Commercial Markets and Consumers My Experience

  1. Commercial Markets and Consumers
    I remember when I saw the shift in how health care coverage changed at my organization. We went from a copay program into a deductible program. The organization explained that health care costs were increasing and we all (the organization and the employees) needed to share the cost. This was my first introduction into the high costs of health care. The organization explained that we all needed to make better heath choices as a people in an effort to reduce the costs of health care.

    Going from a copay plan to a high deductible health plan was a big change I faced. The organization explained that heath care costs are going to keep going up and reimbursement rates were not. In fact, they knew about the proposed changes coming down the pike on the transition from fee for service to flat rates and health care outcome penalties. To keep the organization afloat reforming the insurance coverage was a part of the plan.

    As a patient I was ignorant to the costs of health care. Under the comfort of a copay paid I was able to be blissfully ignorant to the true ugliness of the costs associated with healthcare. I did exactly as my physician said, received a lot the tests he ordered and studies without finding out if they were needed. As a patient I contributed to that 2.9 trillion-dollar deficit in 2013 for health care costs (Cliff, 2015).

    Theses days I'm more of a consumer. If anything, sharing the cost of my health coverage has forced me to be more educated on what I really need as a patient. I challenge the provider when I need too. I look for cost alternatives because now I share in the cost of tests and procedures. I no longer have the option to pay a copay and move along. My copay is more like a percentage that can be in the thousands of dollars if I don't investigate. For example, to get a standard lab panel for an annual exam with my insurance would cost $15,000 (this is a real figure) and the percentage I would be responsible for would be 10% which would be $1,500. That is a ridiculous amount of money to pay for labs. If I go to a different outpatient company that can do the exact same thing it ended up costing $260 and my portion would be $26. I went to the outpatient center to get my labs drawn at. This example displays the disparities in how the pricing works at one health care organization versus another. Now that cost is a factor for me I need to ensure that I am not overpaying for a service I can get somewhere else at for less money.

    I discovered that some patients who are on a deductible plan are not negotiating their options to ensure that they are receiving the best deal for their care. (Rapport, 2017) People need to cross the bridge from the patient to the consumer when it comes to their health care. If there was a sale down the road for the big screen tv and the store you were in did not honor the deal, you would drive down the road and get the tv on sale and save. This is how we need to think of health care services and payment.

    In conclusion as a patient and as a consumer there are positives and negatives to health care reform and the costs associated. In researching I also found an article that discusses how a patient may not get health care services in a deductible plan because the costs are high, but it was also found that deductible plans will help to reduce health care spending. (Rand Corporation, n.d.) Is this because services costs more in a deductible world or is it because services cost the same and now as a patient enrolled in a deductible plan I can no longer afford the care? I think the later is the case.

    Cliff, B. (2015). How Health Plans with High Deductibles Became the New Normal. Retrieved: How health plans with high deductibles became the new normal - The Boston Globe
    Congress of the United States. (2016). Congressional Budget Office: Options for Reducing the Deficit: 2017-2026. Retrieved:
    Rand Corporation, (n.d.) Analysis of High Deductible Health Plans. Retrieved: Analysis of High Deductible Health Plans | RAND
    Rapport, L. (2017). Consumers with High-Deductible Health Plans Could be Smarter Shoppers. Retrieved: Consumers with high-deductible health plans could be smarter shoppers | Reuters
    Last edit by traumaRUs on Feb 13