Where is the healthcare industry heading?

More and more I am convinced that we're heading towards a two tiered healthcare system - a system for those willing to pay and one for those that either don't have the means or feel that healthcare is more of an entitlement than a service. Some may argue that we already have a two tiered system as many healthcare providers do not to treat Medi-Cal patients simply because the payment is too low. Some, particularly specialists, are also choosing not to treat Medicare beneficiaries for the same reason.

I was even more convinced, when several surgeons told me that they hope to have a cash business within the next 3-5 years. It's completely possible given that 40% of the patients treated by one of them pay cash for his services. Within the same week I was dealing with a health benefit issue and the employee specifically asked to participate in Kaiser because all non-Kaiser doctors in her service area only offer their services as a conceirge service - meaning you pay at least $1,800 a year just to be a patient of that provider.

Are conceirge services becoming the norm? Many primary care physicians have left the industry simply because they can't make enough money to make it worth their time while others have gotten creative by catering to those willing to pay a premium. Delivery systems are responding by employing primary care physcians and resurrecting the physician practice management services of the 90s to keep more primary care doctors practicing.

Many healthcare facilities are also opting out of the payer networks in order to be fairly compensated. Now - I realize that there are a few bad apples out there that have taken advantage of certain loop holes - but most non-contracted facilities are out-of-network because they simply couldn't negotiate fair rates for their services. Many still bill on behalf of the patient and often discount the total charge to avoid penalizing the patient, but that too could change. Many health plans are limiting payments to non-contracts providers. Facilities may have no choice but to bill the patient and let the patient collect from their insurer.

The combination of these market forces lead me to believe that insurers will start offering defined benefit plans, much like 401K plans as opposed to the pension plans offered to the boomer generation. The plans would pay a specified rate for each illness, procedure or service. The patient would be responsible for paying the differential between the plan benefit and the amount charged by the provider. I could be wrong, but it's seems to be the next logical step in the "consumer initiatives" underway within the industry. What do you think?