It is true that non-profit insurers are best placed to bring the change that the healthcare industry in the United States desperately needs. This is for the simple reason that for-profit organizations always look for opportunities from which they can maximize their profits and shareholder confidence as opposed to looking for ways to meet consumer needs and the best conditions through which the industry can cater for those needs sustainably (Saucedo & Chess, 2016). Therefore, I agree with Paul Markovich that non-profits are flexible enough and have the room they need to come up with policies and implement them with the support of the government or the state in which they operate for the benefit of consumers/patients and the industry at large.
As far as insurance systems are concerned, the traditional systems are advantageous to health providers in the sense that they can provide as many services as possible and get paid for them, even if the services are not required by patients. The disadvantage is that patients get charged more premiums by insurance providers who have to factor in the costs associated to the many services health providers give patients (Saucedo & Chess, 2016). The result is a system that is unsustainable as many patients will not be able to afford insurance cover given the high premiums charged. With the Accountable Care Organizations systems, the advantage is that the partnerships between health insurance providers and care providers leads to shared risk arrangements in which surpluses and deficits are covered without an extra burden to the patients in terms of premium costs (Saucedo & Chess, 2016). Additionally, it results into better care with lowered costs and higher quality to patients. This has been achieved under the Affordable Care Act regime in which Medicare caters for some costs and other providers cover others not to mention the co-pay scenarios that help lower healthcare costs.
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Profitability for insurers is driven by diversification in offerings in light of increased demand as well as cost pressures for health plans. A diversified customer-base and the ability to operate in a less-competitive environment brings in more profits. The next 5 to 10 years will see more competitiveness in the industry benefitting patients and levelling the playing-field for larger and smaller players alike.
- Saucedo, M., & Chess, R. (2016). Blue Shield of California Case: OIT-112. Stanford, CA: Harvard Business Publishing.
