Reimbursement

Healthcare economics are affected by the push and pull of three participants: the payer, the provider, and the consumer. Consider this example:

You work full time for your employer who provides vision insurance as a benefit. Your contribution is $5 a month or $60 a year. Your employer contribution is $10 a month for each employee enrolled.

You find yourself in need of new glasses and have fallen in love with the designer $600 frames. Your copay on glasses is 20% for one pair of glasses so your out-of-pocket cost is $120. For your new glasses, the insurance company has to pay the $300 difference between what they collected from you, your employer, and your copay.

Clearly, the insurance company cannot do this for every employee every year so they increase rates, which means your employer must increase your contribution as well. In addition, the insurance company adds purchase limits on the maximum it will pay for new glasses or how often it will do so, say once every 2 years.

Consider this scenario as it applies to other healthcare costs, copays, and contributions. If we can demand to have the most expensive healthcare solutions, and only pay our co-pay, that impacts insurance companies, employers, businesses, and other patients.

In this Discussion, you will consider the point of view of each party-the payer, the provider, and the consumer-and reflect on the impact of health insurance and reimbursement on behaviors.

To Prepare:

• You will be assigned to one of the following three perspectives by your Instructor for this Discussion

• • Healthcare consumer
• Reflect from the perspective of your assigned role, on how healthcare reimbursement programs, the demand to improve quality outcomes, and access to healthcare impacts utilization and under-utilization in the healthcare market.

Post a comprehensive response that includes the following:

• Describe the perspective you were assigned.
• Give at least one example of how health insurance may affect healthcare costs, reimbursement, healthcare access, and utilization. Be specific about how health insurance impacts each concept.
• Explain how aspects of healthcare costs, reimbursement, healthcare access, and utilization might affect experiences with healthcare for the perspective you were assigned. Explain.
• Be sure to support your Discussion with a reference to course materials or a reference within the last three years.