Discussion 5
Rose Cates posted May 14, 2023 5:05 AM
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Patient-Physician Continuity: Analyzing Plan Cancellations and Rationale
According to Brown et al. (2021), the Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, lacks a direct provision mandating patients to switch their medical practitioners. Nonetheless, certain insurance schemes may become incompatible with the edicts of the fresh legislation, inducing insurance firms to terminate or discontinue such policies. As a result, insurance contracts that fail to adhere to the provisions of the PPACA may not offer commensurate benefits and coverage as those that comply with the statute. If a patient's present healthcare provider is not associated with the novel scheme, conformance with the PPACA may require them to switch to an alternative plan, which could force them to change their medical practitioner (Koku, 2020). Ultimately, the decision to retain their doctor hinges on the availability of insurance schemes featuring the patient's preferred medical experts within their network. In other words, patients can only preserve their current physicians if they select an insurance plan that includes their favored healthcare professionals within their network. The discontinuation of incompatible insurance plans represents a concerted attempt to ensure that all Americans have access to high-quality healthcare policies that meet certain minimum standards (Koku, 2020).
The state Medicaid enrollments expansion can have both positive and negative outcomes. It may enhance the availability of healthcare services for low-income individuals and families who otherwise lack the necessary financial means to access such care (Zhang & Zhu, 2021). This could translate into a decrease in the utilization of costly emergency department visits, resulting in an overall reduction in healthcare expenses. Conversely, the expansion of Medicaid may lead to an increase in healthcare costs due to heightened usage of healthcare amenities by recently registered individuals (Zhang and Zhu, 2021). Additionally, healthcare providers often receive lower reimbursement rates for treating Medicaid patients in contrast to those insured by private insurance plans. This may dissuade healthcare providers from accepting Medicaid patients, ultimately reducing healthcare accessibility. In addition, the expansion of Medicaid may have implications for non-reimbursable care, as healthcare providers may feel compelled to prioritize Medicaid patients over those with private insurance who can provide more substantial reimbursement rates (Zhang & Zhu, 2021). The potential outcome of this situation could be prolonged waiting periods and a reduced capacity to obtain non-compensable healthcare services, including discretionary medical procedures or non-urgent surgical interventions.
References
Brown, E. A., White, B. M., Jones, W. J., Gebregziabher, M., & Simpson, K. N. (2021). Measuring the impact of the Affordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach. Health Research Policy and Systems, 19(1), 1-10.
Koku, P. S. (2020). Effect of the Patient Protection and Affordable Care Act on for-profit hospitals in the USA. International Journal of Pharmaceutical and Healthcare Marketing.
Zhang, P., & Zhu, L. (2021). Does the ACA Medicaid Expansion Affect Hospitals’ Financial Performance? Public Finance Review, 49(6), 779-814.
