** There are 2 Topics, they both require 3 references. Discussion Topic 1: Cost Shifting Identify health care policies that use cost shifting. Argue the benefits of cost shifting. How might the Affordable Care Act decrease cost shifting within hospitals? Discussion Topic 2: Managed Care In what way does managed care actually manage cost? Does it do so without diminishing the quality of care? If so, how does it accomplish this?

Introduction:

Health care policies have long been focused on managing costs to ensure the sustainability and affordability of healthcare services. Two specific approaches used to manage costs in the healthcare system are cost shifting and managed care. Cost shifting refers to the practice of shifting financial burdens from one party to another, often resulting in increased costs for patients. On the other hand, managed care is a system that aims to control costs by coordinating and managing healthcare services. This paper will discuss these two topics in detail, analyzing the policies that implement cost shifting, arguing the benefits of cost shifting, and examining how managed care manages costs while maintaining the quality of care.

Discussion Topic 1: Cost Shifting

Health care policies have implemented the strategy of cost shifting in various ways to manage escalating healthcare costs. One significant example of cost shifting is the increasing reliance on high deductible health plans (HDHPs). HDHPs require individuals to pay higher out-of-pocket expenses before their health insurance coverage kicks in. By requiring patients to pay more for their healthcare services, cost shifting encourages individuals to be more mindful of their healthcare utilization. This leads to reduced overall healthcare costs as patients become more judicious about seeking medical care, opting for less expensive options whenever possible.

Another policy that employs cost shifting is the implementation of copayments and coinsurance. These cost-sharing mechanisms require patients to contribute a certain percentage or fixed amount for each healthcare service they receive. By shifting a portion of the financial burden onto patients, cost shifting encourages individuals to think twice before seeking unnecessary medical care. Moreover, copayments and coinsurance provide an additional source of revenue for healthcare providers, helping offset costs that would otherwise be borne solely by insurance companies or government programs.

The benefits of cost shifting in healthcare policies are multifaceted. Firstly, cost shifting can help control healthcare costs by incentivizing patients to be more cost-conscious about their healthcare decisions. When patients are responsible for a larger portion of their healthcare expenses, they are more likely to seek lower-cost alternatives and avoid unnecessary or nonessential treatments. This behavior helps reduce the overall demand for healthcare services, consequently reducing costs and preventing the overutilization of services.

Secondly, cost shifting can facilitate the sustainability of health insurance programs. With the rising costs of healthcare, various insurance programs (public and private) face financial challenges in sustaining coverage for individuals. To address this, cost shifting ensures that some of the financial burden is transferred to patients, reducing the strain on insurance programs and making them more financially viable in the long term. By sharing costs, the implementation of cost shifting can prevent insurance programs from becoming financially unsustainable, thus safeguarding access to healthcare for a broader population.

The Affordable Care Act (ACA), also known as Obamacare, includes provisions aimed at decreasing cost shifting within hospitals. The ACA expands access to health insurance coverage, particularly through the Medicaid expansion, the creation of health insurance marketplaces, and the individual mandate. By increasing the number of individuals with health insurance, the ACA aims to reduce the number of uninsured individuals who would typically bear a significant portion of costs through cost shifting. With more insured patients, hospitals can rely on insurance reimbursements, reducing the need for cost shifting as a means to recover costs. Additionally, the ACA imposes limits on the amount of cost shifting that hospitals can implement, preventing excessive financial burdens on patients. Overall, the ACA seeks to mitigate cost shifting within hospitals by increasing the number of insured individuals and reducing the financial burden on patients.

Discussion Topic 2: Managed Care

Managed care is a systematic approach to healthcare delivery that aims to manage costs while maintaining quality care. The primary goal of managed care is to coordinate healthcare services to ensure that patients receive appropriate, timely, and cost-effective care. One of the ways managed care manages costs is through the utilization of a primary care gatekeeper model. In this model, individuals are required to choose a primary care physician who acts as a gatekeeper for all their medical needs. The primary care physician is responsible for coordinating the patient’s care and making referrals to specialists when necessary.