Health Reform in the United States
Who should make the decision about whether to provide coverage and reimbursement for a particular good or service? Use the Discussion / Writing Rubric.
Sample Solution
The decision of whether to provide coverage and reimbursement for a particular good or service should be made by both the payer (insurance companies, government agencies, etc.) and providers (hospitals, physicians, pharmacies). For example, as healthcare costs continue to rise it has become important for payers to weigh the cost versus benefit around any given good or service before making an informed decision about whether providing coverage is financially prudent. On the other hand providers must also consider which services are medically necessary and clinically effective in order to ensure that patients receive quality care that meets their individual needs without imposing excessive financial burden on them (Tsimploulis et al., 2020).
In addition to direct stakeholders these decisions can also involve various regulatory bodies such as state insurance commissioners who hold authority over matters related health plan offerings within their respective states. These policy makers often use evidence based guidelines such as those provided by the US Preventive Services Task Force when evaluating potential new reimbursements in order to ensure that community standards related appropriateness care are being met (US Preventive Services Task Force 2019). Thus it is essential that all of the parties involved across this spectrum come together in order make sure everyone’s interests are taken into account while still prioritizing patient safety.
