Health Outcomes and Insurance
This week our CEO posted her thoughts on LinkedIn regarding some recent studies and the current state of health insurance for the individual and the outcomes of care.
Health Outcomes: How are We Doing?
We spend more but achieve less. “Wasteful administrative spending is estimated to comprise 7.5% to 15% of the nation’s total healthcare spending, translating to anywhere from $285B to $570B in 2019.” I think it is a lot more. Our country’s administrative spend is multiple times as much as other comparable countries and yet the health outcomes are not better. More spend for less results – This is a problem that we need to fix together.
Patients Insured: The Numbers
Nearly 299M Americans had health insurance last year, which is the most ever, while the number of Americans without health insurance was just over 28M (a decline in 1.4 million people from 2019). Since the Pandemic started, Congress has prevented states from disenrolling anyone from Medicaid and has increased subsidies to help pay for individual health plans bought on the Affordable Care Act (ACA) markets. However, this increased insured number has not led to sufficient financial protection and thus, necessary medical care. As we know it, ACA requires insurance plans to provide specific benefits, but the copays and deductibles that patients must pay do not go away. Therefore it is great that more people have insurance but are they sacrificing their financial security to obtain it?
Read: Many Patients Can’t Afford Health Costs Even With Insurance
Treatment
Meanwhile, the Urban Institute issued a report with stunning findings: “9.6% of uninsured adults and 7.4% of publicly insured adults reported experiencing unfair treatment because of their coverage type, more than five times as likely as the 1.3% of privately insured adults who reported such treatment.” (Uninsured more likely to face unfair treatment in medical setting: report – TheHill.com).
In related news, the frequent misapplications of the process and policies around prior authorization for Medicare have resulted in serious harm to patients and unnecessary care delays as outlined by a new study published in the Journal of the American Medical Association (JAMA) analyzes the benefits and harms of prior authorization (PA) policies for Medicare and the impact these policies have on patients and clinicians.
All is Not Lost
Finally! Younger people & health insurance. This could change fraud waste and abuse most dramatically. Supply and demand. When the 20-somethings evaluate insurance differently than the previous generations, we are going to see a shift in the market. This generation’s progressive values – from entrepreneurship to flexible work and becoming contractors rather than taking a job for benefits (health insurance) – has not been seen before and it is exciting to think about what that will do to the market.
Read: For 20-Somethings, a Confusing Rite of Passage: Finding Health Insurance
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