Premium Essay

Physician Affect the Cost of Health Care for Insurance

In:

Submitted By rmohanr
Words 270
Pages 2
Physicians affect the cost of healthcare for insurance thru the administrative costs and doctor’s malpractice liability insurance that will protect them from unwanted legal issues.
American Physician pays nearly $83000 per year, which is the major chunk of administrative cost. That's the cost of the time and labor it takes for physicians' employees to correspond with various insurance plans about claims, coverage and billing for patient care and prescription drugs. Researchers surveyed physicians in Ontario, who said health insurance paperwork costs them an average of $22,205 a year.
If American physicians had administrative costs that matched those of the Ontario doctors, physicians could save as much as $27.6 billion a year.
A major problem with American health care today is what policy experts call "perverse incentives." As shown in the figure above, hospital care and physician/clinical services combined account for half (51%) of the nation’s health expenditures. Doctors and hospitals bill insurers for every individual service — every office visit, MRI or hour of operating-room time — a "fee for service" model that drives health-care inflation by rewarding providers who order potentially unnecessary tests, perform potentially unnecessary surgeries and even make mistakes. A hospital readmission caused by avoidable complications just means more billable expenses.
Doctors are quick to say that much of the 30% of excess health-care spending is on "defensive medicine" — providing extra care in an effort to avoid malpractice liability.

Ref: http://www.time.com/time/nation/article/0,8599,1908477,00.html#ixzz1UmiHUYOb

Similar Documents

Premium Essay

Funding the Rising Cost of Us Healthcare

...Funding the Rising Cost of U.S. Health Care. BY Vilando. HSA500 November 15, 2015 Funding the Rising Cost of U.S. Health Care. The United States continues to spend significantly more on health care than any country in the world, however, even though with this statistics the U.S has a lot of uninsured and does not have the healthiest citizens. In this paper, opinions will be given on the rising cost of overall’s health care’s impact in the U.S economy, followed by a comparising and contrasting factors impacted by the new health care act, pros and cons of using the private insurance rather than using the new health care reforms and the cost associated with its implementation and access to different groups will also be discussed. Rising Cost of Health Care The cost of the U.S health care system is higher than any country in the world. Its efficiency is also under serious scrutiny. If it was not an emergency, most physicians would require insurance verification. Therefore patients will be delayed of treatment. Moreover, the health care system in the U.S should be redesigned in terms of prevention rather than treatment with people who are already sick. Insurance should not go higher for people that have pre-existing conditions or with more health risk. Also the emergence and new discoveries in the field of...

Words: 4666 - Pages: 19

Premium Essay

Where the Nation Should Add or Cut, Why

...Health Care Reform: Manage Care Team B HCS/440 April 16, 2012 John Gaze Introduction Managed care is an assorted agreement that is set up with health care providers and healthcare facilities that provide medical service for patients at a decrease cost. Managed care represent an important part, a manager will keep an eye on and direct the transaction among the physician and the patient. However it is difficult for manager care to keep the cost of medical service down. There have been discrepancies about manager care not allowing a patient to have a procedure done because of the cost. There have been statements made about manage care, stating that they care more about keeping cost down, than saving a patient’s life. The majority of patients are enrolled in some sort of health care plan where manage care service will be initiated. Description of Issues in Managed Care Managed care was designed to help reduce unnecessary health care costs. Because health care in America is a profit driven enterprise structured to favor the bottom lines of insurance companies, health care providers and insurance firms alike are severely impacted by fluctuations in the economy (How the economy affects health care providers, 2010). Most people get their health insurance through their employers, but with the unemployment rate steadily increasing, that results in numerous people without health care coverage. Many doctors are reporting a substantial increase in the numbers of people...

