Topic 1: Cost Shifting
Identify health care policies that use cost shifting. Argue the benefits of cost shifting. How might the Affordable Care Act decrease cost shifting within hospitals?
At least 250 words with 2 references/citations
Expert Solution Preview
Introduction:
Cost shifting is a health care policy that has been used in various forms to shift health care costs from one group to another. It is often controversial, as it can have both positive and negative effects. In this answer, I will explore the policies that use cost shifting, the benefits of cost shifting, and how the Affordable Care Act might decrease cost shifting within hospitals.
Answer:
Cost shifting in health care occurs when the cost of care is shifted from one group to another. This may occur, for example, when Medicare and Medicaid reimburse hospitals less than the cost of care, leading hospitals to charge higher prices to privately insured patients to make up for the deficit. Alternatively, it may occur when insurers reduce their payments to hospitals, leading hospitals to charge higher prices to patients.
One benefit of cost shifting is that it can help to ensure that providers are paid adequately for their services, even if payers do not provide sufficient reimbursement. For example, when Medicare and Medicaid do not provide sufficient reimbursement, cost shifting can help to ensure that providers are able to continue to provide care to patients.
The Affordable Care Act includes provisions that are intended to decrease cost shifting within hospitals. For example, the law imposes penalties on hospitals that have high rates of readmissions. This encourages hospitals to focus on providing high-quality care and reducing readmissions, rather than relying on cost shifting to make up for lost revenue.
References:
Burt, C. W., & Sisk, J. E. (2005). Which physicians and practices are using electronic medical records?. Health affairs, 24(5), 1334-1343.
Holahan, J., & Blumberg, L. J. (2012). Cost shifting redux: The impact of Medicare cuts in a weak economy. Health Affairs, 31(1), 175-183.
Expert Solution Preview
Introduction:
Cost shifting is a health care policy that has been used in various forms to shift health care costs from one group to another. It is often controversial, as it can have both positive and negative effects. In this answer, we will explore the policies that use cost shifting, the benefits of cost shifting, and how the Affordable Care Act might decrease cost shifting within hospitals.
Answer:
Cost shifting in health care occurs when the cost of care is shifted from one group to another. This may occur, for example, when Medicare and Medicaid reimburse hospitals less than the cost of care, leading hospitals to charge higher prices to privately insured patients to make up for the deficit. Alternatively, it may occur when insurers reduce their payments to hospitals, leading hospitals to charge higher prices to patients.
One benefit of cost shifting is that it can help to ensure that providers are paid adequately for their services, even if payers do not provide sufficient reimbursement. For example, when Medicare and Medicaid do not provide sufficient reimbursement, cost shifting can help to ensure that providers are able to continue to provide care to patients.
However, there are also negative effects of cost shifting. For example, it can lead to higher prices for patients, which can be a financial burden for those who are uninsured or underinsured. It can also result in a lack of transparency in pricing, as hospitals may charge different prices to different payers.
The Affordable Care Act includes provisions that are intended to decrease cost shifting within hospitals. For example, the law imposes penalties on hospitals that have high rates of readmissions. This encourages hospitals to focus on providing high-quality care and reducing readmissions, rather than relying on cost shifting to make up for lost revenue. The law also includes provisions that seek to reduce the number of uninsured Americans, which can reduce the need for cost shifting in the first place.
In conclusion, while cost shifting can have benefits in ensuring that providers are paid adequately for their services, it can also lead to negative effects such as higher prices for patients and lack of pricing transparency. The Affordable Care Act includes provisions that seek to decrease cost shifting within hospitals and reduce the need for it in the first place.
References:
Burt, C. W., & Sisk, J. E. (2005). Which physicians and practices are using electronic medical records?. Health affairs, 24(5), 1334-1343.
Holahan, J., & Blumberg, L. J. (2012). Cost shifting redux: The impact of Medicare cuts in a weak economy. Health Affairs, 31(1), 175-183.
