Friday, September 23, 2005

Returns on investment

The National Post points out one possible reason why increased investment in health care hasn't yet produced the results we'd like:
Canada's health care system is rife with fraud that costs the public and private sectors an estimated $3-billion to $10-billion a year, the country's first-ever survey of health fraud indicates...

More than 100 players in the field responded to the survey, including almost 80 who represent the insurance companies and government agencies and departments that make payments to health care providers. Others were police or investigators in the field.

All respondents estimated at least 3% of claims were fraudulent, while about seven out of 10 pegged the prevalence of the problem at 6%-19%.

Naturally, this doesn't mean there's a need to criticize the vast majority of health-care workers who do their job without padding the numbers. But in such a rapidly-expanding field, there's lots of money to be made by claiming to be performing necessary health services. And that leads to a need for countermeasures to ensure that the money goes only where it's needed.

I'm not one to demand audits as a matter of course: in a lot of cases they may add additional costs without much benefit. But where as large a program as health care is facing such systemic problems, the cost/benefit analysis shifts. From the scope of the survey, it doesn't appear that any one province or field has escaped the problem - meaning that only a well-coordinated federal effort is likely to put a serious dent in the problem.

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