Words: 1414 - Pages: 6

Premium Essay

Reimbursement and Payment

...Pay-for-performance “Health care and health policy continue to be controversial domestic issues in the United States. Despite a slowing in the rate of growth of annual costs, most Americans feel that their budgets are strained by what they have to pay for health care, and most employers feel that their share of these costs for their employees is excessive. Currently, many Americans still do not have health care coverage” (Shader, 2013). In hopes of diminishing these cost, the United States Congress and President Obama passed a series of laws to help the American public receive the medical care that so needed. As part of these laws came pay-for-performance reimbursement systems. Even though this procedure for payment still has many details to be determined, this value-based payment system can be a response to quality care and performance. Pay-for-performance The newest trend in reimbursing medical providers is called pay-for-performance (P4P). This valued-based strategy allows a predetermined benchmark to be designated for medical care. If the provider meets or exceeds the standard he or she is paid bonuses for such care. If the provider does not meet the standard payment is reduced accordingly or fines may be put into place. The main focus of this form of payment is to reduce excessive medical costs and to increase quality of care of the patient, especially in preventive and chronic care. As with any new program or idea, pros and cons exist. Benefits to using P4P are that insurance companies...

Words: 1751 - Pages: 8

Premium Essay

Could Healthcare Reform Improve Its Current Overburdened Healthcare System?

...a widespread and affordable health care to its citizens. Will health care reform be able to deliver quality services at affordable cost with its existing workforce crisis in the healthcare system? Number of uninsured Americans has significantly increased, mainly due to aging population and income change. The prevalent issue of America’s healthcare system is insurance coverage, access to healthcare. Americans believe this issue should be prioritized, and it is the direct responsibility of federal government to ensure medical care for those citizens that lack insurance. This essay include history of United States healthcare system, its evolution and how healthcare providers can contain costs of healthcare and provide quality and access to healthcare for everyone. From the beginning of 2014 Affordable Care Act by Obama government is trying to solve the enduring issue of American healthcare system. It is a step in the right direction but this reform is facing lots of resistance from Republican Party, that this reform will put country in debt stress. Many Americans are concerned with quality and access to healthcare with the influx in number of insured entering the healthcare system which is already facing the workforce crisis. United States Health care History Healthcare in United States is enduring issue and it is very sensitive subjects for Americans. United states from the beginning choose a market approach to medical care. Medical care is as a market commodity, that...

Words: 2652 - Pages: 11

Premium Essay

Health Care Utilization

...Health Care Utilization The Patient Protection and Affordable Care Act otherwise known as “Obamacare”, was signed into law in 2010. It was implemented to make health insurance more affordable to people and to increase access to a more affordable health care insurance. Although it works through the existing health care industry, it is still a political target from both ends of the political spectrum. The conservatives prefer to remain silent and not have any involvement into the health care system. The liberals that do agree with the health care reform do not like the “Obamacare” because the for-profit insurance company model stays the same instead of a single payer system administered through the government. Implementation of Obamacare “Obamacare” was rolled out to be spread over several stages rather than being rolled out at once. After the signing of the law, certain parts of the law was implemented. A couple of those changes implemented as part of the law are children remaining on their parents insurance until age 26 and people not being denied insurance coverage due to pre-existing health conditions. The expansion of access to health care was also written into the law. This mainly referred to the younger adults whose income was too low to be able to afford health insurance and for those people with chronic health issues in which pre-existing caused them to be denied new insurance plans. The individual and business mandates and the state insurance...

Words: 1362 - Pages: 6

Premium Essay

Business

...Protection and Affordable Care Act (PPACA) The purpose of the PPACA is to ensure more Americans have access to quality healthcare. According to the Congressional Budget Office (CBO), the PPACA is paid for and will provide quality healthcare to more than 94% of Americans. The PPACA will, or is supposed to, eliminate lifetime and unreasonable annual limits on healthcare benefits; prohibit health insurance policy recessions; extend dependent healthcare coverage up until the age of 26; provide assistance to uninsured due to pre-existing conditions; cap insurance administrative expenditures; require coverage for immunizations and preventative services; develop uniform coverage documents allowing consumers to juxtapose different insurance plans from different insurance providers; create temporary re-insurance programs to support coverage for early retirees; simplify healthcare administration as a means to lower health system costs; create an internet portal for consumers to identify insurance coverage options; and implement an appeals process to guarantee consumers and provide consumers assistance processing and accessing their insurance coverage ("PPACA Summary," n.d.) The PPACA does expand public programs, e.g. expanding the eligibility for Medicaid to lower income people; simplify Medicaid and enhance the Children’s Health Insurance Program; simplify enrollment; and expand resources to community based programs, just to name a few. The PPACA will affect every community in the United...

