Health insurers are variably represented as knights, knaves, or pawns in public discourse. Getting their underlying motivation right is critical.
The British economist Julian LeGrand suggested that public policy is grounded in a conception of humans as"knights,""knaves," or"pawns.” Human beings are motivated by virtue or rigid self-interest , or are passive victims of their circumstances . A society's view of human motivation influences whether it builds public policies that are permissive, punitive, or prescriptive.
Depending on the perspective, health insurers operate for the betterment of society or their own selfish gain; or their actions are defined more by external rules, regulations, and competitive positioning. The role of health insurance companies in US society has been actively debated in US society since the tragic murder of
US perspectives on health insurers have undergone a similar transformation with the increasing cost—both to taxpayers and to individual patients—of health care delivery. As health insurer behavior has been tied to these rising costs and increasing scrutiny has been applied industry behaviors, policy discourse increasingly reflects the perspective that health insurers are an obstacle not an enabler to a functioning health care system.
Insurers have been enablers of value-based models of health care payment such as accountable care organizations, the patient-centered medical home, hospital-at-home, and senior-focused clinics. In these examples, insurers are supporting a more progressive model of care delivery that enables responsible resource utilization. Applied effectively, these models improve individual and population outcomes.
Health Reform Managed Care Knights Knaves Or Pawns
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