Cost Shifting Exists Of United States Multi Payer Healthcare

In 2008, upon the commencement of The Affordable Care Act, the idea was to help millions of uninsured Americans gain health insurance, especially those who are at or just above the federal poverty level. Although the idea behind a universal health care system was great at the time, many citizens are struggling to find a doctor that will accept the subsidized health care insurance, such as Medicaid, and Passport. Furthermore, doctors choose to opt-out of accepting government based health insurance because the reimbursement rates are too low. “It is estimated that private plans pay $1.00 for a service, Medicare pays $0.80, and the ACA exchange plans are paying about $0.60.” (Harvey 1) That shows that the government based subsidized programs are significantly lower than the average market value. A

In the past several years, there have been several changes in economic policy at federal and state levels. The two economic policies that present to be the most precedent for healthcare leaders with concern to facility reimbursement are the Affordable Care Act (ACA) and the switch from volume to value reimbursement. First, there is the ACA policy, which have affected healthcare facilities and their reimbursement methods. In fact, ever since this policy was implemented, provider reimbursement has started to decrease in terms of fee-for-service payments (The Common-Wealth Fund, 2015). In other words, the intention of this policy was to provide budget relief to the government payers as well as giving providers an incentive to provider patients with great quality of care.

As discussed previously, the Affordable Care Act of 2010 passed by the legislature, drastically changed the entire healthcare economy. In fact, ever since the ACA was passed it was required by law for hospitals to increase the amount of attention given to the individuals of the community in order to meet their needs. Also, the ACA allowed close to 10 million individuals to have health insurance through Medicaid and private health insurances, which has a high impact on all the hospitals, such as Yale New Haven. For example, since millions of Americans can now afford health insurance, there is a large influx of patients who can go to hospitals and actually afford the overall cost. The non-profit hospital of Yale New Haven is benefiting in two ways. First, they are achieving their mission by caring for the individuals of their community who now have insurance and secondly, they are being compensated in terms of revenue to improve their organization in regards to hiring the greatest physicians and having the best technology and supplies to treat their large influx of patients (Cunningham, 2015). The rise in health insurances increases the total amount of money earned by that non-profit organization and the amount of patients receiving great quality of care.

Carol Liebau discusses in her article, “ObamaCare Limits Patient Choice”, that hospitals such as Cedars-Sinai and the Mayo Clinic are high-priced and under competitive pressure because of Obamacare. Insurance corporations are in a larger hurry than ever to cut costs (Liebau). However, Americans are coming to realize that those hospitals aren't just thoughtless profit centers. They are pricey because they provide advanced medical care or they offer the specialized treatments that the most ill patients require. Many Americans who had plans they could afford and had access to leading healthcare providers, find that under ObamaCare, they are being excluded from high-quality care unless they want to pay much more for

The increase of expenses - As politicians continue their dissension amongst each other, the situation is worsening in our healthcare system. According to the World Health Organization, to achieve universal health coverage, countries need a financial system that enables people access to all types of health services without incurring financial hardship (Carrin, Mathauer, Xu, & Evans, 2011). This idea would be the foundation of innovative ideas that the U.S. could reform its healthcare system, but too many ideas are sabotaging any valid efforts. In the mean time, the U.S. healthcare system continues to deal with issues such as the increasing uninsured Americans (over 49 million), expensive administrative procedures and the inability to measure the accuracy of quality of care, access of care, and the increasing healthcare spending and financing that limit our ability to efficient utilize resources.

The healthcare system in the United States is a system composed of many private insurance companies who act independently from one another. These companies make their money through premiums which are paid by the insured; therefore a major part of the healthcare system is privately funded. This type of market is considered to be an imperfect market because it does not meet the true requirements of a free market where there is unrestrained competition between providers. In our healthcare system there is an absence of a central agency to govern healthcare. There are multiple payers and third party insurers serving as intermediaries between financing and the delivery of healthcare. The United States has a multi-payer, heavily private system in which thousands of private insurance companies are responsible for paying some claims, while federal and state

A major contributor to the rise of healthcare cost is that heath spending for individuals is primarily funded by third-parties. Because consumers of healthcare share little of the financial burden of the cost of the care they receive, patients and physicians are incentivized to utilize healthcare at a higher rate than they would if cost was a larger factor. The United States healthcare systems is based on a capitalist system but it operates in an imperfect marketplace that is no competitive. The current marketplace is not highly regulated as there is not a national health care program for all Americans which allow prices to be regulated and controlled effectively by a single regulating body. In this imperfect