Words: 1140 - Pages: 5

Premium Essay

Affordable Care Act

...Affordable Care Act: Impact on Providers Quality vs. Quantity Abstract The Affordable Care Act’s proposal was to make sure that health insurance coverage is affordable for individuals, families, and businesses and decrease the amount of uninsured individuals. . Much of the impact of this act will begin when the major coverage provisions take effect in 2014. Providers will experience an increased burden in many aspects of their medical profession including new legal practicing liabilities, less autonomy, administrative encumbrances, shortages of primary care physicians, and political infringement (Horton, Hollier 2012). The provider is to maintain high quality of care while the ACA’s agenda is cost and quantity over quality. The Affordable Care Act is the largest piece of legislative reform in American history relating to health care. The impact to our economy on many levels of scale and our constitutional rights are all being questioned and debated without a definitive answer to long term reality of its implications. Reform is necessitous to the continuance of providing care, controlling fraudulent activities and waste, as well as, exploring new innovative ways to maintain a high level of quality services within the legalities of our legislative branch. The balance of these aspects have been challenging and perplexing in materializing the reforms into fruition. The concentration during reform has been on quantity of the insured population...

Words: 4064 - Pages: 17

Premium Essay

Health Insurance Matrix

...University of Phoenix Material Health Insurance Matrix As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences. Include APA citations for the content you provide. | |Origin: When was the |What kind of payment |Who pays for care? |What is the access |How does the model affect patients? |How does the model affect providers? | | |model first used? |system is used, such | |structure, such as |Include pros and cons. |Include pros and cons. | | | |as prospective, | |gatekeeper, open-access, | | | | | |retrospective, or | |and so forth? | | | ...

Words: 2220 - Pages: 9

Premium Essay

Health Care Matrix

...University of Phoenix Material Health Insurance Matrix As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences. Include APA citations for the content you provide. | |Origin: When was the |What kind of payment |Who pays for care? |What is the access |How does the model affect patients? |How does the model affect providers? | | |model first used? |system is used, such | |structure, such as |Include pros and cons. |Include pros and cons. | | | |as prospective, | |gatekeeper, open-access, | | | | | |retrospective, or | |and so forth? | | | ...

Words: 2172 - Pages: 9

Free Essay

Medical Malpractice

...believe limitations should be set on the amount of damages a plaintiff or injured party can be rewarded by the court. These advocates usually include medical professionals and insurance companies. Their argument is that too many frivolous lawsuits lead to high malpractice insurance, the increasing cost of medical care and a burden on the taxpayers whose tax dollars absorb the extravagant litigation costs for these claims. They believe doctors will eventually be unable to practice medicine due to costly malpractice insurance premiums which may leave many Americans unable to obtain much-needed healthcare. In the past, as the rate of malpractice suits began to grow, so did the rate of malpractice insurance. This ended up having a dire impact on the medical profession. For one thing, many qualified doctors ended up leaving their practices and focusing more on preventative medicine. In other words, they felt compelled to order up costly tests, many of which that were not necessary, in an attempt to stave off lawsuits claiming misdiagnoses. The impact on the medical industry as a whole, raises the cost of medicine and insurance premiums for everyone. However, according to Stephen Daniels, attorneys also pay for malpractice insurance and therefore understand the...

Words: 3268 - Pages: 14

Premium Essay

Stakeholder Dynamics

... MHA 601: Principles of Health Care Administration Prof. February 4, 2013 When you think of working people being uninsured, most will think that it must be a stressful and unfortunate situation for that person. However, it has an effect on everyone across the board, not just the uninsured. Employers, hospitals, and physicians are also affected by the uninsured working class. There is an impact, on some level, to cost, quality, and access for all involved. This case study’s issue based on the topic/content area/change, working people being uninsured not only has an impact on their personal lives but also on businesses and the health care industry. Financials issues begin to arise for the uninsured person and their family, as well as, productivity decreases for businesses when their employees are out sick or working while ill. If employers offered even a small amount of health coverage, or perhaps informed staff of outside options for health coverage, they have a greater chance of ensuring the productivity of their employees, avoiding lost work days and decreasing employees’ financial issues. Stakeholder groups in this case study are Hospitals, Physicians, Employers, Patient, Third-Party Payers (Insurers) and the Government. Impact on Cost, Impact on Quality, and Impact on Access affects each of these stakeholders. The uninsured patients have increased costs; they are expected to pay out-of-pocket...

