How are health care charging and pricing processes different from other industries? How do private and government insurers and payers impact actual reimbursement?

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How are health care charging and pricing processes different from other industries? How do private and government insurers and payers impact actual reimbursement?

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healthcare is different . In the healthcare industries we can see market-based approach. Consumer-directed health plans are at the center of this concept. Client spend more of their own money, they’ll be more prudent users of care and seek better value at lower prices

Following major obdervation we can see in health care industrie-

Health care markets have barriers to entry. The former requires special licenses, the latter requires considerable capital and regulatory compliance.

Trust in one’s doctor is important

Information assymetries exist in health care as in auto repair. Your mechanic (doctor) knows more about your car (your internal organs) than you do.

Health services and health insurance products are differentiated and complex, as are other products like cell phones or personal computers.

Health professionals want a good income, as do those in other fields.

Healthcare industry have government regulation, and so forth, we could harness all the characteristics of the free market–characteristics

How do private and government insurers and payers impact actual reimbursement

reimbursement system is based on mixed public/private third-party payment system whereby government, employers, and individuals share the cost of care. Premiums are paid to private insurance companies for private coverage either by individuals or employers. Individuals within the federal government, private insurers, and non-procedure-based medical specialties felt that this system perpetuated rising health care costs and inequities in medical care. These individuals believed that this system served as an incentive for physicians to inflate charges, even in those instances where actual costs were decreasing, and to continue the inequities in fees between proceduralists and non-proceduralists

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