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Notes -
It's worth noting that specific market segments in the U.S. can and do do things like this but while that stuff can be a large fraction of the profit it isn't a large percentage of the overall activity.
A large part of the problem is that insurance companies will deliberately provide poor service because their clients are usually unrelated institutions and not the individual patient or anyone on the healthcare side (remember we mostly get our insurance from our employer).
When they do fuckery like the examples I'll provide below nobody has any recourse unless they randomly manage to fuck up the CEO's healthcare or something.
Right now one of the world's most prestigious health systems (Johns Hopkins) is threatening to punt United from their health system. One of the two will blink but the service insurance provides to everybody is awful as hell.
A few classic examples: -My patient has been stable on an inhaler for 20 years. They get new insurance company which is one of the ones that has some kinda of complicated kickback program where they rotate the covered inhaler every year. My patient might die if they change inhalers and switch to one that doesn't work for them, so I can spend 5-10 hours on the phone fighting insurance or just cross my fingers and switch. FUCK THIS.
-Patient is sitting in the hospital and needs rehab placement after discharge. The insurance company refuses to approve rehab. The patient sits in the hospital getting hospital level care for an extra 3-5 days before going to rehab. The insurance company pays for that care. Why did they do this? WE DON'T KNOW.
-Psych patient in the ED, clearly needs involuntary care. Insurance refuses to approve, likely hoping that the patient calms down enough to be sent home with suboptimal care or the ED gets frustrated enough to roll the dice on sending the guy home and hope he doesnt kill anybody. THIS WORKS DAMNIT.
Also the "Hawaii" example: You provide a service, you are the only one on your island who does it. Insurance offers you a deal that's barely over cost for your services. You say no. The insurance company spends the next five years flying patients to one of the other islands for their care until you break or go out of business.
The more charitable explanation for what is going on is that when the private insurance is functionally the whole system (Medicare/Medicaid aside) it has to work for all parts of the system not just the ones where you can make things simple and offer a boutique product like your UK elective stuff.
Or if they manage to fuck of the CEO of healthcare.
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