Congressional Policy in Payer Mix: Useful or Useless?

Abstract

For decades there have been ongoing debates on the quality of healthcare, access to healthcare, and the allocation of funds to different healthcare programs. In hospitals, the rhetoric regarding quality of healthcare, and ethics of the healthcare providers ranks among the bottom of the average patient. The concerns narrow down to access, and is the patient in position to pay for the health services. David Dyke, vice president of RelayHealth Financial states that “There’s a mix of long-and-short-term solutions to achieving the right payer mix” (Lagasse, 2016).

Congressional Policy

The Congressional Budget Office (CBO) implemented a change in the cost-sharing rules. Cost sharing according to the CBO, this applies to the “Out of pocket expenses that enrollees are required to make when they receive health services.” (Congressional Budget Office, 2016). Since a substantial number of patients in the hospital (i.e. Emergency Room) are paying via Medicare or Medicaid, this change is considered one of many policies implemented to marginalize the number of patients that make non-emergency trips to the hospital, and accruing hospital expenses. Such cuts in 2016 was expected to reduce the deficit, leaving more money to expand Medigap insurance.

Plan to minimize impact of policy

Such change will discourage patients from coming to seek medical attention. This implementation will slow down the volume of patients. The Canadian Medical Association stated “Care providers have been asked to cut costs by shifting the management of patients with chronic conditions back into the community and reducing avoidable hospital costs” (Tannenbaum, 2014). When dealing with a volume of patients with healthcare concerns, it is not a good idea to just turn them away. The patient may leave the hospital; however, the problem won’t leave the patient. The most viable solution to minimizing the number of patients to visit hospitals and not be discouraged by having higher out-of-pocket expenses is to create another department that would offer medical advice to potential patients. With this approach will serve as a filter for the hospital and encourage people not to come due to less severe circumstances that would cause them to frequent the hospital. Such approach is used in the police department in major metropolitan areas. Due to the high volume of callers, dispatchers have created a separate line for people to call if it is a non-emergency. This department would include medically trained professionals who will be certified to listen and diagnose common problems. If the further observation is needed, they will be advised to see a physician at the hospital and if not, they will be advised simple over-the-counter remedies.

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