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Consumer and Provider Costs

Discussion in 'Healthcare Reform Discussions' started by M. DaSilva, Aug 26, 2019 at 10:21 PM.

  1. M. DaSilva

    M. DaSilva new user

    Jul 7, 2019
    Likes Received:
    The health care sector continues to undergo significant changes as health insurance plans are progressively developing high-deductible insurance policies and networks with minimal options to providers as a response to governmental policies that have been implemented. The policies are geared to both public and private market insurances with a focus on reducing overutilization and controlling prices.

    The impact that federal and state health care policies have on consumer costs is a significant one. For public insurance plans such as Medicare and Medicaid, the reduction of overutilization is happening through payment reforms such as ACOs or bundling of payment for services while they are controlling prices through cuts in base rates for hospitals, physicians, and managed care plans. For private insurance plans, the reduction of overutilization is happening through payment reforms, patient cost sharing, and limiting the tax break for employer-based plans. Those private plans are also controlling prices through market approaches such as price transparency, narrow provider networks, antitrust enforcement, and rate regulation (Brown, 2018).

    The positive effect on the consumer-based trend in insurances is that it can potentially lead to healthier individuals in the long run. According to Hempstead (2014), “There are other trends which may have implications for utilization experience in the commercial market—a shift toward higher consumer cost-sharing and an increase in risk-based contracting and other types of care management, all of which are designed to reduce utilization, particularly of hospital care.” Patients who are more mindful of cost and are aware that their coverage only allows for limited accessibility will be more likely to monitor their health better making better lifestyle choices and are less prone to frequent hospital and outpatient visits.

    On the negative outlook of these policies that are being implemented as a way to drive consumer-based insurances is that there have been a reduction in the amount of health plans being offered by different insurance carriers. These policies make it difficult for new health plans to be introduced into the market to become alternatives for plans that have become obsolete. Some plans are not able to be sustained based on the way in which the policies outline for payments to take place (Gottlieb, 2015).


    Brown, E. C. F. (2018). Health Reform and Theories of Cost Control. Journal of Law, Medicine & Ethics, 46(4), 846–856. Retrieved from http://eds.b.ebscohost.com/eds/pdfv...b-d003-4127-a872-b6e9ffa8985c@pdc-v-sessmgr06

    Gottlieb, S. (2015). The State Of Competition In The Health Care Marketplace. Retrieved from http://www.aei.org/publication/the-state-of-competition-in-the-health-care-marketplace/

    Hempstead, K. (2014). Early Trends in Health Care Utilization in the Commercial Market. Retrieved from https://www.rwjf.org/en/library/art...are-utilization-in-the-commercial-market.html