Most health care insurers have a breakdown of services listed by their availability as either an in-network service or out-of-network service. Services are considered in-network if the provider of the service has an agreement with the health care insurer to charge a price for the service that is previous agreed upon by the provider and insurer. This way, the insurer can save money on the service and pass that saving down to the policy holder in the form of lower premiums. Out-of-network services are any health care services that the provider does not have an agreement with the insurer on the price. Usually, an insurer will only over the amount that they would pay to an in-network provider, leaving the rest to be covered by the policy holder.
Positive Effects Consolidation will have on Health Care Consumer Cost
Consolidation of health care organizations have impacted consumer cost by providing a wider range of services. Coupled with agreements to health care insurers, the health care organizations can provide more in-network options and overall, lower that amount of out-of-pocket expenses the policy holder must pay of health care.
Negative Effects Consolidation will have on Health Care Consumer Cost
Consolidation can have a negative effect on health care cost. As more health care organizations merge to form larger entities that have more bargaining power to negotiate more reimbursements and less cost burden for the policy holders from insurers, Smaller health care group struggle to match their rates with larger groups. As the smaller groups disappear, the larger groups come closer to a monopoly of the local health care market, creating an environment that without federal or state policies to keep the health care group in check, could dominate how health care is given and reimbursed.
As consolidation creates larger health care organizations, younger physicians are more likely to employ at these larger entities rather than begin solo practices or partner with smaller groups. The lack of smaller practices in the area gives the larger entities more control of the health care market and gives health care consumers less options to who or how they receive their health care treatments.
Smaller health care insurers struggle with the same when attempting to compete with larger insurers. Employers whose organizations stretches across many different states must have a health care insurer that can cover their employees in each one of these states. So, they turn to the insurer that can accommodate this need.
References
Ginsburg, P. (2017, February 03). Health care market consolidations: Impacts on costs, quality
and access. Retrieved January 28, 2019, from https://www.brookings.edu/testimonies/health
-care-market-consolidations-impacts-on-costs-quality-and-access/
Morse, S. (2018, February 20). America's Health Insurance plans to address the impact of federal
and state policies, market issues. Retrieved January 28, 2019, from
https://www.healthcarefinancenews.com/news/americas-health-insurance-plans-address
-impact-federal-and-state-policies-market-issues
The Impact of Hospital Consolidation on Medical Costs. (2018, July 11). Retrieved January 28,
2019, from https://www.ncci.com/Articles/Pages/II_Insights_QEB_Impact-of-Hospital
-Consolidation-on-Medical-Costs.aspx
Positive Effects Consolidation will have on Health Care Consumer Cost
Consolidation of health care organizations have impacted consumer cost by providing a wider range of services. Coupled with agreements to health care insurers, the health care organizations can provide more in-network options and overall, lower that amount of out-of-pocket expenses the policy holder must pay of health care.
Negative Effects Consolidation will have on Health Care Consumer Cost
Consolidation can have a negative effect on health care cost. As more health care organizations merge to form larger entities that have more bargaining power to negotiate more reimbursements and less cost burden for the policy holders from insurers, Smaller health care group struggle to match their rates with larger groups. As the smaller groups disappear, the larger groups come closer to a monopoly of the local health care market, creating an environment that without federal or state policies to keep the health care group in check, could dominate how health care is given and reimbursed.
As consolidation creates larger health care organizations, younger physicians are more likely to employ at these larger entities rather than begin solo practices or partner with smaller groups. The lack of smaller practices in the area gives the larger entities more control of the health care market and gives health care consumers less options to who or how they receive their health care treatments.
Smaller health care insurers struggle with the same when attempting to compete with larger insurers. Employers whose organizations stretches across many different states must have a health care insurer that can cover their employees in each one of these states. So, they turn to the insurer that can accommodate this need.
References
Ginsburg, P. (2017, February 03). Health care market consolidations: Impacts on costs, quality
and access. Retrieved January 28, 2019, from https://www.brookings.edu/testimonies/health
-care-market-consolidations-impacts-on-costs-quality-and-access/
Morse, S. (2018, February 20). America's Health Insurance plans to address the impact of federal
and state policies, market issues. Retrieved January 28, 2019, from
https://www.healthcarefinancenews.com/news/americas-health-insurance-plans-address
-impact-federal-and-state-policies-market-issues
The Impact of Hospital Consolidation on Medical Costs. (2018, July 11). Retrieved January 28,
2019, from https://www.ncci.com/Articles/Pages/II_Insights_QEB_Impact-of-Hospital
-Consolidation-on-Medical-Costs.aspx