Report: Commercial Insurance Flaws Affect Patient Safety, Ability to Pay

By Jonathan Springston, Editor, Relias Media

A new report from the American Hospital Association suggests the costs of premiums for commercial health insurance plans are “increasing at an unsustainable rate — squeezing individuals and families, employers, and public programs” while various bureaucratic hurdles “create dangerous delays in care, contribute to clinician burnout, and significantly drive up administrative costs for the healthcare system.”

According to the report, over the past 11 years, the average cost of premiums for family insurance has risen 47% while hospital prices have gone up 2.1% over the same period. The report authors listed several other problems with the modern commercial insurance landscape, including prior authorization, business conflicts of interest, pharmaceutical “white-bagging,” transaction fees, and “fail-first” policies.

“We recommend identifying and measuring unnecessary administrative costs because of health plan abuses and excessive requirements. Currently, much of this information is reflected in national datasets as spending on hospitals, health systems, and physicians because they are the ones who must absorb the cost of paying staff and acquiring the expensive products needed to comply with these commercial health insurer policies,” the report authors wrote. “We must adopt policies to streamline, standardize, and reform these burdensome processes to reduce administrative inefficiencies.”

This analysis dropped just as the CDC reported that between the first quarter of 2021 and the first quarter of 2022, the share of uninsured American declined 1.5%, representing about 4.4 million additional people who are covered with health insurance. The agency attributed the change to an expansion in private coverage and more federal coverage for qualified individuals.

Earlier this year, several national organizations urged Congress to make permanent the tax credits that help Americans buy plans through insurance marketplaces.

For more on this and related subjects, be sure to read the latest issues of Healthcare Risk Management.