to see his/her doctor regularly. For relatively less severe problems, this arrangement would allow office visits before they develop into major health issues. In the medical health care system  100 , personal physicians  104  are independent operators who are compensated based on how many subscribed patients they manage to enroll. Keeping their patients happy and healthy means the doctor  104  has more time for other subscribed users  102  and more time for referrals. Insured consumers  102 , in certain cases, would be allowed to seek a second opinion from a different personal physician  104 ′. 
         [0057]    The second decision is to pick a WMP  106  which determines how services, tests, treatments are selected, as well as medication one required for general health and well being. The system  100  will provide insured consumers  102  with a professional shopper, WMPs  106 , whose main duty is to acquire the services necessary and requested by insured consumers  102  and their personal physicians  104 . WMPs  106 , like personal physicians  104 , are paid a fixed amount based on number of subscribers  102  and with that money they pay 80% of the cost of treatment to CSSPs  110 . Unlike the HMO system we have today, WMPs  106  cannot veto or otherwise delay treatment agreed upon between insured consumer  102 , their physicians  104  and CS SPs  110 . Still, WMPs  106  have quite a number of ways to keep down the cost, hence to increase profit, such as keeping their subscribers  102  healthy, negotiating down the price of curative treatments and medication, looking for cheaper alternatives and preventing fraud. 
         [0058]    The third decision is to select CSSPs  110 . As discussed, the market for curative treatment should be completely unencumbered and free of anti-competitive price fixing. CSSPs  110  should be allowed to charge what ever the market will bear. The idea is that medical treatment is not a commodity. Higher quality doctors, i.e., those with more experience, those with better track-records, those who practice using newer and more effective treatments, etc., should be able to command higher prices. It benefits all to encourage doctors to achieve more and practice at higher levels in their respective fields of practice. Insured consumers  102  will pay 20% out of their own pocket through SMIP  110  payment which will help keep the decision rational. WMPs  106  may try to convince consumers  102  with more economical options to maintain financially strong as they are paying 80% of the cost. However, as shown in  FIG. 2B , they can only provide advice and have no power to veto or delay treatment or to dictate provider selection. In addition, the SMIP  110  contribution provides impetus that will motivate consumers  102  to stay healthy. 
         [0059]      FIG. 3  is a chart illustrating the supply and demand relationship between WMPs  106  and CSSPs  110 . As shown in  FIG. 3 , new cases put pressure existing supply and drive demand, price and total cost up. Due to the high demand, new CSSPs  110  will enter the market to make prices more competitive. As the market settles down, supply and demand are more in balance as both prices and total costs decrease to an optimal level. 
         [0060]      FIG. 4  illustrates how the medical health care system  100  of the present invention works in three different need situations of insured consumers  102 . As shown in  FIG. 4 , in the situation where prescriptive medication is required, the process  302  starts when a personal physician  104  issues prescription base on the consumer&#39;s medical condition. Insured consumers  102  will then get their prescription for free either at WMP  106  or pharmaceutical vendor  116 . WMP  106  will then pay the cost at full to pharmacy  116 . 
         [0061]    As shown in  FIG. 4 , in the situation where medical treatment may be needed, process  304  starts when insured consumers  102  go to their personal physicians  104  on account of their medical conditions. Patients  102  and their doctor  104  will then discuss and determine possible treatments and options for CSSPs  110 . Patients  102  will then get a Personal Physicians&#39;  104  suggestion on CSSPs  110  costs, performance and quality. Patients  102  will then make a final decision with or without their personal physicians&#39;  104  input and/or second opinion. Selected CS SPs  110  will then provide the treatment and WMP  106  and SMIP  112  will then pay CSSPs  110  according to the 80/20 split. 
         [0062]    Also shown in  FIG. 4 , in the case of a medical emergency, process  306  starts when urgent medical help is required by an insured consumer  102 . Insured consumers  102  will be sent to the nearest ER capable of treating patients&#39;  102  condition. WMP  106  and SMIP  112  will then pay the ER, which is likely also a CSSP  112 , according to the 80/20 split. 
         [0063]    In this system, short term savings come primarily from two sources. Firstly, encouragement of prevention of diseases at all levels through financial incentives. Secondly, group bargaining power of the WMPs&#39;  106  will keep the cost of treatment, medication and recurring services down. Long term savings will come when the focus has been shifted from the containment of ailments to the cure of them. The exact savings are hard to be defined. This, after all, will be a system consisting of individuals with their own free wills and entrepreneurial spirit. 
         [0064]      FIG. 7  illustrates optional measures to further strengthen the medical health care system  100 . The measures include a disaster planning and relief fund, small business loan guarantee for start up CSSPs  110 , catch-up classes for foreign physicians, refresher courses for personal physicians  104  and financial support for special and continuing medical education. 
         [0065]    Other optional additions to the medical health care system  100  includes multiple SMIPs  110 , which will guard against bank failure, using account pairing, and interest averaging for individual accounts. Multiple physician accreditation agencies will encourage the most effective way of meeting physician  104  demand. Government may also demand services from citizens in lieu of payments, such as periodic blood donation and organ transplant waivers. 
         [0066]    Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the present invention belongs. Although any methods and materials similar or equivalent to those described can be used in the practice or testing of the present invention, the preferred methods and materials are now described. All publications and patent documents referenced in the present invention are incorporated herein by reference. 
         [0067]    While the principles of the invention have been made clear in illustrative embodiments, there will be immediately obvious to those skilled in the art many modifications of structure, arrangement, proportions, the elements, materials, and components used in the practice of the invention, and otherwise, which are particularly adapted to specific environments and operative requirements without departing from those principles. The appended claims are intended to cover and embrace any and all such modifications, with the limits only of the true purview, spirit and scope of the invention.