A Short Summary of the Cape Care Proposal

DESCRIPTION: A proposed not-for-profit Community Health Insurance program, covering all Barnstable county residents; formulated and operated as a social insurance system based on health care as a basic human right, regardless of means - similar to Medicare and Social Security, or to municipal services such as Police, Fire & Rescue, Libraries, Schools, etc.

ADMINISTRATION & STANDARDS: Professionally administered, and governed by a community Health Policy Board, with the advice of a Medical Advisory Board of health care providers. Its policies and universal benefit package will be developed through a transparent public process to provide all appropriate preventive health services; acute care including out- and in-patient, as well as home; rehabilitation; mental health care; and prescription medicines. There will be free choice from among all affiliated providers.

COST ARRANGEMENTS: Re-directs most current health expenditures to a Community Health Insurance Fund, through a system of progressive premiums; the exact reverse of current financing where the poorest rate payers pay the highest percentage of personal disposable income. For individuals covered under Medicare, Mass Health, etc., their program 'capitation' fees will go to the Community Health Insurance Fund. There will be few if any cost barriers to care.

EMPLOYERS' FINANCIAL RESPONSIBILITY: None (for employees who are covered County residents.)

RATE SETTING: Coverage and reimbursement rates are set by the Health Policy Board so that health care services to meet residents' appropriate medical services needs are readily available.

COSTS SAVINGS: Substantial cost savings are generated though a) reducing the high administrative overhead of commercial insurance plans b) eliminating most corporate insurance profits c) controlling the soaring costs of health care delivery through budgeting and improved coordination of care and d) volume purchasing of pharmaceuticals and medical supplies.

LONGER-TERM BENEFITS AND SAVINGS: The plan generates human benefits and financial savings through improvements in health. Preventing illness, disability and premature death represent real savings in our community health.

HEALTH CARE PROVIDER BENEFITS: a) All providers who are certified to receive Medicare, Mass Health (and other) insurances are eligible, b) Providers will experience cost reductions and improved income, because most patients are covered by a single, administratively straightforward insurance program with a standard package of covered services and benefits and a less complex direct claims processing system, c) Providers will receive prompter payments with direct payment from the Community Health Insurance Fund, screened through a simple fraud control process, d) No cost-shifting to cover the cost of medical services for the un-insured and e) No change in provider ownership or governance.

PLAN FEASIBILITY: This type of plan has been validated by studies in many states and demonstrated in health care systems around the world where this kind of plan generates more health care for all - at a cost less than what we now spend and with much greater control over the content and quality of that care.