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Article Critique

Article Reviewed:

LaPointe, J. (2016). Market Power, Not Quality Linked to Higher Healthcare Costs. Revcycle Intelligence. https://revcycleintelligence.com/news/market-power-not-quality-linked-to-higher-healthcare-costs

The article, Market Power, Not Quality Linked to Higher Healthcare Costs, by Jacqueline LaPointe, seeks to address the association between the cost of healthcare and the enhanced market power and essential quality care (LaPointe, 2016). Jacqueline Lapointe is the Editorial Director for RevCycleIntelligence. She graduated from King’s College London with a doctorate in English Literature. According to the author, medical expenses are up to 2.7 times more high-priced in some infirmaries due to heightened market power. In her article, she indicates that more expensive healthcare facilities have developed market advantages, such as higher market share, greater healthcare regulatory engagement, rural state, and more limited competition (LaPointe, 2016). Nevertheless, other studies discovered that progressed markets leverage limited competition, product modification, care clarity, and medical expense containment approaches that might minimize variation and improvements.

Analysis

According to LaPointe’s (2016) article, healthcare costs are higher in some healthcare facilities because of the increased power market. The author advocates that with stronger contracting capability with payers, healthcare facilities with added market power have more powerful claims payment valuations and reduced incentives to reduce care expenses and rates. In her article, Lapointe identified that market power resulted in notable price variation among healthcare facilities for similar services. LaPointe (2016) also identified that healthcare expenses at the highest-priced hospitals are two times extra costly than the lowest-priced health care facility in the community. The author indicates that even healthcare facilities in the corresponding peer group including scope, services, and teaching classification, encounter notable cost disparity. Remarkable healthcare organizations have medical expenses three to four times more expensive than their rivals.

The article indicates that healthcare cost variations are not consistently associated with care diversities. According to Fulton (2017), based on twelve hospitals’ performance on twelve quality standards, the scholars discovered no connection between healthcare facilities’ performances and cost. This signifies that no local groups or insurers consistently compensated high-quality healthcare organizations with tremendous reimbursement levels than their lower-performing rivals. Neither did they punish lower-quality organizations with more inferior compensation standards (Syverson, 2019). Instead, LaPointe discovered that market advantage was intimately related to increased healthcare expenses in New York healthcare facilities. Healthcare organizations with increased costs and prices tend to have a bigger market portion, are a part of a more comprehensive healthcare scheme, have rural standing, and encounter scarcer contestants. 

According to the article, to improve healthcare costs, the health organization recommends that the states interpret claims compensation approaches, restrict some contractual conversation from healthcare facilities and payer agreements, and advance market dysfunction observation (Kanter et al., 2019). Moreover, the article indicates that healthcare stakeholders can better comprehend infirmaries costs if claims reimbursement approaches are simplified. For instance, hospitals should acknowledge demanding payers to adopt the similar Diagnosis Related Group for inpatient compensation and outpatient infirmary payment program.

Regarding the article’s strength and usefulness, the author clarifies the association between healthcare costs and the enhanced market power, and more eminent quality care. Moreover, the article offers suggestions on how healthcare facilities should revise healthcare costs and ensure high-quality care. These suggestions might permit the insurer and healthcare facilities to arrange various foundation standards or multipliers. They might offer a standardization level to infirmary compensation that might make prices more efficiently comparable.

I would suggest this article to a friend due to various reasons. For instance, I have learned that Healthcare facilities should restrict some contractual semantics from claims payment agreements including confidentiality, anti-steering, and tiered system ban conditions, to reduce medical expenses over the long-term (Papanicolas et al., 2018). According to the article, prohibiting such language would enhance clearness and improve overall values in the short-term as reduced-priced providers might necessitate higher payment. Moreover, I have learned that States should implement measures that designate how tiered systems should convene similar standards.

Conclusion

The article, Market Power, Not Quality Linked to Higher Healthcare Costs, by Jacqueline LaPointe, seeks to address the association between healthcare costs and improved market power and quality care. According to LaPointe’s article, healthcare costs are higher in some healthcare facilities because of the increased power market. Her article indicates that more expensive healthcare facilities have developed market advantages, such as more prominent market division, comprehensive healthcare regularity engagement, rural standing, and more limited competition.  LaPointe discovered that market advantage was more related to increased healthcare costs. I have learned that Healthcare facilities should reconsider banning some contractual semantics from claims payment agreements, including confidentiality, anti-steering, and tiered system forbiddance conditions, to reduce medical expenses over the long-term. The article is essential in future research since it provides reliable information about the association between healthcare costs and the increased market power.

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