Sunday, August 21, 2011

Healthcare: The Importance of Bureaucracy

Suzy Kliff has a post talking about participation in ACA/healthcare reform, noting the very low participation in the pre-existing condition plan.  She focuses on CHIP--Children's Health Insurance Program for its lessons:

What does CHIP do to get kids enrolled? It all revolves around reducing red tape. Eliminating face-to-face enrollment interviews, for example, significantly increases enrollment numbers. Allowing for renewal of benefits by mail, rather than in person, helps too. Pre-populated enrollment forms, where a lot of a beneficiary’s information is already filled out, are currently being tested. In total, anything that makes it easier to sign up tends to increase enrollment. And that’s going to be key to moving 32 million people into an insurance system pretty soon.
One other thing we can learn from CHIP: enrollment levels could end up varying widely by states, and how many of these streamlining strategies they use. In Vermont, 92.4 percent of eligible kids are enrolled in CHIP; in Nevada, only 62.9 percent are. The disparities show just how much can hinge on how states decide to structure their enrollment processes
In other words, it's all about bureaucracy: how well do the bureaucrats at HHS and the state departments design their processes, their forms and websites.  I hope Dr. Berwick is a skilled bureaucrat.

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