Payers and Consumers in Enhancing Access to Healthcare Services

• Your responses should include elements such as follow-up questions, a further exploration of topics from the initial post, or requests for further clarification or explanation on some points made by the classmates.
• APA 7th edition formatting and citation.
• (50-100 word each)

Peers #1

I do believe consumer driven Healthcare plans (CDHPs) are here to stay. “Many healthcare stakeholders see CDHPs as products that create mutual benefits for payer organizations and consumers, because they hold health plans and consumers responsible for efficient use of healthcare services and spending” (Beaton, 2017). Consumers have a choice of high deductibles coupled with tax-advantaged personal health spending accounts (HSAs) to increase consumer accountability for their own health care spending. There is an opportunity for health savings accounts, flexible spending arrangements, health reimbursement, opportunity for employers to offer healthcare benefits, arrangements, and medical savings accounts all bring tax benefits along with them. “Lower premiums, or monthly payments, are the major advantage of CDHPs over traditional benefit plans. According to an analysis from the Health Care Cost Institute, people with CDHPs spent $540 less per year on health care than those with traditional plans” (Athem.com, 2018). There are some disadvantages to CDHPs is that there is a lot of out-of-pocket costs required each year if you use the plan frequently (Smith, 2017). With this type of high deductible expense plan you will have to constantly watching your spending.I do believe thr plan for the future is to continue to allow the consumer to have as much controll as possible when it comes to their healthcare plan and making decisions of what plans will better suite them and their family.

Peers# 2

A consumer-driven health plan (CDHP) offers lower monthly premium rates in exchange for higher deductibles. They are often combined with tax-free health savings accounts (HSA) that allow users to pay for medical expenses with money saved, free from federal taxes. The higher deductibles usually lead to higher out of pocket expenses which makes health care more expensive. The effect is “to minimize both the use of and spending on unnecessary health services” (Frost & Kennedy, 2016).

In some ways these plans encourage individuals to be engaged and thoughtful in how they utilize health care. People are generally more selective when seeking out healthcare services if they are going to be responsible to pay a greater portion of the cost. But this may come at a cost. Agarwal et al. (2017) discovered that CDHPs are associated with lower-health care costs because of a reduction in the use of health care services. These include necessary services such as preventative care and routine office visits. They found that CDHPs were associated with decreased use of preventative care services, primary care visits, laboratory and diagnostic testing and a reduction in medication adherence (pp. 1765-1767).

CDHPs are a good option for people who are able to put the money saved on the low monthly premiums aside in an HSA. It’s like a personal “insurance” stash to use as medical needs and expenses arise. They also work for people who have the time and capacity to research, educate themselves and possibly negotiate their health care services. But, CDHPs are not a good option for individuals who do not save or who are high utilizers of health care. They could be stuck with enormous health care bills, or worse, be forced to not seek care when they need it because of the high out of pocket cost.

Peers# 3

The Patient Protection and Affordable Care Act (ACA) is a federal statute that contains a set of health care reforms passed by Congress and signed into law by President Barack Obama on March 23, 2010. The Affordable Healthcare Act reduces the health coverage and individual insurance for all the individuals who qualify. Thus, this law ensures healthcare insurance to the population who did not have access to healthcare insurance previously (Courtemanche et al., 2017).

ACA encouraged consolidation. It increased incentives to move patient care from inpatient to outpatient, motivating hospital systems to acquire physician practices to secure referrals for hospital-based services. There are few positives for consolidation:

• Increased care coordination
• Improved clinical integration and management
• Increased local access to acute care service

Consolidation has reduced competition which thereby leading to increased premium rates and healthcare charges. It has caused a decrease in the quality of care provided due to the lack of competition. Patient benefits are reduced after consolidation.

Even though Affordable Care promises all the citizens affordable or low-cost health care, lack of competition due to consolidation has instead caused inflation in healthcare service rates. To reverse this damage, policymakers need to unleash competition in the healthcare industry.

Peers# 4

According to Zhao et al. (2020), on March 23, 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law. ACA was created to improve health insurance coverage, quality of care, patient outcomes, and maintain or lower healthcare systems’ costs. After reading this statement posted by Christopher Pope, I believe many pros and cons derive from his message. These pros and cons can depend on one’s social status.

Pros/Cons

Christopher stated, “By mandating that general hospitals provide uncompensated care, state and federal legislators have given them cause to insist on regulations and discriminatory subsidies to protect them from cheaper competitors”.

I believe if one is coming from a low-income status, someone that will benefit from ACA. They could view ACA as a pro. They will typically see the government wanting to be on their side. ACA takes away barriers, allowing access to healthcare for those in need. Eliminating any discriminatory standards. Ultimately, this can be a con for those who do not qualify for ACA. Those who pay out of pocket for their insurance may feel like people are getting a “handout” while they have to work for access to healthcare.

In total, I believe there was nothing but pros that stemmed from the statement. ACA creates access to affordable healthcare for all. Eliminating the pre-existing conditions some get denied for, anyone being treated no matter insured or not, as well as getting rid of the “playing field”. Everyone gets to see the doctor. ACA creates the same level of playing field.