Laws concerning healthcare are always a controversial topic. The legislature has ideally tailored these laws to the benefit of all parties involved, but they are not without their share of flaws. While some of these flaws are minor and may be addressed by smaller roleplayers taking charge, there have been some difficulties that practitioners have had to face in light of these complications.
The publicly accepted notion at the time was that private insurers were more difficult for physicians to bill. However, a study into 44-million claims worth $8.4-billion discovered that Medicaid was two to three times more difficult than Medicare and other private insurances. Containing data from 2013-2015, this study was only recently published by researchers from the Vancouver School of Economics. Some physicians then had actively refrained from receiving patients covered by Medicaid if it were not for the later changes made. The research estimates that in the $54-billion of disputed claims, over $11-billion could have been saved if the billing were more efficient. This reflects much of the work that legislature still has to do before a more equitable and efficient system is adopted.
In early 2015, Dr. Jim Kahn, a professor at the University of California, identified that the massive disputes to be the result of poor administrative procedure. In an article he wrote, Dr. Kahn claims that since the US has multiple insurance providers, compared to countries in which insurance is state-run, over $375-billion are wasted each year due to paperwork. This reflects 15% of the total healthcare budget.
In the same article, Dr. Kahn presents that the money goes to the unnecessarily layered procedures of ‘multi-payer’ insurance systems. These steps include the designing of health plans, contracting between insurers and providers, creating bills, sending them out, collecting, and more. This is billing and insurance related (BIR) waste: money, manpower, and time.
Members of the Organization of Economic Cooperation and Development are progressive and industrial states which have single-payer policies, or a single absolutely standard comprehensive health plan, covering at least 98% of the population. All these first-world countries avoid BIR waste. The US on the other hand, despite being a member of the same organization, only has 87% of its population insured at the time of this research.
What these two researches bring to the table with regards to billing difficulties in healthcare is that the US has spent so much effort in creating a system that could best serve the population but that the same system is constantly failing. Not only is it procedurally cumbersome, it is unnecessarily time-consuming, and never cost-effective. The best remedy is not to allow entry for more insurance options but rather to prohibit insurance as a business and push for a legislative shift making insurance a state-run stratagem.
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