Bitcoin can fund quality, equitable healthcare for all

The current global health system is broken

As of June 13, 2022, over 6.2 million people have died from COVID-19-related deaths. This is despite the fact that in 2019, US$8.9 trillion or 9.8% of global GDP was spent on healthcare worldwide.

In general, half of the world does not have access to basic health services. In addition, the current healthcare system leaves out the most vulnerable groups, leading to health disparities and inequities.

Health is a basic human right. This is how it should be for everyone.

Today, health care is provided in two ways:

Insurance-based healthcare systems: In general, economically strong countries have insurance-based health care systems that may or may not provide universal coverage. In addition, health inequalities and inequities are widespread even among the most protected groups of people. For example, in the United States, racial and ethnic minorities, economically vulnerable segments of the population, and people living in places other than large metropolitan areas continue to experience poorer health care.

Out-of-pocket healthcare systems: Economically weaker countries usually have out-of-pocket healthcare systems. It is important to note that even in economies with insurance-based healthcare systems, the most vulnerable group of people may still need to use out-of-pocket healthcare. In most countries around the world where out-of-pocket schemes are widespread, corruption, favoritism and a lack of accountability are ingrained.

Both systems share a common feature: intermediaries controlling patient access or creating inefficiencies, or both.

Bitcoin can make health a human right for everyone

The current healthcare system increases the cost of mediation. Like banks, health insurers are financial institutions that suffer from the inherent weakness of the trust-based model. More broadly, current systems have resulted in additional intermediaries adding further inefficiencies to the healthcare system. For example, it is estimated that out of every $100 spent on prescription drugs purchased at a retail pharmacy with commercial insurance in the United States, over $40 is collected from intermediaries.

These high mediation costs limit the minimum practical transaction sizes, which has a disproportionately negative impact on preparedness. In out-of-pocket health care systems, the societal cost of mediation in the health care networks is even higher, ie without any insurance safety net, the most vulnerable groups are either completely excluded or underserved.

To quote Satoshi Nakamoto, “What is needed is an electronic payment system that relies on cryptographic proof rather than trust and allows two willing parties to transact directly with each other without the need for a trusted third party.”

The best way to fix the currently broken healthcare system is to build a new integrated peer-to-peer healthcare system (IHS) between patients and providers that can provide quality and equitable healthcare as an easily affordable public good for all.

This new peer-to-peer IHS can work as follows:

  • First, an insurance-like product built on Bitcoin is needed. Anyone enrolled in this product is eligible to receive medical care at the proposed IHS. Anyone with internet access should be able to sign up. The only “insurance premium” people will pay is their anonymized data on health determinants. Each member retains permanent ownership of their data.
  • Second, transparent, secure, and efficient supply chains should be built on Bitcoin. This will solve many critical challenges such as counterfeit medicines and artificially inflated drug prices to meet the needs of intermediaries.
  • Third, healthcare providers should only be incentivized to optimize patient outcomes. This can be achieved by strongly promoting the practice of evidence-based medicine, including a focus on prevention.
  • Fourth, each healthcare provider should contribute data collected during patient care in addition to the data contributed by registered members.
  • Fifth, value-added services whose purpose is to drive long-term optimization of patient outcomes and maximization of system efficiency can be created by anyone. Some of the revenue generated from such services should be used to reduce the cost of ownership or provide further incentives for providers to help patients achieve optimal outcomes.

This Bitcoin-based IHS can bring many transformative changes:

General health insurance: “One can assume that at some point every person on this planet will have access to the open Internet. We cannot make the same assumption about participation in the global financial system,” Jack Dorsey said recently. The same applies to the Internet and the healthcare system. With peer-to-peer IHS, anyone with access to the internet can be part of the system simply by contributing their health determinant data.

Evidence-based, equitable healthcare for all: Since all each member pays in “premiums” is their data, and provider incentives are tied to patient outcomes, everyone will have access to similar quality, equitable healthcare.

Accelerating the development of new health technologies: Many of today’s medical technologies were discovered by accident (e.g. penicillin, x-rays and cardiac pacemakers). Similarly, trial and error is a common strategy in today’s R&D efforts. When a dataset is available that contains all the determinants of health information in a population, the development of innovative health technologies is accelerated.

Better allocation of the health budget: By 2030, the US will spend $6.8 trillion annually on healthcare, according to the latest “official” estimates. Assuming that focusing on prevention and practicing evidence-based medicine can even lead to a 5-10% reduction in healthcare spending, that would result in savings of $340-$680 billion. This is enough to cover all out-of-pocket health care expenses of the US population. The available evidence indicates how the proposed savings can be achieved even if evidence-based care is implemented in the current system itself.

A call to action:

I believe it takes a critical mass of three core criteria for a new idea to get off the ground:

1. A well thought out concept that can create transformative change.

2. Technical know-how how to implement it well.

3. The necessary resources are available.

This article summarizes my thoughts on the first point. I choose to do this as my current expertise is in healthcare. With this article, I challenge the bitcoin community to explore ways we can achieve number two and three.

This is a guest post by Vishvas Garg. The opinions expressed are solely their own and do not necessarily reflect those of BTC, Inc. or Bitcoin Magazine.

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