In typical bundled payment models, providers and payers share in savings and/or losses. When actual health care costs fall below the lump-sum payment, both parties keep a portion of the difference as additional profit. Conversely, the provider must provide extra services at a loss when health care costs exceed the lump-sum payment, though payers mitigate some of this loss. The potential for savings for payers lies in upfront discounted payments for episodes of care, as well
As far as the costs associated with health care, they may be concerned with the suggested payment system. Being a CCE, they are required to obtain reimbursement through a risk-adjusted, capitated basis. In addition, patients are allowed to choose health plans that best fit them and can change plans at any point. Furthermore, CCE must compete for patient based on their value and quality of service that they provide. In addition, the providers have various criteria that they must meet.
“Healthcare Reform 101,” written by Rick Panning (2014), is a wonderful article that describes, in an easy-to-understand language, the Patient Protection and Affordable Care Act, signed into law March 23, 2010. The main goal of the Patient Protection and Affordable Care Act was to provide affordable, quality healthcare to Americans while simultaneously reducing some of the country’s economic problems. Two areas will be covered throughout this paper. The first section will include a summary of the major points and highlights of Panning’s (2014) article, including an introduction to the ACA, goals of the signed legislation, provided coverage, and downfalls of the current healthcare system. The second part will be comprised of a professional
The affordable care act presented the United States with the most extensive overhaul since the passage of Medicare and Medicaid in the 1960’s. The act was a response to staggering statistics on the price of healthcare and the resulting uninsured rate within the United States. The affordable care act uses Individual Mandate and Health Insurance Exchanges to combat major factors causing high insurance cost and low insured rates. As with most reform, the public has not been one hundred percent unified on the potential effectiveness of the Affordable Care Act.
Although this is under Obamacare exchanges, it shows that state-run exchanges can effectively control the cost of premiums. A state that has efficiently and effectively controlled the health insurance markets is California. Through their state-run exchanges, California has managed to control the type and price of care provided by setting up a system that required all health insurers to provide the same deductibles and benefits within each of their coverage levels (Scheffler, Para. 7). Their plan is set up so that “insurers in all marketplaces must offer a defined set of “essential health benefits” in all plans and may offer plans at four coverage levels: platinum…followed in descending order of cost and coverage benefits by gold, silver, and bronze. ”(Scheffler, Para. 7)
In addition to the dismay of many healthcare professionals, patients, and citizens who are uninsured, several flaws about the current healthcare system show the necessity for reform. The three flaws that exacerbate the current healthcare crisis are: the tax code and tax breaks, the lack of preventable care and adequate care of chronic diseases, and administrative costs. A single payer, universal healthcare system can resolve the major flaws of the
Previously, medical costs were largely paid for by individual patients through out-of-pocket expenses or private insurance premiums. While the Affordable Care
Healthcare costs in the United States are constantly rising straining the budgets of families and employers. As a result of the rising healthcare costs, insurance premium rates have been also increased. The premiums rates are increasing more rapidly than income which is part of the reason why Americans aren’t able to have access to affordable health insurance. Although the Affordable Care Act has been passed, there are many people still uninsured. The purpose of the Affordable Care Act was to improve the quality of care, provide more Americans with access to affordable insurance, and minimize healthcare spending in the United States.
The United States is the only Western nation that does not authorize free health services to its people. The cost of healthcare to the uninsured is beyond prohibitive, and insurance plans are far more captivated with profit costs, rather
The United States no longer posses the ability to effectively drive down premium costs through the means of insuring healthy people. For example there is a town with ten houses, and, on average, one house a year burns down. If no one in the town pays for insurance they have a 10% chance of their house burning down each year. If everyone in the town pays insurance they spread the risk because no matter whose house burns down no one will have to pay anything as the insurance company will cover the cost of the house that burns down each year and make a slight profit. This is the same logic applied to the whole medical insurance market.
However, there are some out-of-pocket costs associated with Part A, such as a deductible and coinsurance. Part B: Medical Insurance
Explain how your changes will impact those middle income families who want and can afford premium coverage. The changes and recommendations proposed above are not being put in place to stop those middle income families who want and are able to afford premium coverage from getting the type of coverage they want or decide they need. The purpose of these recommendations and changes is really to bridge the gap for low income families in terms of purchasing and receiving health care. However, these initiatives will impact middle income families, even though they can afford premium insurance coverage, they might not be able to access their chosen doctors due to increased demands on doctors (Atlas, 2015).
You made a valid point high deductible plans do determine how individuals utilize healthcare services. A person who has financial difficulties will opt not to seek medical attention due to the cost. Would you choose not to get care if you had a high deductible plan? At times I prefer not to go the doctor because not only will I have to pay for the visit but also lab work and testing. Even after reaching my deductible I am still responsible for 20% of the cost until I reach the maximum out of pocket expense.
I agree with you that people’s state of health will determine utilization, individuals who are generally in good health will seek care less often than those who suffer from an illness. Smokers also have a higher premium than non-smoker due to the medical issues that can arise due to smoking and the cost to provide care to these individuals. Cost is a key factor that will impact utilization many people will opt not to seek medical attention even if they need treatment due to the high premiums and any potential out of pocket cost expenses. In regards to the monopolistic approach in a health care setting, it can be beneficial if the organization is the sole provider in the market that offers particular service. The organization not only has to
Health care cost has seen to increase gradually as years go by. This has been influenced by major factors such as political influence, emerging chronic diseases, new procedures that are coming up including the technologies being invented for treating illnesses, pricing of medicines and treatment is not regulated and when treating ailment their may arise repetition of tests or a patient gets over treated for a particular ailment. The cost of healthcare has increased due to chronic diseases such as cancer and diabetes etc. The lifestyle people are living in this generation has led to the development of diseases that are expensive to treat or has led to there being over treatment in such for a cure of a particular ailment.