Words: 1434 - Pages: 6

Premium Essay

Ip 5 Human Resource in Healthcare

...5 Liz Palomo AIU Online HLTH330 Abstract This paper will explain how the new Affordable Care Act came to existence in March 2010. In addition, key features of the law will be described and how these new changes affect employees and employers. Introduction The Affordable Care Act (ACA) as signed on March 23, 2010 by President Barack Obama with the purpose to provide complete health insurance that will; hold insurance companies’ accountable, decrease the cost of healthcare, guarantee more choices, coverage expansion, and enhance the quality of care for all Americans (ACA History, 2016). The affordable care Act is comprised of two separate pieces of legislation; Patient Protection and Affordable Care Act, the Health Care and Education Reconciliation Act of 2010 (ACA History, 2016). How ACA Came to Existence For the last 75 years democratic Presidents had attempted to create a nationwide insurance system but they were all unsuccessful. In 2009 was the first year of Obama’s presidency and the house of Democrats introduced a plan of 1,000-page plan with the intention to overhaul the healthcare system on July 14th causing a raged debate on the topic (ACA History, 2016). The senate prohibited individuals that were unlawfully present in the U.S. to benefit from the health reform. Although all republicans voted against it, the senate bill was amended and approved by the House on March 21, 2010 with...

Words: 1188 - Pages: 5

Premium Essay

Reimbursement

...Programs and the Movement of Finances in the United States Health Care System by Ronald J. Sanders MBA520, MBOL2, Health Care Organization Instructor: Dr. Sandra Washington Saint Leo University Distance Learning March 17, 2013 Abstract Effective payment program strategies are a major part of administering health care. Reimbursement programs are a part of the United States (U.S) health care system. They represent a financial tool for providing cash flow to service physicians and hospitals. Many times, the ability to provide quality health care depends on the payment for the services given by physicians and hospitals. This paper presents a view of payment reimbursement systems within the health care industry. A comparative overview and description of payment reimbursement will be given in order to understand the flow of finances in the health care industry. The focus will be on the capitation and fee-for-service reimbursement systems. Readers will then be able to conclude that the appropriate reimbursement method is dependent upon the amount of risk a party is able to assume. Comparison of Reimbursement Programs and the Movement of Finances in the United States Health Care System Physicians that are part of the managed care system have several methods in which to be compensated or be reimbursed for services. Two popular methods are Capitation and Fee-for-Service. Physicians have confronted several challenges in organizing and financing...

Words: 1558 - Pages: 7

Premium Essay

Access to Insurance Versus Access to Care

...Access to Insurance Versus Access to Care Access to Insurance Versus Access to Care and the Impact of the Affordable Care Act Tyanna Qualls Walden University Access to insurance differs from access to care because of cost. One example of my personal experience of insurance and access to care was when I had to assist my brother with his sickness battling sickle-cell anemia. My brother resided with me the last six months before he transitioned over so I witnessed firsthand the lack of quality care he received due to being underinsured. Medicaid was my brother’s only source of health insurance. His sickness prevented him from maintaining a full-time job. The full-time jobs he did hold did not offer him an affordable insurance plan due to his condition. One employer denied him coverage completely because it cost too much to insure a person who needs extensive long-term care. Pre-existing clauses prevented him from receiving necessary preventatives services. The pharmaceutical companies charged high copays for name brand medications that he needed. Medicaid drug formularies limited his access to many beneficial drugs. Lack of insurance coverage prevented him from having a primary care physician to see consistently so he frequented the ER departments at the community hospitals. Whenever he was admitted into the hospital, he had a certain amount of days they would keep him, a lot of medical services were not provided to him because of his level of benefits with Medicaid, and he was...

Words: 1091 - Pages: 5

Premium Essay

Health Care Utilization

...University of Phoenix Material Health Insurance Matrix As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences. Include APA citations for the content you provide. | |Origin: When was the |What kind of payment |Who pays for care? |What is the access |How does the model affect patients? |How does the model affect providers? | | |model first used? |system is used, such | |structure, such as |Include pros and cons. |Include pros and cons. | | | |as prospective, | |gatekeeper, open-access, | | | | | |retrospective, or | |and so forth? | | | ...

Words: 1061 - Pages: 5