Health Insurance Blessing or Curse on NPBusiness.org

Health Insurance: Blessing or Curse?

The cost of health insurance is steadily increasing, yet we’re not getting our money’s worth! This seems to be true for consumers and providers alike.

Consumers are paying more for insurance premiums, deductibles, co-insurance, and co-pays. Meanwhile, providers have to contend with shrinking reimbursement levels for services rendered.

Any way you look at it… it doesn’t add up.

According to “Health at a Glance 2017,” published by the OECD (Organization for Economic Co-operation and Development), the United States spends more on healthcare than any other county.

Unfortunately, spending more doesn’t guarantee higher reimbursements to providers or better outcomes for patients.

The following figures are quoted from “Health at a Glance 2017:”

  • Health spending was 9% of GDP on average in the OECD, ranging from 4.3% in Turkey to 17.2% in the US.
  • The US spent almost $10,000 per person for each resident, almost two-and-a-half times the average $4,000 of the 35 OECD countries.
  • 54% of adults in OECD countries today are overweight, including 19% who are obese. Obesity rates are higher than 30% in Hungary, Mexico, New Zealand and the United States.
  • Gains in live expectancy in the US have been modest compared to most other OECD countries. In 1970, US life expectancy was one year above the OECD average. Today, it’s almost two years below the average.

In all fairness, the United States doesn’t rank poorly across the board. But all in all, there is much room for improvement!

You have to ask yourself: “What’s going on here? How is it possible to spend so much on healthcare, without achieving better outcomes?

Is it that Americans use health care services more frequently than other countries? No, that doesn’t seem to be the case.

Based on data published in Health Affairs by Princeton University, Americans utilize healthcare services similar to citizens of comparable countries.

However, the US is spending more on healthcare because it costs so much more to purchase healthcare in the US than anywhere else.

The reasons for the high price of healthcare in the US are complex. There are some that stand out more than others, including:

  • The US utilizes more technology
  • The US uses more prescription drugs
  • The US pays higher prices for prescription drugs
  • The US utilizes a fee-for-service payment system
  • The US health insurance market is complex and expensive to administer

It’s this last point I want to talk about more.

Health Insurance Is Complex

You know firsthand, both as a consumer and provider, how complex the American health insurance system really is.

There is nothing simple, straightforward, or efficient about the American health insurance system. There are too many insurance companies and too many insurance plans, and that’s expensive.

There are too much duplication and too much paperwork. The rules are different depending on the insurance company and the plan; that is until they change!

Who can keep track of it all? Who benefits from it all? We already know medical outcomes aren’t better because of it.

More complexity translates into higher expenses for employers, consumers, and healthcare providers. You know all too well how much it costs to accept insurance in your practice; not to mention all the headaches that come with it.

And just listen to this…

According to a 2015 article published on KevinMD.com, the US wastes more than $375 billion each year in excess paperwork to pay medical bills. Yes, that’s billion, with a B!

So let me get back to my original question.

Is health insurance a blessing or a curse? What do you think? Leave me a comment below and let me know your opinion.

For the time being, let me share with you what I think.

Health Insurance Advantages

In my view, health insurance is a blessing. It even saves lives, by providing access to healthcare far too expensive without coverage.

Most people either carry insurance through their employer, are privately insured, or are insured through government programs. And if it wouldn’t be for these programs, a good number of people would not be able to access care beyond basic healthcare services.

Working with insurance companies benefits providers too. Insurance companies do the bulk of your marketing for you.

Once you’re part of an insurance panel, you can expect a constant flow of patients coming through your doors. Needless to say, this comes with a hefty price tag!

At its core, health insurance is a great idea. Under ideal circumstances, it would provide quality coverage to its participants.

The coverage would cost far less than they could purchase on their own. And that’s how it works in many countries, but unfortunately not the US.

Health Insurance Disadvantages

Of course, health insurance can be a curse. This is particularly true when the system is outdated and slowly falling apart.

  • People may be denied coverage for a variety of reasons
  • Certain conditions may be excluded from treatment
  • Costs are going through the roof
  • Providers may not get reimbursed because of a technicality
  • Providers routinely have to wade through piles of paperwork
  • Providers have to live with reduced reimbursements

The US healthcare system is ripe for an overhaul. Just like other countries, we need a system that provides care at affordable levels, without a crushing mountain of paperwork.

In the meantime, how can you as a provider continue to accept insurance without losing your mind and more money?

Of course, you could decide to leave insurance behind and go to a cash practice. However, many providers don’t want to do this.

So if you’ll continue to accept insurance in your practice, there are things you can do to make the process a bit easier. Some of them are:

  • Understand that once you sign a contract with an insurance company, they are in charge. You are playing in their sandbox, and it’s up to you to know the rules.
  • You must understand all conditions of your contract. You must follow them and stay up-to-date with any changes.
  • You must be pro-active and know what will and will not be reimbursed. You don’t want to provide services just to find out they’re covered only when, for example, pre-approved.
  • You may want to limit the number of insurance companies you work with. But this makes sense only if you know which company is easy to work with, reimburses on time, and reimburses the correct amount.
  • Train your patients to pay all patient responsibility in full. Not only did you agree to collect from patients in your insurance contract, but patient responsibility is also a substantial part of your bottom line.

Both providers and consumers want the same thing.

We want to give and receive good healthcare. Consumers want to pay a fair and reasonable rate; providers want to be reimbursed in a fair and equitable manner. It’s that simple!

How do you feel about our healthcare system? Let us know by sharing your thoughts below.

 

By Johanna Hofmann, MBA, LAc; regular contributor to the NPBusiness blog.

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