Health Insurance Managed Care

The Overlooked Reason Our Health Care System Crushes Patients

That is the title from a recent N.Y. Times article. Here is an excerpt:

There’s a general sense that all that unpaid labor required to get medical care is increasing. This is in part because as health costs spiral upward, health plans have tried to find incentives to steer treatment to reduce costs. These incentives can be a crucial part of managing costs in a country that spends about twice as much on health care, as a percent of its economy, as other high-income countries.
Sometimes administrative burden is a result of a good-faith effort to assist patients. For instance, a well-meaning rule by medical leadership to try to best utilize clinic resources can add delays for some patients. Sometimes a pharmacy wants to help a patient avoid a large bill, but doing so requires a long back-and-forth with clinic staff and the insurance company.
At the same time, creating administrative burden is a time-honored tactic for insurance companies. “When you’re trying to incentivize things, and you don’t want to push up the dollar cost, you can push up the time cost,” said Andrew Friedson, the director of health economics at the Milken Institute.

The author, Chavi Karkowsky, provides an example where a patient was denied full coverage for a $12 medication, but then paid thousands of dollars for an emergency department visit which could have been prevented with that very same $12 medication.

You can read the full article here.