Posts Tagged ‘health care reform’

I’m into the third week of the UI (user interface) design course I am taking via Coursera called Human Computer Interaction. The lectures for this week include a discussion of some prototyping techniques to use to quickly create a mockup of the interface for your system. The objective is to have a prototype to put in front of users to see how they interact with it and identify issues early in the development cycle. One of the techniques is called the “Wizard of Oz” method.

The name is inspired by the movie of the same name in which the wizard is really just a small man behind a curtain who is pulling the levers to make something much bigger appear operational. This technique is really great for early evaluation of user interfaces because you don’t have to spend a lot of time solving complex issues in the backend. You just need to have an interface that looks somewhat realistic. A “wizard”, which is a person behind the scenes not usually visible to the users, operates the controls to make it appear as if an automated system is actually running everything.

Today I was reading a story at Natural News with the headline “Head fake! Is only an empty shell MOCKUP of a working Obamacare exchange?” and it struck me right away that maybe really is just a mockup in a Wizard of Oz prototype fashion. All the evidence would seem to indicate that. Like the fact that the people in charge can’t even say how many people have signed up through the system. That kind of information just falls out of a real system. Maybe they don’t know because it really is just a mockup with a bunch of people behind the scenes pulling the levers and they have to poll all them and collate the information before they know.

Another reason to think it might just be a mockup is how quickly and thoroughly it has been overwhelmed. Seriously, any system designed for this purpose would have to consider this volume of users at initial roll-out. I don’t think there is really any system on the backend.

And finally, anyone who has done contract work for the government knows how ridiculous it is. It is standard procedure to have specifications thrown at you that are bloated, poorly written, and often times scoped by inexperienced people. Then the specs get changed repeatedly, causing rework and delays. Then there is a funding issue at the end of each fiscal year when funding runs out, the project has to shutdown, and then later gets restarted again when the funding finally comes through, but in the mean time the previous development team went off and found other jobs. I know this one well from my previous work at an aerospace firm where I was a project manager.

My guess is that the system was not completed in time due to all the vagaries of government contracting. The government was firmly committed to a roll out date, but the system wasn’t ready so they threw up a mockup. The wizards, of course, were immediately overwhelmed.


As I said in an earlier post I’ve been wondering about how the medical tourism industry will be impacted by the U.S. health care reform law. Well, there’s a conference on that.

According to a press release I read, Irving Stackpole, President of Stackpole & Associates, a health care market research and marketing company, will give a presentation on the impact of US health care reform on the medical tourism sector at the First Latin American Global Medicine and Wellness Congress in San Jose, Costa Rica on Monday, April 26, 2010.

The preamble says that the new health care law will have far reaching consequences for the international health travel sector. Historically, the industry in the U.S. has marketed mainly to uninsured Americans and self-insured health plan providers. Stackpole says that as a result of the new bill the industry will be in flux for the next two years. I don’t know but it seems like it might be longer than that because the provisions in the new law are phased in for longer than that. He says that there do appear to be some opportunities for international health travel organizations as a result of the law.

Ah, but no details in the press release on where those opportunities may be. I guess you have to sign up for the conference. But since it’s in Costa Rica I don’t think I’ll be making it. I’m still thinkin along the lines of my earlier post, that the big opportunity might be with insurance companies trying to reduce their costs by sending patietns overseas.

In a previous post I wondered what kind of moves the insurance companies would start making now that the health care reform bill has been signed. Mainly I was thinking about how they might try to reduce costs by encouraging more patients to practice medical tourism. Of course I expected the companies would start to “review” their accounting practices. And so they are. Reuters reports that the insurance industry is already beginning to game the system and WellPoint has already reclassified more than half a billion dollars of administrative expenses as medical expenses. They idea is to make it easier to meet the requirement that 85% of premiums are spent on actual medical care and not administrative costs (read that as fat cat salaries). No problem. A few little accounting adjustments it’s business as usual.

I have been watching the U.S. health care reform debate with only slight interest. That’s because I no longer live in the U.S. and don’t have any need for insurance there. We go to the world class private hospitals in Thailand for all our medical care – so fantastic compared to all my experiences with health care back in the states. I’ve had more than a passing interest in the whole medical tourism field since moving to Thailand. I didn’t realize it at first but this country is a huge medical tourist destination, something like half a million Americans per year come here for elective or uninsured medical procedures. I had no idea it was that well-known.

The thing I’m wondering about is what effect the new health bill in the U.S. will have on Americans traveling overseas to see a doctor. I haven’t paid so much attention to the details, mostly read just sound bites in news stories about it. As I understand it, Americans now are required by law to buy medical insurance. That seems just so amazing in a commie sort of way. I can’t imagine how I would feel if I was living there. BTW, does this new law mean that even expats like me have to buy insurance? LOL at them if that is the case. I’m doing fine paying out-of-pocket over here.

All thumbing my nose at the U.S. government aside, if people are forced to pay for insurance then that means they are probably going to be highly motivated to use those benefits. So that kills the medical tourism option for most of them, right? Or does the new system mean that Americans will end up with wait times like the ones so famous in the UK and Canada? So much that although they are forced to pay for insurance they still will travel to get the health care they need in a timely way – is that going to happen? I suppose it will take some time for that to develop so we won’t know for a while.

Or maybe something else will evolve from this. Some insurance companies have already started to cover medical tourism by paying for patients to get things like major surgery overseas. With new restrictions on insurance companies that forbid them from canceling policies when people get sick and denying coverage for people with pre-existing conditions, maybe the insurance companies will accelerate the trend to cover and encourage patients to get treatment at lower cost overseas hospitals.

It seems like it could go in several directions, or maybe all directions at once. I guess I will have to keep watching the news about moves the insurance companies are making to survive and prosper in the new legislative environment.