Proposal of a new shared payment model for healthcare financing in the United States: a hypothesis

Bruce H Ziran,E Kathleen O’Pry

doi:10.1186/s13037-020-00242-w

Abstract

The healthcare repayment system in America is highly flawed due to several factors such as uncontrolled costs, unequal access, varied reimbursement systems, and complex patient interfaces. In fact, it is rated the worst among the eleven developed nations analyzed in the Commonwealth Fund’s evaluation conducted every three years. We propose a novel three-tiered model for healthcare repayment designed to fulfill the needs of the patients, the providers, the payers and the nation as a whole. We hypothesized that our new plan may spread cost between multiple entities and offer better coverage and access to care. Our model uses a shared-cost approach wherein the total risk expenditure becomes the responsibility of various stakeholders including the government, insurance industry, hospitals, patients, providers as well as the nation’s economy. While there is no perfect solution to healthcare in America, we believe our three-tiered model can create an economically balanced solution to break deadlock between party lines and result in better outcomes and patient care.

Highlights

Healthcare spending in the United States (US) continues to grow and outpace inflation and other economic indicators
In the article by Hoff et al in Health Affairs, a healthcare economist outlines the potential conflicts of interest noticed when there is only a fixed reimbursement utilized with multiple providers competing for the funds
Medicare provides for the elderly and those with permanent disability who require ongoing medical care (19%); Medicaid covers those of lower income as well as mothers and children via Federally subsidized state Medicaid plans and Children’s Health Insurance Program (CHIP)/WIC plans (15%), and there are the various factions of Private Health Insurance which make up the majority of healthcare services (31%) and provide health insurance to both individuals and companies

Summary

Introduction

Healthcare spending in the United States (US) continues to grow and outpace inflation and other economic indicators. The shift in cost has forced plans (both individual government options and those which are employer provided) to incur very high deductibles and/or co-pays, which subsequently reduces the ability of lower income patients from either purchasing or using their health insurance.

Results

Conclusion