Healthcare Legislation Reform: Transparency in Pricing Schemes

1036 words | 4 page(s)

Healthcare reform is a debatable topic particularly with the affordable care act right around the corner. The Obama Affordable Healthcare Act will change many dimensions of what healthcare looks like. One consistent area of controversy among state and federal legislators is the subject of cost transparency among health providers. Specifically, human service agencies are interested in how well healthcare facilities disclose, report, and publish charges and fees to public users. The cost of healthcare has always been impactful, even more so to low-income and under insured or for individual citizens having little or no health insurance. Many states have recently enacted legislation requiring greater transparency among hospitals and emergency healthcare establishments. In Arizona for example, Rev. Stat. Ann §36-125.05 requires the Arizona Department of Human Services implement a uniform charge and reporting system in all healthcare facilities including hospitals, ER facilities and surgical centers, detailing the average charge incurred for each patient and per physician billing patients (NCSL, 2013). This is similar to legislation enacted in California, Colorado, Illinois, Missouri and several other states (NCSL, 2013).

Does this legislation help or hinder human service efforts to provide more equitable access to healthcare and improve service? The Journal of Comparative Family Studies suggests that many policies across welfare state regimes serve to reinforce “social class stratification” (Pankratz, p. 4). Social policies play a central role in “shaping the experiences and lives of families and their social surroundings” (Pankratz, 504). The authors suggest that a change in approach to social welfare can dramatically influence society and one’s experience of society. For this legislation to be truly impacting, it must be reformed further, requiring the costs of all healthcare services be fully disclosed prior to service rather than some services. Further, healthcare agents should provide uniform fees to all patients regardless of whether patients are insured, over-insured or under-insured to provide equitable care and to prevent disparate care that is often seen among underinsured or low-income populations.

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According to an article published in The Washington Post, it is not uncommon for one hospital “to charge $8,000 for a procedure while another hospital may charge $38,000” for the same procedure (Klifff & Keating, 2013). Cauchi & Valverde (2013) state the price discrepancies in Medicare-covered treatments can vary by as much as $3,000+ dollars in some hospitals, while the cost of treating asthma and bronchitis in one New York City hospital varied by as much as $20,000. The results of their investigation were published in the September issue of State Legislatures Magazine. Such charging disequilibrium may be the result of location and the amount of insurance a patient has available for the facility to bill. Variations are not uncommon from state-to-state (Cauchi & Valverde, 2013). While the carrier may not pay the total of the exorbitant price disparity, carriers still end up paying widely different charges. Policies like these simply “reinforce gender and class stratification” (Pankratz, 506). Social services agents can help by acting as progressive advocates, working with families and legislators to make uniform policy changes as new healthcare policies are put in place to make healthcare insurance more widely available to citizen’s at large (McEwen, 2009). A progressive advocacy program can serve as a support system for families that lack the resources to make changes on their own or to advocate in corporations that charge outrageous or hidden fees a consumer may not be aware of (Donaldson, 2008). Many patients are not aware they can ask to see a list of prices or compare prices just as much as they doctor shop. They can also ask for a second opinion before they agree to have services performed for a healthcare need. A progressive advocate can look into healthcare matters and find out what the “best” services are for a consumer prior to having services rendered to protect the best interest of the consumer.

In the meantime, human service agencies should be working diligently to enact legislation that will not only publish pricing schemes of hospital, emergency and surgical services, but also general healthcare services. Private physicians are not restricted to the pricing limitations that many general practitioners are. Physicians argue that publishing fees would limit their ability to practice. Transparency in pricing may not take into consideration certain specialties in medicine, the skill requires of physician’s and the income required of certain healthcare practitioners. If more streamlined reforms were in place, this may reduce class stratification and open healthcare up to the masses. Some misguided citizens may believe higher costs are associated with better care, but this is not necessarily the case. Often higher costs are simply higher costs. Low cost care can provide as great quality as high cost hospitals. A balance between price and need must be established in healthcare to ensure consistent and quality care among all populations regardless of socio-economic status.

Healthcare reform is an arduous process. Transparency in healthcare can have many beneficial effects. It can help patients understand what procedures they can and cannot afford, and can help healthcare advocates work with physicians to determine what hospital or healthcare facility may best suit a patient’s overall needs. Transparency may also reduce competition among hospitals and healthcare establishments, so that more agencies begin offering comparable and equitable services. According to American Hospital Association CEO Rich Umbdenstock, healthcare financing and delivery systems should change, altering the charging system so that all parties including the government develop solutions to charge variation so that consumers can make “better choices about healthcare” (Cauchi & Valverde, 2013). This comes right on the wings of healthcare reform.

While in the past physicians have argued their right to charge disparate fees based on their skill and specialty, the impact of Obamacare may change this type of thinking, making it nearly impossible for competition to continue in this respect. Patients have come to associate higher fees with better service, although this is not necessarily correct. Often higher fees simply reflect the name and reputation of a hospital. Proper advocacy, further legislation changes, and advocacy support among selected populations can help prevent class disparity and ensure that all consumers have appropriate access to the healthcare services required when necessary. Freedom of healthcare choice will be increasingly important in the years to come as the affordable healthcare act unravels and affects each citizen uniquely in the coming months.

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