Question

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Answer 1

1. The US healthcare system is fragmented and it spends the most for healthcare than any other country . It's health care system is complex because :-

- data is siloed with no sharing

- insurance is mostly bought by employers and removes the buyers from the purchasing process

- healthy people don't want to buy the insurance that they don't need because plans are one size fits all

- pharmaceuticals companies are relatively free to raise prices

- US government pays very poorly and often does not pay at all , leading to few provider's willing to accept Medicare/ Medicaid patients besides hospitals

- Geographical maldistribution

- Hospitals treat uninsured people who can't pay only during emergencies . That lead to them charging more on people who can pay

- Government regulation more unnecessary admin and billing hires for hospitals and provider's to deal with regulatory and compliance paperwork .

- Not enough effective public health initiatives and preventive measures taken on all ends . Because few consumers wants to pay for prevention or even do it if it's free .

2. No, all the players don't pay the same for the same services . Its all dependent on insurance . Those who have insurance or Medicare / Medicaid have to pay less than those who don't have an insurance .

3. Third party payers are agents of patient who contract with providers to pay all or a portion of the bill to the patient . A person pays only a portion of the cost, but they may be paying high insurance rates. It effects the organizations financial management due to how they pay - Fee for service? Or discount fee for service? Then there is the possibility that the service was rendered but no payment by either the insured or the insurance company is received.

4. A contractual allowance is the difference between what an insurance company approves according to its contract and what the health care provider charges for the service.