Third-Party Payers: A Review of Their Impact on Healthcare
The healthcare system in the United States is complex, and third-party payers have become increasingly important to its function. Third-party payers are organizations that pay for a portion or all of an individual’s healthcare expenses, such as health insurance companies, Medicare, and Medicaid. This review focuses on the impact that third-party payers have on healthcare in the United States.
Third-party payers are increasingly responsible for a greater portion of healthcare costs. According to a report from the Centers for Medicare and Medicaid Services, in 2018, third-party payers were responsible for 86% of all healthcare spending in the United States. This is a significant increase from the 68% in 2000. With such a large portion of healthcare costs being paid by third-party payers, their policies have had a profound impact on healthcare delivery.
Third-party payers have been found to influence the cost and quality of care provided. Studies have found that third-party payers have a direct impact on healthcare costs, with policies such as prior authorization, which requires healthcare providers to obtain approval from the payer before providing a service, leading to increased administrative costs and delays in care. Additionally, third-party payers have been found to influence the quality of care provided, with providers focusing on treatments that are reimbursed by the payer rather than treatments that may be more appropriate for the patient.
Third-party payers have also been found to influence the decision-making process of healthcare providers. Studies have found that providers often base their treatment decisions on the policies of the payer, which can lead to unnecessary treatments or treatments that are not in the best interest of the patient. Additionally, third-party payers have been found to influence provider behavior, with providers often providing treatments that are more likely to be reimbursed, rather than treatments that may be more beneficial for the patient.
In conclusion, third-party payers have had a profound impact on healthcare in the United States. They are responsible for a large portion of healthcare spending, and their policies have been found to influence the cost and quality of care provided, as well as the decision-making process of healthcare providers. As third-party payers continue to play a larger role in healthcare, further research is needed to understand their impact on healthcare delivery.
References
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