By Bitcoin 杂志 - 1 年前 - 阅读时间：9 分钟
Bitcoin 激励数百万美国人以患者为中心的医疗保健
Why a new healthcare system should be the first product developed in Web5 to offer equitable, affordable and patient-centered healthcare for Americans.
这是 Vishvas Garg 博士的评论社论。新墨西哥大学药物经济学、流行病学、药物政策和结果研究专业。
在之前的文章中，我介绍过 an idea of a new Bitcoin-enabled healthcare system. In this article, I discuss the details of my proposal by using a case example of the private insurance market in the United States. First, I describe the unmet needs in this private insurance market. Then, I discuss the idea of a new bitcoin-enabled, patient-centric health plan structured as a public good and a new electronic health-record system where patients own their data. The Bitcoin network creates an opportunity for patient-centric healthcare.
患者收回数据
全球生成的总数据中，30% 来自医疗保健领域。这些数据，包括患者自己的医疗记录，均归机构所有。这些医疗保健数据分散在不同的卫生系统中，即使是研究人员也很难访问这些数据来推进医疗保健领域的研究和开发工作。在任何以患者为中心的医疗保健系统中，患者将拥有自己的数据。
A Bitcoin-enabled innovative solution can deliver high-quality, equitable, patient-centric healthcare in an affordable manner to millions of Americans.
中本聪在 Bitcoin 白皮书，“互联网上的商业几乎完全依赖金融机构作为受信任的第三方来处理电子支付。”
保险提供商也是金融机构。我相信我们可以建立一个新的综合医疗保健系统，以负担得起的方式提供高质量、公平、以患者为中心的医疗保健。
这个的目的 Bitcoin-based innovative solution should be health empowerment.
We can start building this new system by developing a new electronic health-record (EHR) system based in Web5 and a Bitcoin-enabled health insurance product.
新的电子病历系统
医疗保健是数据驱动科学的实践。美国疾病控制与预防中心 (CDC) 分类 影响健康的因素分为：遗传、行为、环境和身体影响、医疗保健和社会。
传统的 EHR 包含患者的医疗信息 例如管理和计费数据、患者人口统计、病史、药物、实验室等。这些信息中的大部分只是影响健康的因素的一部分。
相反，可以设计一个新的电子病历系统来捕获影响健康的所有因素的数据。例如，可以通过医疗保健提供者、患者、护理人员、可穿戴设备、旅行和食品应用程序捕获数据。健康信息可以由患者、护理人员、可穿戴设备以及各种类型的应用程序（例如饮食、体重管理、旅行、女性健康等）输入。
该 EHR 系统将基于 Web5, which is a decentralized web platform that uses bitcoin to revolutionize the commerce of the internet. Within Web5, the decentralized identifiers (DIDs) built on Bitcoin (e.g., via ION) can empower the patients to own their digital identity and 保护自己的数据。 Web5 中的去中心化网络节点 (DWN) 可以成为存储健康数据和中继数据的新标准，使任何类型的实体（患者、提供者等）能够发送和存储符合 HIPAA 的消息和信息。
通过 快速医疗保健互操作性资源 (FHIR)，开发人员可以构建超越当前基于文档的环境的应用程序，并且无论用户的基础设施采用哪种 EHR 操作系统，都可以访问数据。这也意味着患者现有的电子病历可以作为拟议系统的基础，从而显着降低进入门槛。
这种新的 EHR 系统的主要好处是：
Patient-centric healthcare system: Patients should own their data in any patient-centric healthcare system.Seamless patient care: A patient having the ability to seamlessly share their data with any healthcare provider of their choice will ensure continuity of care.Data on all determinants of health will drive higher-quality care: Having access to data on all factors that influence health can help enable and improve the quality of evidence-based medicine for each patient.Acceleration of development of new health technologies: Value-add services can be built atop this EHR system to promote research efforts for innovative, life-changing health technologies. The purpose of such services should always be to maximize patients’ health and optimize system efficiencies. Such services can also create new revenue streams for the key participating stakeholders.Waste reduction: Overall, 据估计 美国大约 25% 的医疗保健支出被浪费了。数据驱动的增值服务可以通过提高系统效率并减少欺诈和滥用来减少浪费。一个新的 Bitcoin-Enabled Health Plan
该健康计划将具有以下主要特征：
Operate as a public good: Like the internet, this insurance will operate as a public good making no profit. This public-good nature will make this the only plan available that will stand to benefit from driving the total cost of healthcare down versus up. This is because any savings will be directly passed on to the sponsors, which will make the plan more affordable. The more affordable the plan becomes, the stronger its value proposition is for expansion.Anyone who has access to the internet can enroll: This will allow the beneficiaries to be seen at a healthcare practice of their choice. This is important because not all healthcare practices will see uninsured patients or even take all health insurances. In this health plan, anyone can sponsor coverage for themselves or anyone else.Coverage and payments: Preventive care should be highly proactive and always offered without any out-of-pocket costs. The level of coverage for other healthcare services can be customized per the sponsor’s choice. Fairer credit products like “buy now, pay later” can be offered to help patients budget for the out-of-pocket portion of such healthcare expenses. Sponsors may also purchase a stop-loss coverage for larger health bills.The system will strongly encourage and reward evidence-based medicine (EBM). EBM is using the best research for making healthcare decisions. EBM can be strongly encouraged and rewarded on both the healthcare provider (HCP) and patient levels.Preventive care and early intervention. Practicing EBM will strongly encourage proactive and preventive care, which is always the best option for healthcare. After preventive care, the second-best option to maximize health is always early intervention. The system should also strongly promote EBM-based early intervention.