“These investments could lead to further governmental influence, calls for greater oversight and compliance, and for even greater privatization of services such as continuing the growth of the Medicare Advantage program or eventual centralization of services toward a single-payer system,” Smith says. “Each would lead to demands for greater accountability and better accessibility to health and healthcare services and lower costs.”
Furthermore, under a Clinton administration Mack expects to see some type of bundled payment system. “We will see continued experimentation of commercial accountable care organizations or private exchanges in which self-insured employers, including hospitals, create their own HMOs and/or partner with national insurers to control the defined contribution costs of insurance,” he says. “These organizations compete in the market on premium pricing and quality. Some of these initiatives have already been successful by shifting price risk to employees. The challenge for insurers, and particularly for providers, is true cost reduction rather than merely shifting risk from employers and/or providers to insurers with larger risk pools, and increasing value to consumers.”
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.