One of this health care’s programs objective is to limit the number of uninsured (Shi & Singh, 2015). This controversial healthcare plan incorporates a privately funded insurance which is paid for through employment and solely by the patient and a publicly funded insurance by the government. Medicare is provided for senior citizens 65 and older, and Medicaid is provided for low income citizens. The federal government and state government both partake in the funding of Medicaid. Although insurance is provided to the low income through Medicaid, the United States continues to suffer from cost escalation spending 17.1 percent of GDP on healthcare in 2013, a 50 percent more than the second nation (Commonwealth, n.d.) The high cost and limited coverage continues to spark up the conversation for a

The first concern that is affected by cost shifting lies in the Medicare system. Medicare is provided to individuals who are 65 and older to obtain adequate healthcare, as well as decreasing financial worries. The government’s involvement in controlling the healthcare system can be a major disadvantage to the Medicare system, as well as private insurances. Reimbursement from private insurances and Medicare can be affected so severely that obtaining access to Medicare can become a major issue. Furthermore, the repercussion is illustrated by Dr. Lichter’s statement, “Either something happens or the healthcare system is threatened.” Without cost containment, there will be major shifts of costs to private payers and Medicare beneficiaries” (Hayes, 2008).

In the United States, health care has become a huge expense and has threatened the economy; additional measures need to be taken to address the rising cost of care. An individual spends an estimated eight thousand dollars a year in health care expenditures. Therefore, we need to recognize that how a physician reimbursement for payment has a vast impact on the economy and the rising cost of health care.

Health care costs have been a contributor of America’s long-term fiscal imbalance. In 2015, total health care expenditures accounted for 17.8% of the U.S. economy (Center for Medicare & Medicaid Services, [CMS], n.d.). And of that 17.8%, 50% accounted for government spending. This conflicts with our notion of a predominantly private financing system of health care in the United States (Himmelstein & Woolhandler, 2016; Kolata, 2012). Moreover, two often overlooked tax-funded health expenditures—tax subsidies to health care (10.1% of total spending) and government payments for public employee’s private health insurance coverage (6.4% of total spending)—together, put the U.S. in first place for health care taxes. Yet, many patients are

Blue Cross, the only remaining non-profit insurance agency within the private sector, was unable to compete, forcing their surrender to the for-profit industry in the mid 1990’s (Rosenthal 18). This significant change within the health insurance industry marked the beginning of a war between consumers, insurance agencies, doctors, pharmaceutical companies, and politicians that would last decades. Many American citizens would find themselves either uninsured or with skyrocketing premiums and copays, resulting in horrific debt whether they had coverage or not. So, while the American public struggled, quite literally, to survive, private insurers were making billions off their most vulnerable clients. Now, many wonder what happened to the original vision; that which had been exemplified by Blue Cross not long ago. When did it become acceptable for companies to profit off of the sick and injured? When did it become acceptable for insurers to turn their backs on those who need it the most? Over the course of her book, Rosenthal argues that in staying quiet, the federal government and the American people have enabled the monopolization of the healthcare industry (although the recent decision made by the U.S. senate not to repeal and replace the Affordable Care Act, as well as the ACA in itself, was a positive development). It has become increasingly evident that a system in which private-sector insurance agencies exist cannot be

The real problem as pertains to the reimbursement of managed care organizations is that these managed care has had an effect on slowing the rates of growth concerning the costs of hospitals and specialist physicians. For both the hospitals and practitioners, the sources of revenue have been shifted with over 20 percent of the charges being paid from the pocket, others coming from third parties who demand for complex accounting of the charges, lack a pre-authorization process and they can review in a retrospective manner and deny the reimbursement (Furrow et al., 2013). The

As stated above, 11.4% of the population is still uninsured or under-insured. Of these patients, 40% have outstanding medical bills that will most likely go unpaid to the providers (3). This equated to $74.9 billion in 2013 of total uncompensated care across hospital systems and community providers (4). Not surprisingly, hospitals took the brunt of this cost at 60%, equaling $45 billion in uncompensated care. This raises the question of whether providers or other organizations can supplement the already subsidized monthly premiums. In theory, this model would be a win-win for the patient and provider, such that the patient stays covered and the provider is reimbursed for their

Increases in health care spending are not necessarily due to Americans visiting hospitals or physicians more frequently than residents in other countries. Higher health care prices in the United States can be attributed to the increased use of medical technology compared to other countries, the privatization of the healthcare industry, as well as a higher use and cost of pharmaceuticals