Health care costs are a major worry for many Americans, especially in the wake of the COVID-19 virus. Health insurance can help protect individuals and families from the financial burden of surprising medical expenses, but it can also be costly and complex to navigate. How can one balance one’s health budget and health insurance to achieve affordability, ease of understanding and have a variety of options?
One possible approach is to expand insurance coverage to more people, especially those who are uninsured or underinsured. This can help to decrease uncompensated care costs, improve health outcomes, and further health balance. The Affordable Care Act (ACA) has made substantial progress in expanding coverage through Medicaid, premium tax credits, and other reforms, but more work is needed to close the coverage gap and address affordability challenges, especially regarding healthcare budget.
Another practical approach to improving healthcare is to incorporate health insurance strategies that aim to quicken the transition to value-based care, which is a fee model that rewards providers for presenting high-quality, cost-effective care rather than for the volume of services. Value-based care can help to position incentives amongst payers, providers, and patients, and encourage care coordination, prevention, and innovation. Medicare, Medicaid, and private insurers have been experimenting with various value-based payment arrangements, such as Accountable Care Organizations (ACOs), bundled payments, and shared savings programs.
A third possible strategy is to move ahead with home-based care, which is the delivery of health care aid in the patient’s home rather than in a hospital or other facility. Home-based care can benefit in reducing hospitalizations, readmissions, infections, and costs, as well as improve patient approval and quality of life. Home-based care can include telehealth, remote monitoring, home health aides, and calming care.
A fourth possible strategy is to improve the affordability of drugs and other therapeutics, which are a major driver of health care spending. The health insurance strategies can be done by fostering competition, openness, and innovation in the pharmaceutical marketplace; controlling prices; negotiating discounts; and encouraging the use of generics and biosimilars¹.
A fifth possible strategy is to develop a high-value labor force that can meet the existing and future needs of the health system. This can be done by investing in education, training, retention, and diversity of health professionals; expanding the scope of practice and roles of nurses, pharmacists, and other allied health workers; and addressing workforce shortages and maldistribution¹.
By balancing one’s healthcare budget and health insurance using these strategies, one can achieve better access, affordability, and equity in health care.
