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Consumer and Provider costs

Discussion in 'Healthcare Reform Discussions' started by S.N.S, Aug 27, 2019 at 10:00 PM.

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  1. S.N.S

    S.N.S Guest

    Consumer and Provider Cost

    High deductibles and narrow networks seem to be the norm lately. Americans are finding it harder to pay exuberant out of pocket costs and stay insured. Some say that when consumers are forced to pay more from their own funds, they tend to make better lifestyle choices that positively impact their health. Consumers tend to utilize their preventative health care program to stay healthy and avoid major health issues. Some of these preventative health care programs may include annual checkups, smoking cessation, etc. These programs also have a positive impact on consumers' quality of life. This permits consumers to become healthier which reduces costly hospital utilization.

    “Health care markets could work more efficiently, and Americans could receive more effective, high-value care if we remove and revise certain federal and state regulations and policies that inhibit choice and competition.” Acosta, Azar, Mnuchin (2018). As health plan premiums rise, many consumers are unable to afford the available health plans and its out-of-pocket costs associated with the plan. This leaves many Americans uninsured and without access to affordable preventative care to maintain their health. This also places a burden on the health care system because the uninsured that does not receive preventive care usually

    As droves of 65+ and/or disabled become eligible for Medicare, the government will need to find new and inventive ways to keep costs low. “Between the Medicare Shared Savings Program (the statutory Accountable Care Organization program created as part of the ACA) and payment models developed through the ACA’s Center for Medicare and Medicaid Innovation, more than 30 percent of Medicare payments are now tied to “alternative payment models” that reward efficient delivery of high-quality care, rather than being made on a purely fee-for-service basis.” Aron-Dine, (2017). This drives up costs for consumers.

    Unfortunately, several providers won’t accept some Medicaid because of slow payment. This limits where consumers can receive care. Which then allows many consumers to receive poor quality health care. Cutting costs associated with Medicaid health insurance impacts the consumer in a way where the consumer has limited resources and access to care. A lack of access to care, in the end can cost the consumer and the insurance companies more money.

    Those in need of prescription drugs are limited because some drugs are not eligible under Medicaid or Medicare. Many times, only the generic option of the drug is available which may not have the same impact on their health as the brand name. This decrease in spending, greatly impacts consumers. The cost of some prescription drugs are extraordinarily high which means that many consumers will not have access to these drugs to improve their health. These policies that sound good to the government, isn’t helping the people it was made to assist.


    Aron-Dine, A. (2017). Center on Budget And Policy Priorities. Health Care: Issues Impacting Cost and Coverage. Retrieved from https://www.cbpp.org/health/health-care-issues-impacting-cost-and-coverage

    Acosta, A., Axar, A. & Mnuchin, S. (2018). HHS.gov. Reforming America’s Healthcare System Through Choice and Competition. Retrieved from https://www.hhs.gov/about/news/2018...re-system-through-choice-and-competition.html