Doctors’ bills often come with sticker shocks for patients -but health insurance can be re -creation.

I made an appointment with the medical service provider, but no matter how hard I try, no one can do it stably. Please tell me how much of the visiting cost you. Do I have to pay $ 20, $ 1,000?

The patient Increasingly on the hook Medical expenses Deduction, joint payment and other fare. As a result, there is a patient Tricky Cost information Before you make an appointment, choose the place where they are treated and control the budget.

But nevertheless Recent law And regulationsPrepaid information on the cost of the patient’s self -pay is still difficult to obtain from medical service providers and insurers.

Forecast cost

Why is it so difficult to tell the patient how much the cost is?

This is a question Health economist I’m going to answer like me. The fundamental reason is that it is simply an unpredictable characteristic of health care, but the fact that the patient is shifted to an unpredictable copayment cost is a policy choice.

The following US health insurance plan Medicare and Medicare AdvantageMost of them, as well as individual and Group planA percentage The cost of treatment for patients settle in pockets. Here is included Deduction -The amount that the patient must pay the service before the insurance begins. Joint insuranceThe ratio of treatment costs that the patient must pay after the deduction meets.

Naturally, most patients want to know the cost of the doctor’s office or before traveling to the hospital. However, the cost of treatment (therefore the cost of the patient) is often not available until it is delivered after treatment. This is due to the way medical service providers pay their work costs.

Medical service providers generally receive a pay -to – -payment for each patient. Volume And robbery The service they provided. But both are hard to predict. Doctors usually need to meet the patient before deciding how to solve the need for health care. Sometimes you need an additional test or imaging scan to check the diagnosis or planning treatment.

Crucially, there may be a variety of unexpected complications in everyday procedures. To solve these unexpected complications, you often need to provide unexpected services and participate in other medical service providers who were not part of the visit. And this additional service was expensive.

As long as policymakers maintain their health care payments in relation to the amount and intensity of medical services, the patient’s expenses related to paying health care will not be known in advance. Simply making Medical service prices that can be used openly It will not change it.

What can the patient do to ensure the cost of the burden before the patient makes an appointment?

Delivery of health care as a supply chain

One of the ideas suggested by the researchers Health care delivery is reconstructed as a supply network. This will shift to medical service providers, similar to the way that the risk of production is provided to consumers with other complex products.

Consider the air travel ticket. Consumers flying from one city to other cities receive services from several institutions, such as airlines, airports, aviation fuel suppliers and catering companies. Many of these entities face the uncertainty of operating, such as departure delays or variable fuel consumption due to unpredictable weather. However, airlines, the final link to the supply chain, provide consumers with prices for the entire travel.

In health care, the main providers who pursue treatment by the patient can act as a price group. They collect a single guaranteed price for promises and compensate for other providers as needed. Some researchers suggested The side of this idea In a potential method that reduces amazing claims from emergency doctors other than networks working in a hospital in a network.

However, the main reconstruction of these medical services will be very difficult because all providers have to enter into new contracts. It can not only cause unprecedented legal projects, but also be financially deadly. Small -scale practices.

Health plan for joint payment

There is another approach that provides a reliable and prepaid price to patients who do not need complete inspection of the health care system. The United States already has the necessary infrastructure: Health Insurance.

no way Main purpose of health insurance It is to protect beneficiaries from financial shocks. Health insurers can modify the benefits of the policy so that the patient can obtain the guaranteed the cost of the patient before receiving the treatment.

One way to achieve it Say goodbye to deductions and joint insurance And patients who have insurance Co -payment – Fixed dollar A meeting party like $ 20 per doctor, $ 35 per prescription drug Or $ 500 per hospital, some insurance plans already offer this.

However, this approach removes incentives that can be treated from providers who provide high -quality services at low prices. It is also possible potential Increase monthly health insurance costsIt is also called a premium.

Innovative health insurance design

Based on my own research, I suggest that alternative solutions that can be trusted and prepaid prices can be implemented. Sharing episode -based costs Health insurance plan.

According to this model, a health insurance company will create a series of services that patients can receive during their health care. This approach provides patients with a single prepaid price for the entire bundle, depending on the pre -known factors such as health insurance benefits and major medical service providers. For example, the price tag is guaranteed for the cost of having children or replacing joints.

The deviation from the ultimate treatment cost due to unexpected situations will not be paid by an insurance company that can hardly control the patient. That is what an insurance company makes for a living. They know how to manage risks. These modifications of these health insurance benefits are preserved incentives to protect the patient from unexpected health care costs and to be treated with expensive suppliers. It also helps to maintain health insurance premiums.

Caring for health problems is already a lot of stress. It is not necessary to add stress due to cost uncertainty. Some approaches that help patients to inform the treatment costs that policy makers can consider. In the meantime, the patient may have to answer the hospital and call the hospital claim office. The amount they get It is close to the amount they can finally find in medical expenses.