Health insurance is designed to ease the burden of people's
medical bills. However, due to its complexity, it can sometimes seem more of a
burden than an asset. Many people are left without care for various reasons,
including the development of political procedures. We will see how the
structure of the plans affects access to care and costs.
High prices
It is often difficult for the average person to understand the health care cost-sharing policy. Cost estimation is a complex process. Research
shows that uncertainty in payments depends on four design features:
The type of fees, including copays, coinsurance, or
deductible.
Payment speed.
Annual cost-sharing limits.
When is the expiration date (point of care, billing after
treatment)
Many of them don't get a proper explanation for the person,
and when the bills start to pile up, they can't figure out why. Even if people
have a good plan that offers a wide range of coverage, they are less likely to
use it.
This is because they do not understand what the insurer is
covering and what shortfall they need to cover.
Policy options when developing cost-sharing programs
The four design features are used in various combinations
for most health insurance programs. For example, in the United States, copayment is often used to pay for prescription drugs. It is combined with
different tiers to encourage people to use generic or cheaper alternatives.
Annual out-of-pocket expenses are limited per person or
family. Specific medical services, such as maternity care, are exempt from cost-sharing. Current packages are designed in the context of service charges. In
other words, providers are paid for the services they provide.
This is shifting from a volume-based approach to more
value-based care delivery. One example is that batch payments allow you to pay
for a full cycle of treatment administered by multiple healthcare
professionals.
Coverage is calculated as a total price per treatment group.
Insurance companies may offer packages that encourage the use of holistic
therapies rather than focusing solely on treatment.
Lack of health knowledge
Doctors themselves are often unsure whether the policy
applies to a particular procedure. Doctors cannot tell patients which
combination of treatments their insurance covers.
This is mainly because they differ by health insurance plan
and some groups may be exempt from these payments. Lack of clear information
can lead people to refuse treatment because they fear it will cost them a lot
of money.
However, the are other alternatives that you can consider
that are included in the insurance plan package. This knowledge is "health
literacy." It is the ability to process and understand the information
necessary to make good health decisions.
Policy design improvements
With so much information from individuals on current
policies, it is clear that the most important factor is cost transparency. People
want to know exactly how much they will have to pay a provider if they need
treatment.
This clarity needs to be on both sides and clinicians need
to know how the policy applies to different treatments. Staff must understand
the factors that affect copayments, coinsurance, and deductibles.
They must inform the patient so that she can make an
informed decision. Therefore, a person can choose carefully whether he wishes
to continue providing necessary medical care.
