Price Discrimination in Health Care

H. (04/2015). Comprehensive Health Insurance: Billing, Coding & Reimbursement, VitalSource for Allen School of Health Sciences, 1st Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323131503/

Melnick, G., & Fonkycj, K. (2013). Fair pricing law prompts most California hospitals to adopt policies to protect uninsured patients from high charges. Health Affairs, 32(6), 1101-1108. Retrieved from http://ezproxy.nu.edu/login?url=http://search.proquest.com/docview/1372932073?accountid=2532

In the current U.S. system the free market prevails and companies, in this case, major insurance providers “compete” for business. This competitive business approach should in theory drive costs down. For some reason, however, an argument can be made that it has produced the opposite result in profiteering. The nation’s largest insurer, UnitedHealth, boasted over a 10 percent revenue increase in 2013 according to Forbes (2013). Health insurance affordability contributes to the disparity in access to health care, as evidenced by the fact that there are millions that are still uncovered. A greater majority of certain minorities lack both health insurance and the financial resource to seek out either health care or insurance. While insurance companies reap huge profits the percent of private sector companies offering health insurance has dropped to less than 50 percent (Kaiser, 2013). There is decidedly a lack of coordination of care for this at risk population as well, since treatment is rendered sporadically and with continuously changing providers. The last major challenge is that of improving the quality of health care. According to a 2010 report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG), an estimated 13.5 percent of Medicare beneficiaries experienced adverse events during their hospital stay and an additional 13.5 percent experienced a temporary

Through the history of health care, the standard of care changed from protecting our patient from injury and illness to a systemic entity to make money for insurance companies. Access to services and clinical outcomes are dependent on what health insurance providers will “pay” for in a clinical or community setting; as a result, patient safety, care and satisfaction has been negatively impacted.

Additionally, scarcity affects how people view health care in a general sense. Many critics of the Affordable Care Act maintain that it creates a new increase in overall healthcare expenditures (Barr, 2011). Yet while addressing this issue of access, it also raised new questions about costs in the short term (Barr, 2011). It is very difficult to convince consumers that a rise in price in the short term will be beneficial in the long term. The ACA tampered with the set health ‘square’ by increasing access for all Americans. It

The hospitals inpatient visits vary from the routine to the most complicated IPPS, and it analyzes the historical costs of providing inpatient services for a diagnosis. Additionally, it sets the payment amount to treat the diagnosis in patients at different profiles like age, sex or complications. For instance, in 1983, Medicare applied historical information to introduce inpatient prospective payment systems with a basis on DRGs (Reimbursement Methodologies, 2016). When an inpatient facility submits a claim to a third-party payer under PPS, the application enters a diagnosis related group which determines the amount receivable by a hospital. Also, hospitals submit healthcare bills for each Medicare patient to Medicare Administrative Contractors (MAC), a private insurance company working in collaboration with Medicare to offer the programs’ operational functions. Therefore, MAC administers the funds while replacing previous fiscal intermediaries and Medicare

When referring to health care economics, “cost” refers to the funds that are used to deliver health care to patients. Cost can also mean the amount of funds used to access health care or to deliver health care (Getzen, 2007). It is applied in many different ways such as, health care professionals applying economic principles like cost benefit analysis, or cost effect analysis to determine if the choice is good or bad. The principles help the government to provide the best intervention in health care (Getzen, 2007).

Currently it is often difficult to make informed decisions about their care because of the opaque nature of health care pricing. Houk and Cleverly (2014) contend that pricing transparency could give health care providers a chance to garner increases in patient census; even if they do not have the least expensive price for a specific procedure, by allow health care providers the qualify why their services cost what they do. The demand for price transparency should be embraced in the future because it could create a forum that allow actual competition for patients and allow health care providers a chance to differentiate

There are so many different health care providers and types of health care services that we as consumers can receive. All those different services or facilities are going to have competitive prices for our medical care. I think a patient as a consumers are going to benefit from this. Not only do medical facilities have competitive prices but also insurance

Besides, the financial incentives for hospitals and physicians that belong to ACOs, Jaffery & Golden 2013, asked and then answered the question “why would providers join this program? One reason is to prepare for the future”. Fee-for-service reimbursement, which has been how hospitals get paid for their services rely solely on the volume of patient seen without taking into consideration the quality of care provided. Payers today, such as government, commercial insurers, employers, and individual consumers are now requesting on value -based-payment, which consist of delivering the highest level of care at a lower cost. The volume based system even though the traditional way of how payments are made is not a viable long-term option (Jaffery and Golden, 2013, p.98).

Maintenance of the charge master is best accomplished by representatives from health information management, clinical services, finance, the business office or patient financial services, compliance, and information system. An inaccurate chargemaster adversely affects the facility reimbursement, compliance, and data quality; negative effects of inaccurate chargemaster include overpayment, underpayment, undercharge for delivery of healthcare services, claims rejections, and fines or penalties. The chargemaster automatically bills for numerous services for high volumes of patients without human intervention. Therefore, a single error on the chargemaster could result in multiple errors before it is identified and corrected, which results in a severe financial impact (Sayles, 2013, p.

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

The health care debate has been a tricky one over the years with legislators ongoing decision on whether rules should be put in place that would even out the playing field between regular folk and health insurance companies. Obtaining affordable health care has been difficult for many and has raised some eyebrows about how these health care companies continue to make billions of dollars a year while people’s health continue to suffer. In 2010, a health care reform, the Affordable Care Act or “Obamacare”, was signed into law which eliminated those obstacles and limitations set forth by the healthcare industry.

I deal with price discrimination everyday with the profession that I work in. Health Insurance. When you are selling Medicare plans for the government, unfortunately, you have to deal with price discrimination. For the supplements plans that I sell, if you are under age 65 you pay triple the price. If you are over the age of 65 you pay double the price for health insurance. Medicare is designed for individuals who are age 65 and over. However, individuals who are on disability and who are under age 65 can receive Medicare as well.

Besides, studies delving into the economics of the medical marketplace consistently find that a moderately higher or lower price doesn't change consumer purchasing decisions much, if at all, because in health care there is little of the price sensitivity found in conventional marketplaces, even on the rare occasion that patients know the cost in advance. Most hospital administrators defend such chargemaster rates at all, they maintain that they are just starting points for a negotiation. But patients don't typically know they are in a negotiation when they enter the hospital, nor do hospitals let them know that.