Follow French on smart card
By Giffin Daughtridge
The invention of the credit card in 1950 changed financial transactions forever. As long as the seller had a machine, the card-carrying customer was set.
What if paying your health-care bill were just as easy?
The Carte Vitale is the "credit card" of the French health-care system. A person's identification information, next of kin, medical-insurance data, and medical history are stored on a memory chip and can be edited by the provider when the card is swiped and the patient's PIN is entered. Every person with a French social security number has a card, and it is scanned at every doctor's visit, prescription pickup, or other interaction with the health-care system.
T.R. Reid, who writes about the Carte Vitale in his book The Healing of America, claims that "it is the secret weapon that makes French medical care so much more efficient than anything Americans are used to."
What exactly are Americans used to? A health-care system that spends more than double what the French system spends per capita, yet ranks last out of 19 Organisation for Economic Co-operation and Development countries in mortality amenable to health care, according to Ellen Nolte of the Rand Corp. France is first.
Why are we spending so much yet still seeing such poor results?
A major contributor to the inefficiency of U.S. health care is the complex billing system. As Paul Dutton of the Brookings Institution reports, 5 percent of health-care expenditures go to administration in France. In the United States, it is 14 percent. Half of that "pays for the legions employed by doctors and hospitals to fill out billing forms, keep records, apply for credentials and perform the myriad other administrative functions associated with health care," according to Dr. Zeke Emanuel, of the University of Pennsylvania School of Medicine. The Healthcare Administrative Simplification Coalition estimates that reducing administrative costs by 10 percent would save the United States up to $500 billion over the next 10 years.
Enter: The Carte Vitale.
A smart card could dramatically reduce the work of the "legions." When the patient enters an office, the doctor would scan the card, detail the visit afterward, and digitally submit the billing information to the individual's insurance payer - no paperwork, no wasted time, fewer financial complications, and drastically reduced costs.
The idea of using a smart card to streamline billing and facilitate the sharing of electronic medical records is not new, but several concerns have been raised. Four of the most common are:
1. Savings from a smart card would come at the expense of jobs. True, there are 2.2 administrative personnel per doctor, and that exceeds the number of nurses, clinical assistants, and technical staff combined in the health-care system. But the government savings from a Carte Vitale could be used to employ these workers in a more productive manner.
2. Having patients carry their health histories around is a security liability. Also correct, but since 1998, France has not had one security breach involving a Carte Vitale, and the encryption technology to protect against such a thing improves by the day. Compare that with the United States, where, in 2007, 16,097 complaints of health-care fraud and identity theft were reported.
3. Sounds good in theory, but would never work in practice. Au contraire. Mount Sinai Hospital implemented a smart-card system in 2003 and has experienced both financial savings and improved security as a result. Rather than confusing two people of the same name when filing medical records, for example, everyone has an individual card and PIN now. The program has been so successful that it has expanded it to produce more than 100,000 cards. Unfortunately, the benefits are limited because the cards do not work in other New York City hospitals used by Mount Sinai patients.
4. Even if one hospital system could do it, the health-care system would need a single payer to implement a uniform billing system. Though not a single payer, Independence Blue Cross accounts for 60 percent of the commercial market in Philadelphia. This market dominance means providers would be forced to accept a payment system like a smart card should the insurance company choose it, or risk losing a substantial portion of their patient volume. Large market share in regional markets may be able to help in the establishment of national standards.
Generating change in an entity as complex as the U.S. health-care system is difficult. Nevertheless, the urgency of the financial situation, coupled with momentum toward reform generated by the Affordable Care Act's 2014 implementation dates, has focused efforts on improving quality and reducing costs. What better time to introduce a smart card?
There are some things money can't buy. For everything health care, there could be the smart card.
Giffin Daughtridge is a medical student at the University of Pennsylvania. E-mail him at firstname.lastname@example.org.