8 min read
Having an understanding of the healthcare market should be a first priority to healthcare providers. It’s essential to understand the good, the bad, and the ugly of the healthcare industry and, more importantly, the improvements that need to be made to provide good patient care.
In this article we present the two key factors that will strongly impact the healthcare industry in 2023 and offer advice on how healthcare providers can overcome them.
The health insurance marketplace
Last year health insurance companies raised prices by 24%, which equated to nearly $12 billion in profits for those organizations. While it benefits insurance companies, it has a disastrous effect on patients and healthcare providers. These high costs make it impossible for low-income families to pay for private insurance, and they then put off seeking healthcare to avoid those costs.
“38% of Americans now report they or a family member put off needed medical care because it was too expensive” – Sen. Bernie Sanders.
The effect of costly health coverage
With the scaling prices of private insurance, the percentage of Americans that delayed medical services in consequence of the higher prices climbed 12 points in one year. In 2021 it was 26% and rose to 38% in 2022. This will clearly have deadly consequences, as those with serious conditions aren’t going to the hospital to get the care they need.
For healthcare providers this means that with more people postponing hospital visits, the less income they receive.
There is mounting pressure on insurance companies to reduce their costs to ensure that their insurance plan meets the needs of those with a reduced income. Although this is unlikely to happen anytime soon.
However, for lower-income households there are medicaid services which cover healthcare for low-income children, adults, seniors, and those with disabilities. The eligibility for medicaid is different for each state. As a result of the ACA, US states have the option to expand medicaid eligibility to adults with incomes up to 138% of the poverty level. Meaning more people will have access to life changing hospital visits, and providers can receive more money from the government to make improvements in their hospital.
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People turning to the emergency department
Currently, there are a record number of Americans going to the emergency department as go-to locations for routine care or preventable visits. It is considered preventable when the conditions could have been handled in a non-emergency setting, or if the patient had adequate preventative care prior to the visit.
Now, this affects the patients, healthcare providers, and the workers in the ER department.
However, firstly, we should understand the WHY. Why is this happening?
Studies have suggested that there is a correlation between the income level of patients, and the frequency of preventable emergency care visits. While there are other factors that come into this like education, employment, health insurance coverage, transportation access, and internet access – income was the strongest correlation.
The effect it has on health care services
With more and more patients relying on the emergency services to treat routine or preventative illnesses, it leaves them at risk. Now, fewer people are getting lifesaving preventative screenings or consistent help in managing their chronic conditions. Therefore leading to problems that may be avoidable such as heart attacks, strokes, and cancer. These problems are not small or inconsequential, but preventing them would be lifesaving.
As a result of ERs bustling with non-emergency patients, others that have a true emergency situation are left waiting longer for evaluation and treatment.
Patients turning to the emergency department could massively increase the burden on providers. The workers in the ER department would be overrun, which could lead to increased burnout and workers leaving the ER at high rates. Which in-turn increases costs for providers by having to source new talent regularly.
Education is needed. People need to have an understanding of when they’re eligible to go to the ER and when they aren’t. This could be through leaflets, tv adverts, or online adverts. It is something that is needed to prevent overcrowding in the ER and therefore save lives.
Another solution could be hospital workers sending patients to different departments if it’s not an emergency or booking an appointment the next day in the department they would need. It would prevent overcrowding in the ER, and help patients to understand when they should be going to the ER and when they should book an appointment in another department.
Overall, there are two clear issues at play for providers – the rising cost of health insurance, and patients turning to the ER for non-emergency illnesses and injuries rather than going to their regular doctor. To provide patients with good quality care the price of insurance needs to decrease, or if patients don’t know about medicaid services, then they should be made aware by providers. There also needs to be an understanding of when to go to the ER to prevent multiple organizations having their ER overrun.
Unless healthcare providers take steps to prevent these issues occurring, then there will be a significant impact on their worker retention, burnout and team morale. This will occur because if the ER is overrun with patients it means that workers cannot provide as good care to their patients since the patient-to-nurse ratio will be over the recommended safe limit.
Providers need to educate their workers and patients about when it is suitable for a patient to be in the ER, and when they should be in another ward, or book an appointment for another day. Moreover, if a patient cannot afford healthcare, then it’s important to tell them about Medicaid, to see if they’re eligible for it and can then receive the treatment they need.
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