[RFC] Feature Proposal - Insurance

General talk Tagging general discussion
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Throughout the world, insurance is used by individuals, companies, and organizations to protect from financial loss in exchange for a private or public fee. Many times a location that accepts insurance will openly express such or such information is easily sourced in-person or online making the tag verifiable. Furthermore, some locations will accept a particular insurance but not be “in-network” which negotiates a discounted rate for customers of particular insurance plans and providers. In addition to looking into potential practitioners, individuals may also seek out an in-network practitioner or operator. Such information is also beneficial to researchers and scholars who aim to study healthcare and other practice availability or diversity in a given geographic area.

While British English sometimes differentiates between assurance and insurance, the term insurance is used for coverage of an uncertain event, whereas assurance is used for coverage of a certain event, such as death. Knowing this, the key insurance=* was chosen for this proposal.

This tag should be considered different and unique from office=insurance which is a location you purchase or manage an insurance policy, not accept an insurance policy.

Link to proposal. Please discuss this proposal on its Wiki Talk page.

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You first write general things about the concept of insurance, but when you go into details it seems you are talking about very specific aspects of certain national health insurance systems, that are unrelated to other types of insurance (or health insurance in other countries). Or am I mistaken? In many insurance situations the provider of services doesn’t even have a say because the insurance pays money to the insured who then pays the service provider.

It sounds to me as if this is the umpteenth proposal to reflect contracts between businesses in OSM: This shop is part of this coupon redemption scheme, that doctor has signed up with this insurance, and this vendor uses that payment processor.

I am against modelling such detail in OpenStreetMap because it is mostly fleeting. These alliances can change willy-nilly.

If I want to find out which doctors I can go to that accept my insurance, then my insurance should be able to give me a list of their current business partners - and I can then find these doctors on OSM. Instead of OSM trying to model those business partnerships.

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You might want to review this previous proposal about tagging the acceptance of health insurance in more general terms. It was rejected unanimously. Your proposal addresses some of the concerns by naming specific insurance providers, but getting more specific raises other concerns.

What follows is based on my personal experience as someone who lives in the U.S., where health insurance is, shall we say, unusually complicated.

When a business openly accepts a payment method, they’ll usually post its logo on the front door, so that you can tag payment:*=* without even going inside. They might post it on the website too.

Insurance is more complicated. I can call up the doctor, dentist, or optometrist down the street to ask which insurance they accept. The receptionist or the website may generalize, listing some popular insurance providers or brands like VSP or BCBS. However, this is not a binary in or out status. Some of these insurance companies have multiple plans; the doctor is only in network for some of the plans but not others. Every BCBS affiliate has its own network. I’m sure there are other nuances.

For a clear answer, I would need to give the health provider my group number, or I’d have to log into my insurance provider’s website to look up the practice. The affiliation can be so ephemeral that only active customers would find out about any change. And this is before considering large practices such as hospitals, in which individual doctors and departments may participate in different plans.

The exception is government-run public insurance programs like Medicare, Medicaid, and CHIP. Health providers advertise their acceptance of these insurance plans quite prominently, if not on the door then in advertising. We also have access to authoritative data about accepting health providers in the public domain. I think mapping public insurance acceptance would be more feasible.

I don’t deny that insurance acceptance would be useful to researchers, but there are lots of things that researchers might find useful that require them to join OSM data to other datasets. Overall, it isn’t clearly a good tradeoff for this project. At the very least, we would need to revise our disclaimer: an end user shouldn’t rely on OSM data to determine where they can seek medical treatment within their insurance network, because this is potentially urgent information that we have no control over. When we map a medical facility in the first place, we aren’t making such strong claims about suitability as when we start tracking, in some cases, criteria for admittance.

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Thanks for the input! I tried to be as generic as possible to accommodate all sorts of insurances a POI may accept. Though, as a US contributor, I will say I run the risk of being US-centric in my wording there. Perhaps insurance=* could indicate public / private instead of yes / no and insurance:in_network can be changed to a more generic insurance:association or similar.

As far as the concern about update frequency, at least here in the US, practices tend to give you lots of heads up (or they are supposed to at least) about changes and those agreements tend to be negotiated on years timelines. It’s much easier for a practitioner to suddenly stop accepting payment:amex=* than it is they suddenly stop accepting a particular insurance.

Finally to your point about extra information and it being unnecessary since the information can be found elsewhere. While true, the same can be said for opening_hours=* and phone=* and similar. The extra relevant information regarding insurance may also give some insight for researchers to, for example, study healthcare deserts or diversity of acceptance across geographic regions.

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Perhaps to limit the scope a bit it can be reduced to adding the subtag payment:insurance=yes/no to the already widely used payment:*=* and adding a subtag to that addition for payment:insurance:private=yes/no and payment:insurance:public=yes/no and then we can think about if and how to better implement more granular information in subsequent improvements. At the very least, this would signify that a practice accepts insurance and what type if not what provider.

Thoughts?

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I could see insurance acceptance being a useful attribute of less mainstream practices such as urgent care and walk-in clinics, as well as optometrists. It could be even more relevant in some other countries.

There are already 88 occurrences of payment:insurance=*. You don’t need to go through the proposal process to extend the payment method scheme; new payment methods get added all the time. Some subkeys like payment:credit_cards=* are generic, so yes wouldn’t necessarily mean that every insurance plan would be accepted. I think this would address the main concern that befell the previous proposal without needing to get into too much detail.

Further subkeys would be possible, but as with the payment scheme in general, I would intuitively expect us to focus on superficially observable payment methods, without attempting to be comprehensive. This may limit the utility to researchers, but a consumer application could indicate (any) insurance acceptance alongside out-of-pocket payment methods, to provide some balance.

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This proposal has been canceled following community feedback and I have made a new topic on the payment=* talk page to discuss adding this tag to the overall payment tag. Link to talk page discussion.