About halfway into this interview with Managed Care, Princeton University health care economist Uwe Reinhardt prognosticates where the U.S. health system is headed in the post-Patient Protection and Affordable Care Act era. And it’s not Canadian-style single payer where a government monopsony pays providers.
However, Medicaid as a public payer could go away in a three-tiered system foreseen by Reinhardt and replaced with publicly financed providers: public clinics and hospitals. Potentially accelerating Reinhardt’s prediction are significant challenges states are experiencing ensuring those eligible for Medicaid get timely, continuous coverage and have access to a sufficient pool of providers. These challenges have been heightened by expanded ACA Medicaid eligibility in some states and difficulties complying with the ACA mandate that state health benefit exchanges employ a single, electronic application process for both commercial exchange plans and state Medicaid programs.
For most people in private insurance plans, Reinhardt predicts the growth of reference pricing where payers set a standard reimbursement for common procedures or medications. Providers would not be reimbursed above reference price level but could opt to charge more and give patients the option of paying the difference out of pocket. Reinhardt sees higher relative prices charged for procedures and medications compared to other nations as the primary reason why U.S. health care costs are often double or more that of other countries for the same procedure or medication.
The third and top tier of the future U.S. health system is concierge or “boutique” medicine where those who can afford it have their own personal physician on retainer.
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