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Role of third-party payers in the healthcare world

The need of third-party payers

The potential risk of illness naturally will lead people to demand some help or protection against it, but not all patients are able to pay for the care and services rendered. Private health insurance companies and government programs as the third-party payers help to mitigate the controversy between health care consumers and providers by bearing the health care related expenditures. On one hand, health care consumers seek to maximize their medical services. They desire to get advanced high-quality treatments, but want or can afford to pay just minimum amount of the cost for that. On the other hand, health care providers seek to make hospital profits as large as possible and as soon as they can because they are business organizations and no one want to work for free.

There is definitely should be someone who could compromise and protect the first and second parties. In addition, among other things those parties meant to mitigate the ethical issues to insure that health care will stay basic human right for everyone. Therefore, third-party payers were found to help managing the financial risk associated with the purchasing of health related care, products, and services. They play an important role in the health care system especially if taking into account the fact that the incidence of illness and the cost of treatment associated with that in most cases are uncertain from both hospitals (providers) and individuals (consumers) perspectives.

Does third-party really change everything in health care world for the better?

Unfortunately, anything is perfect and third-party payers are also a blessing and a curse for the U.S. health care system at the same time. Those payers seek to minimize their costs and control for their budgets which is understandable from one point of view because many (if not all) organizations want to decrease their expenditures in order to boost their profits. Health care insurance companies want to increase their chances for survival and therefore stay in business.

However, even though the third-party payers somewhat ease collection of account receivables for health care providers from pretty much big percentage of patients, but some physicians might have different opinions about health care insurances motives and strategies. They think that those third-parties are over controlling and make doctors depend too much on them. The conflict of interests is often time an issue. In addition, since majority of health care insurance companies are tied to employment there are approximately 15 percent of population is uninsured in the U.S. (at the time this article was published).

Pervasive third-party payers affect the structure of the medical care industry. They vastly influence just about everything related to decision making process in health care, such as the quantity, quality, and cost of care or services offered. Government, as the single largest insurer and payer of health expenditures in the country, acts as provider of last resort for those who cannot pay for care. However, such government programs expenses as for Medicare, Medicaid, and public hospitals are ones of the largest in its budget. It might create problems of handling that in the future.