Outpatient Treatment Evolution: The Role of Healthcare Exchanges

This essay explores the transformative impact of healthcare exchanges on outpatient treatment. Healthcare exchanges, designed to promote competitive health coverage markets, offer standardized insurance plans for individuals, families, and small businesses. The shift towards healthcare exchanges is expected to reduce the cost of outpatient care by requiring a breakdown of services, including primary care, mental health, and specialist visits. Managed insurance plans will likely require policyholders to access care within designated networks, potentially increasing out-of-pocket costs for out-of-network services or even denying coverage. Additionally, some care plans may necessitate selecting an outpatient care physician to oversee treatment, which could also lead to coverage denials in certain cases. The increasing popularity and potential cost reduction of outpatient healthcare, driven by the widespread implementation of healthcare exchanges, is a significant trend, although it may introduce complexities related to network access and coverage.

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How will healthcare exchanges change the concept of outpatient treatment?
Organisations that are known to promote competitive and structured markets
supportive of purchase of health coverage are known as health insurance market-place or
simply health exchanges. Such healthcare exchanges offer health insurance plans that are
standardised and cater to small businesses, families and individuals. It would be noteworthy
to adjudge how healthcare exchanges might modify the existing concept of outpatient
treatment.
Outpatient care is the medical service provided by a healthcare facility wherein the
patient is not required to stay at the facility for a long duration. Fundamental routine services
are the basic element of the outpatient treatment process, and thus such care is less expensive
as compared to inpatient care wherein patients are required to stay at the facility for a longer
duration. For the purpose of healthcare exchanges or insurances, most outpatient care would
be required to be broken out on the basis of the services provided. These would include
primary care physician, mental health, specialist and so on. As a result of the widespread
implementation of the concept of healthcare exchange, outpatient care would become lesser
expensive. Outpatient healthcare is found to be increasing in popularity. It can be expected
that it would get cheaper in the coming years if healthcare exchange is more widely
implemented and the trend is likely to continue prominently (Buchbinder & Shanks, 2016).
As opined by Choi et al., (2016) healthcare exchange would make a drastic mark on the care
service delivery in the form of outpatient care. Managed insurance plans would be requiring
policy holders to access care from the network of designated care providers. This would be
dependent on the different levels of coverage. If patient desires to get access to care outside
the network, a higher percentage of the cost might be required to be paid. In certain instances,
the insurance company might be refusing payment for certain services obtained out of the
network. This would be inconvenient for the patients at large. Further, a number of care plans

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at the outpatient care department entails patients to select an outpatient care physician
overseeing the care and recommendations are made relevant to the treatment. In such cases,
the companies might be denying coverage for services to patients.

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References
Buchbinder, S. B., & Shanks, N. H. (Eds.). (2016). Introduction to health care management.
Jones & Bartlett Publishers.
Choi, N. G., DiNitto, D. M., & Marti, C. N. (2016). Relationship between the types of
insurance coverage and outpatient mental health treatment use among older
adults. Journal of Applied Gerontology, 35(12), 1343-1362.