Do you think principles such as demand or competition should dictate pricing, or should insurance companies or government agencies set pricing for physicians?? Speak in first personR

Ashley Discussion:

The following are the benefits and drawbacks of insurance for patients, providers (physicians), and insurance companies:

Patients

Benefit: Insurance allows patients to pay for healthcare services which they might not be able to afford otherwise.  It offers financial protection from unforeseen high medical expenses and encourages preventive care to help avoid future illnesses (3 Reasons to Enroll in 2019 Marketplace Coverage, 2018).

Drawback: Some patients might find it difficult to afford healthcare services due to insurance limitations such as copayments, deductibles, and out-of-pocket costs (Bean, 2023).  

Benefit: Insurance ensures that healthcare providers receive reimbursement for the quality of services they deliver (Wilcox-Lee, 023).  It also helps to minimize financial barriers to patient care, improving their ability to access healthcare services.

Drawback: Insurance companies must abide by laws and regulations as well as requirements for coverage, financial stability, and transparency.  They also incur financial losses if they underestimate the cost of providing coverage.

According to demand theory, each stakeholder's relationship with the insurance industry is determined by their perception of the value of insurance.  Insurance is more likely to be demanded by patients and providers if they believe that it is more valuable than it costs, and it is more likely to be provided by insurance companies if doing so will allow them to make a profit.

Insurance can impact the quality of care provided by physicians in several ways.  Individuals who have health insurance are more inclined to seek medical attention when necessary, increasing the number of patient visits for healthcare professionals.  Insurance companies might also encourage healthcare providers to provide additional services by offering incentives.  

References

3 Reasons to Enroll in 2019 Marketplace Coverage.  (2018).  U.S. Centers for Medicare & Medicaid Service.  

           https://www.healthcare.gov/blog/reasons-to-enroll-2019-health-insurance/

Bean, C. (2023).  What are Health Insurance Lifetime and Annual Limits?  eHealth.

           https://www.ehealthinsurance.com/resources/affordable-care-act/lifetime-and-annual-limits

Wilcox-Lee, C.  (2023).  Value-Based Reimbursement: An Overview.  Health Recovery Solutions.

           https://www.healthrecoverysolutions.com/blog/value-based-reimbursement-an-overview

Kalopu Discussion:

Hello Everyone 😊

Patients

               Benefits: Healthcare insurance coverage helps the patients and population by reducing medical costs for interventions, making health care more affordable and more accessible. “Having health insurance also facilitates access to care, resulting in lower death rates and better health care outcomes. On a basic level, health insurance can mean the difference between sickness and health or even life and death” (Arvantes, 2023).

               Drawbacks: Although health insurance helps with reducing the cost of health care, the patients first must purchase the insurance policies which would be a financial burden itself. Medical insurance could cost hundreds of dollars a month, with family plans being much higher. Even if the patient can afford the policy, many policies come with a deductible that the patient must first pay out of pocket for before the insurance starts to pick up their portion of the medical claims (Protective, n.d.).

Providers

               Benefits: Physicians benefit from insurance companies as they are reimbursed for the interventions, they provide to the patients at an agree amount between the insurance company and the physician or organization.

               Drawbacks: Insurance companies will not pay for non-covered services that were performed or may deny the medical claim due to being not medically necessary. Another concern would be having to wait to do medical procedures or testing until the insurance company has approved the service or prior authorization for the intervention which may impede the care being provided.

Insurance companies

               Benefits: Insurance companies generate revenue by selling healthcare policies and collecting monthly premiums. The main way that an insurance company makes a profit is by ensuring the premiums received are greater than any claims made against the policy” (Mehta, 2022).

               Drawbacks: Attracting consumers to purchase insurance would be one concern for insurance companies. “In 2021, 27.5 million nonelderly individuals were uninsured, a decrease of nearly 1.5 million from 2019” (Tolbert et al., 2023).

The demand theory relates to the patients as they are the consumers in need of medical interventions and insurance allows them to obtain these medically necessary treatments without putting them in a financial situation they would be in if they were without insurance. With physicians, they rely on the insurance companies for reimbursement for medical claims submitted after medical intervention is completed. Insurance companies rely on insurance as this is there source of revenue.

Insurance should not have a bearing on the quality of care provided to the patients, but in many cases does. If a patient is without insurance and is needing medical treatment, it could cause the patient to deny specific treatments or studies that may better aid the physicians in providing care due to the financial burden these tests come with.  Even if insurance is obtained, there is the matter of getting approval for services, paying your deductible before the insurance would start paying their portion, copay amounts, and denial of claims. These are all issue that may affect the quality of care for patients.

References:

Arvantes, J. (2023, July 26).  Health insurance really is important, and here’s why. ValuePenguin. https://www.valuepenguin.com/why-health-insurance-is-important#:~:text=Health%20insurance%20helps%20to%20reduce,and%20better%20health%20care%20outcomes.

Mehta, J. (2022, March 14).  How do insurance companies make money? – financial edge. Financial Edge. https://www.fe.training/free-resources/fig/how-do-insurance-companies-make-money/

Protective. (n.d.).  Advantages and disadvantages of health insurance. protective.com. https://www.protective.com/learn/advantages-and-disadvantages-of-health-insurance#:~:text=Disadvantages%20of%20private%20health%20insurance&text=Many%20individual%20policies%20can%20cost,before%20their%20coverage%20kicks%20in.

Tolbert, J., Drake, P., & Damico, A. (2023, May 12).  Key Facts about the Uninsured Population. KFF. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/

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