The inside story of hospitals?! The secrets of medical expenses that are worth knowing are revealed!
Hello, this is John! This time, I'm going to tackle a somewhat difficult topic. But don't worry! I'll explain the behind-the-scenes of medical expenses in an easy-to-understand way, using analogies and familiar examples. The topic this time is, "If a hospital has a specific medical insurance, does it affect the medical expenses of other insurances?"
What is Medicare Advantage?
First, let me explain the technical terms that will be used in this article. "Medicare Advantage (MA)" is one of the medical insurance systems for elderly people in the United States, called "Medicare." It is similar to National Health Insurance in Japan. There are various types of Medicare Advantage plans, and each has its own network (affiliation) of hospitals and medical institutions.
The topic of this article is to explore the question: does being in a particular Medicare Advantage network affect the medical fees (medical fees) that a hospital receives from other private health insurance plans?
Hospital negotiation techniques!?
Why does this matter? Because many insurance companies offer both Medicare Advantage and private insurance, which means that when hospitals negotiate rates with Medicare Advantage insurers, the results of those negotiations can affect private insurance rates as well.
It's like negotiating with a greengrocer, saying, "I'm going to buy a lot today, so please give me a discount!" Hospitals may also be using various strategies when negotiating with insurance companies.
Two possible scenarios
Researcher Marr and his colleagues considered two scenarios for how private medical costs would change when a hospital joins a particular Medicare Advantage network.
- Pattern 1: Improve your negotiating skills!
- Pattern 2: Discount war!?
By joining the Medicare Advantage network, hospitals may see an increase in patients. This could allow them to be more aggressive in negotiating with private insurance companies, saying, "Our hospital is popular, so patients will come even if we charge higher medical fees!" In other words, private medical fees may rise.
Conversely, if Medicare Advantage medical costs are low, hospitals may think, "Since we're doing our best to keep medical costs low for Medicare Advantage, maybe we can give private insurance companies a little discount..." In other words, private medical costs may go down.
Which pattern occurs will depend on various factors, such as the strategies of hospitals and insurance companies, and local conditions.
What's the truth? Check out the research results!
Marr and his colleagues' research examines how private medical costs change when a hospital joins a specific Medicare Advantage network. We'll leave out the details of the data and analysis methods (because it would be difficult!), but what did the study's results tell us?
Well... (The original article contains detailed analysis results, but we won't go into the specific results here to prioritize clarity. If you're interested, be sure to read the original article!)
Summary: Understand how medical expenses work!
In this article, we discussed how if a hospital has a certain medical insurance, it may affect the medical expenses of other insurances. The medical expenses system is complicated, but knowing even a little bit about it may give you an opportunity to think about your own medical expenses.
I hope that after reading this article, you'll think, "Oh, I didn't know that could happen!" If you'd like to know more about medical expenses, please check out the various information available.
Personally, I found it interesting that medical costs change depending on negotiations between hospitals and insurance companies. There are a lot of negotiations going on behind the scenes that we don't know about. I hope there will be more transparency about medical costs.
This article is based on the following original articles and is summarized from the author's perspective:
How does hospital participation in a Medicare Advantage
preferred network impact commercial reimbursement?