This is a valid concern, but I would prefer providers making those decisions rather than insurers. Regulations could create mechanisms for dealing with outlier situations like temporary price increases (this happened in Maryland in the early days of the pandemic when discretionary use collapsed) or catastrophic reinsurance pools for at-risk providers, which have proven successful in several states in reducing the cost of ACA plans.
Thanks...I'm not sure I trust providers more. In the U.S., healthcare businesses — hospital systems, large provider practices owned by hospitals or private equity — are profit optimization machines (regardless of whether they're "nonprofit").
Maybe the best argument for making providers take on risk is Maryland, if there's no evidence there that hospitals are skimping care under global budgets. As for "mechanisms for dealing with outlier situations," the one that comes to mind is risk adjustment -- and we know how *that* works out in MA.
Merrill, if providers are paid to take on risk like insurers, why wouldn't they gear themselves to deny expensive-but-necessary care as insurers do?
This is a valid concern, but I would prefer providers making those decisions rather than insurers. Regulations could create mechanisms for dealing with outlier situations like temporary price increases (this happened in Maryland in the early days of the pandemic when discretionary use collapsed) or catastrophic reinsurance pools for at-risk providers, which have proven successful in several states in reducing the cost of ACA plans.
Thanks...I'm not sure I trust providers more. In the U.S., healthcare businesses — hospital systems, large provider practices owned by hospitals or private equity — are profit optimization machines (regardless of whether they're "nonprofit").
Maybe the best argument for making providers take on risk is Maryland, if there's no evidence there that hospitals are skimping care under global budgets. As for "mechanisms for dealing with outlier situations," the one that comes to mind is risk adjustment -- and we know how *that* works out in MA.