Case Study:Health Savings Accounts
The United States has arguably the most advanced health care in the world. And yet, a large proportion of Americans do not have access to this care due to its high cost. Providers, consumers, and the government have long searched for a way out of this paradoxical situation. HSAs offer one solution.
The American health care system is complex. A part of the population has access to health care through Medicare and Medicaid. Another part simply pays for care out of pocket. A substantial proportion of the population uses third-party payers to pay for care.
Payers have reacted to the rising costs of care by introducing various gatekeeper mechanisms. These have not been popular with consumers who see them as restrictive. The American population is aging and the need for care is likely to increase over the next decade.
While the earnings of health care professionals have been increasing, insurance premiums have also increased. Among hospitals, many are non-profit organizations offering substantial charity care. But for-profit and non-profit hospitals alike must show return on investment to remain viable. Providers must also factor reimbursement policies of payers into their decisions, sometimes even clinical decisions. These groups of stakeholders-patients, providers, payers, and the government-have different goals and different responses to the rising cost of care.
Based on your understanding, response the below:
• In your opinion, can HSAs be aligned to the expectations of all these groups?
• Do you think HSAs can help improve health care cost, quality, and access? Why or why not?
Risk-Based Reimbursement:
A primary care physician is often reimbursed by Health Maintenance Organizations (HMOs) via capitation, fee-for-service, relative value scale, or salary. Capitation is considered as a risk based compensation.
In an effort to understand the intricacies involved with physician reimbursement, particularly in an era of health care reform, identify and interview an expert in the field, such as:
• Hospital Administrator
• Managed Care Organization (MCO) executive
• Health care Consultant
• Legal Professional
Assumption: MCOs use risk-based reimbursement for primary care physicians.
Ask the below questions in the interview:
• What kind of risk do the MCOs assess?
• Does risk-based compensation limit the freedom of primary care physicians in any way in terms of patient care? Why or why not?
• How does the capitation model of reimbursement work? Do physicians generally prefer one model over the other? Why or why not?
• Why do HMOs prefer the prepaid, monthly premium?
• Is pay-for-performance a better model than existing models of compensation? Are there limitations to it as well?
Feel free to add additional follow-up questions for depth and clarification as you see fit.
Create a 4- to 5-page report in Microsoft Word document, analyzing the responses provided (which should be included as part of the report) using the evidence from the literature to help support or refute the responses provided.