While the debate between private sector and government control will rage on in Washington, D.C., the marketplace and its consumers will be most impacted by increasing costs and, in some cases, reduced access.
Different geographic regions will experience different realities, but following are some trends that we will see in overall industry.
- Additional fees charged to consumers whenever and wherever possible. Think airline industry. We sometimes pay for checked bags, pillows, better seats. Health care providers are moving in the same direction. As a patient, you can expect more “extra charges”… some of which will not be covered by your insurance policy. Examples include dispensing fees, facility fees for doctor visits and additional diagnostic tests, which may not be medically necessary.
- Insurance companies will cut back on “free member services.” The Patient Protection and Affordable Care Act (PPACA) sets the medical loss ratio for carriers at 85 percent, which tightens administrative costs, requiring that carriers reduce the services provided within those administrative costs. This means member benefits like employee assistance plans, wellness programs and paper communications will be reduced or possibly eliminated.
- Costs for tests and outpatient surgeries performed in a hospital setting will increase for patients while outpatient facilities will hold their costs steady. Hospital overhead and inefficiencies continues to burden hospital balance sheets. These facilities will have to raise costs in the growing area of outpatient procedures in order to survive. This means that patients/consumers will pay more out of pocket at a hospital if they don’t research costs for elective procedures.
- Increase in individual insurance customers and individual insurance products with high deductibles and out of pocket maximum requirements. As smaller employers decide not to provide employer-sponsored coverage due to the cost, more individuals will be forced to shop for coverage on their own. This means that carriers will offer more competitive products with increased member cost sharing, creating more engaged health care consumers.
- Shortage of primary care doctors to take care of patients will increase the use of physician assistants and nurse practitioners. Primary care doctors are underpaid and overworked, which means more are retiring and fewer medical students are choosing primary care as their focus and an aging population and additional consumers coming into the system through PPACA means more demand for primary care services. The only way health care systems can respond is by connecting patients with different types of health care providers.
With all of these trends coming into play in 2011, the bottom line is to be a better health care consumer. More transparency on the provider side is going to be expected from a consumer standpoint. Taking all of these trends into account, I ask, “How are you going to be a better health care consumer in 2011?”