网络是任何保险系统最强大的保护。网络越大，就越容易在整个参与者群体中分配与健康相关的支出风险。随着拟议健康计划的患者和提供者网络的发展，可以实现许多协同效应和创新，例如与提供者的议价能力更强以及运营费用的规模经济。通过预防性护理和早期干预，人口将变得更健康，从而降低总护理成本，从而降低健康计划的成本。所有这些都可以帮助为数百万美国人建立一个无与伦比的负担得起、高质量和公平的健康计划。
Hypothetical Example Of The Bitcoin 健康计划
如下图所示，该健康计划可以设计为自筹资金或水平资助的保险产品。在这种保险类型中，赞助商有资格收回或展期其未使用的保费供款。这为保持受资助者的健康创造了经济激励。赞助商还可以 定制 效益设计。
（图形/Vishvas Garg）目前， 64％的工人 在美国，参与自筹资金计划的人 然而，在小公司（199 -21 名员工）中，只有 82% 的人参与自筹资金计划，而大公司（200 名以上员工）则有 XNUMX% 的人参与自筹资金计划。即使是大型的、自我保险的雇主——工人通过自筹资金的计划得到保障—— 缺乏力量 有效协商医院的高价格。
水平资助计划是一种较新的混合选择，公司（通常是中小型）可以利用相对名义上的自筹资金选择，同时附加高额医疗费用的止损保险。
无论企业规模如何，目前的自筹资金或水平资助计划都无法满足当前雇主的需求。至少在过去二十年里，医疗保险的费用每年都在上涨。事实上，健康保险是雇主仅次于工资的第二大员工相关费用，平均健康计划费用为 $22,221 2021年家庭保险将全面覆盖。因此，降低保险费用不仅可以让更多雇主负担得起健康保险，还可以提高企业的竞争力。
85% of the collected premiums can be allocated towards paying medical bills and improving quality of care. The latter can include bitcoin rewards to patients for continuously improving their health and to healthcare providers for delivering high-quality care. The remaining 15% of premiums can be used for operating expenses and investing in bitcoin 矿业。
可以改变 85/15% 假设以优化计划设计。目前同样基于 平价医疗法案 85/15 规则 传统的全面保险计划，目前有数百万美国人通过该计划获得健康保险。
上一节提出的健康计划的关键特征将推动长期节省。医疗保健和质量改进的示例：
EBM：短期内，可能可以实现 10% 的节省，而长期来看，预计可以节省更多。例如，在 Medicare Advantage 计划中启用 EBM 的平台已经证明 医疗保健比率差异超过1,100个基点.Bargaining power: 经验证据 suggests that increasing market concentration of both insurance providers and hospitals in any given market is associated with more bargaining power.Reducing waste: 上文提到的，如果可以消除总浪费的 20-40%，则可以节省 5-10%。所缴保费的剩余15%可分配如下：
运营费用：将健康计划作为公共利益来运行将产生运营费用。我假设这些比例约为 10%，但这个数字可以更低或更高。为了以轻资产模式运营， 第三方管理员 (TPA) 可以杠杆化。 TPA 可以处理或裁决索赔、收取保费、签订医疗保健服务合同、提供索赔的使用审查以及为福利计划的运营提供类似的辅助服务。Bitcoin mining: The remaining amount from the premiums paid can be invested into bitcoin mining. This will have two benefits: It will strengthen the security of the Bitcoin network and the mining rewards can be used as a unique revenue stream to supplement the growth of the insurance network through offering referral bonuses and more.Biometric screenings can be leveraged to establish person-specific goals for health and wellness promotions with bitcoin rewards. In 2021, 26% of small firms and 38% of large firms 提供的机会 for biometrics screening to their workers. Using these person-specific goals, bitcoin rewards can be offered for quality improvement purposes to incentivize those who continue to improve their health and wellbeing. The beneficiaries can apply these rewards against future healthcare expenditures.
同样，可以为提高质量而对提供者进行奖励。例如，已建立的指标，例如 质量措施 医疗保险和医疗补助服务中心使用的术语可用于定义高质量护理。
增值服务
增值服务是该提案中最具活力的部分。随着网络的发展，可以构建更多创新服务，以最大限度地提高参与者的健康状况并优化系统的效率。一些例子包括提高质量、加速研发、优化系统效率和减轻巨大行政负担的服务。
的角色 Bitcoin
Bitcoin will play many roles in this proposal. Some key examples are:
Making healthcare delivery patient-centric by enabling decentralized identity and giving ownership of the data back to the patients.Improving quality of care and reducing healthcare costs through enabling EBM and offering rewards to patients for improving health and to providers for improving quality of care.Supporting growth of the plan network through rewards from bitcoin mining.A superior payment mechanism that is desperately needed in healthcare. For instance, bitcoin can provide instant settlement versus the current time (often 30-plus days) it takes to process medical claims. This will not only reduce the revenue cycle for the healthcare providers but could also help lower the rate of claims denials.总之，我的建议只是初稿。我邀请任何愿意以负担得起的方式为数百万美国人提供高质量、公平、以患者为中心的医疗保健做出贡献的人提供意见、反馈和合作，以进行改进、开发或执行。我希望我们能够共同努力，有一天让每个人都能负担得起高质量、公平的医疗保健。
This is a guest post by Vishvas Garg. Opinions expressed are entirely their own and do not necessarily reflect those of BTC, Inc. or Bitcoin 杂志。
原始来源： Bitcoin 杂志