Healthcare Access and Pricing Transparency

This assignment delves into two critical aspects of the US healthcare system: price transparency and access for women. The first section examines the need for greater transparency in medical pricing, highlighting how it empowers patients and potentially leads to a more equitable healthcare market. The second section focuses on persistent disparities in women's health coverage, despite advancements made by the Affordable Care Act (ACA). The paper analyzes examples of essential services often excluded from insurance plans, ultimately hindering access to care for women.

Running head: 8005 MODULE DISCUSSION 1
8005 Module Discussion
Name
Institution

8005 MODULE DISCUSSION 2
Discussion 1
8005 Module Discussion
According to Sinaiko and Rosenthal, “one approach for decreasing spending is to
increase price pellucidity in health care” (Sinaiko & Rosenthal, 2011). Reducing excessive health
care costs is a substantive topic in the US health care system. Rising costs contribute to long-
term deficits that hinder the United States’ ability to grow the economy and create jobs ("Deficit-
Reducing Health Care Reform", 2016). Slowing the growth of these costs is vital to fiscal
stability (Sinaiko & Rosenthal, 2011).
Recently, more patients are obtaining high-deductible health plans (HDHPs). Therefore,
the need for transparent pricing has become more important to these patients. Before their plan
covers any costs, they can be liable for thousands of dollars (Kane & Harvey, 2015). In 2014,
only Maine and Massachusetts performed well in regards to medical price transparency laws.
Some laws require providers to respond to patient cost inquiries by providing direct cost
estimates or procedure codes that the patient can submit to their insurance provider and obtain an
estimate (Kane & Harvey, 2015) Additionally, there are health systems, such as Texas Health
Resources (THR) that use pricing tools offering estimates.
The opacity regarding cost in health care contributes to high costs. If patients knew
approximate costs of certain procedures, it would allow them to shop around. It would empower
the patient and give them control over their expenditures. The result of this would hopefully be a
uniform pricing system, where one hospital cannot charge 2,000 dollars for an MRI while

8005 MODULE DISCUSSION 3
another charges 1,000. Dialogue between insurers and providers are necessary for proper
negotiations of reimbursements..
Discussion 2
Women Denied Necessary Coverage
The article I selected highlighted continued gaps in health coverage specifically related to
women. Since the implementation of the Affordable Care Act (ACA), more women have
obtained coverage because it forbids practices that victimize women. The authors reviewed
health plans from 109 health providers throughout sixteen states for 2014, 2015, or both years.
They discovered that six services were consistently not covered.
These service include maintenance therapy for conditions that typically affect women;
genetic testing which can help women determine best treatment plans for breast or gynecological
cancers; fetal reduction surgery to improve chances of a successful pregnancy; treatment of
injuries associated with attempted suicide; and prophylactic services such as mastectomies,
removal of ovaries and fallopian tubes (Palanker & Davenport, 2016).
Lack of Coverage Equals Lack of Access
According to Shi and Singh, “access to health care is a right that should be definite to all
Americans” (Shi & Singh, 2015). However, there are two disparities to this social justice
principle. The first is “all citizens have a right to the identical level of care” and the second is “all
citizens have a right to some minimal care level” (Shi & Singh, 2015). The US has not defined
their definition of access to care regarding policy. In the article, the authors showed that women
in various parts of the United States were being denied coverage on certain items they needed,
which ultimately denies them access to care. Therefore, women who obtain health care coverage

8005 MODULE DISCUSSION 4
which can be a significant investment for some women, are still unable to receive the care they
need.
Evaluation
As a female health care administrator, this would impact my work because these issues
could affect me depending on where I work. Being a health care administrator, part of our job is
to have knowledge about events that occur in legislature. As health care delivery changes, this
issue would be something that I would follow closely. It is surprising that women still face
discrimination when it comes to health care. The fact that an insurance company would not cover
a procedure that would increase the chances of a successful pregnancy or increase women’s
mortality through a prophylactic mastectomy is disheartening.

8005 MODULE DISCUSSION 5
Reference
Deficit-Reducing Health Care Reform. (2016). The White House. Retrieved 3 August 2016, from
https://www.whitehouse.gov/economy/reform/deficit-reducing-health-care-reform
Hostetter, M. & Klein, S. (2016). Health Care Price Transparency: Can It Promote High-Value
Care?. Commonwealthfund.org. Retrieved 3 August 2016, from
http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/april-
may/in-focus
Kane, C. S., & Harvey, G. (2015). Demystifying patient price estimates. The advantages of
transparency. Healthcare Financial Management: Journal Of The Healthcare Financial
Management Association, 69(5), 78-82.
Laureate Education (Producer). (2015b). Future challenges of the health care system - Part 1
[Video file]. Baltimore, MD: Author.
Palanker, D. & Davenport, K. (2016). Women's Health Coverage Since the ACA: Improvements
for Most, But Insurer Exclusions Put Many at Risk. Commonwealthfund.org. Retrieved
12 August 2016, from
http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/womens-health-
coverage-since-aca
Shi, L., & Singh, D. (2015). Delivering health care in America: A systems approach (6th ed.).
Burlington, MA: Jones & Bartlett.
Sinaiko, A. & Rosenthal, M. (2011). Increased Price Transparency in Health Care — Challenges
and Potential Effects. New England Journal Of Medicine, 364(10), 891-894.
http://dx.doi.org/10.1056/nejmp1100041