The Pie: An Economics Podcast
The Economics of Health Insurance: Denials, Pre-Authorizations, and Cost Control
Feb 18, 2025
Josh Gottlieb, a health economics expert, discusses the burdens of insurance denials on healthcare providers. Zarek Brot-Goldberg delves into how pre-authorizations affect prescription drug choices in Medicare, highlighting the complexity patients face. Maggie Shi reveals the influence of waste-reduction programs in Medicare on both government spending and healthcare practices. Together, they unpack the bureaucratic challenges in the U.S. healthcare system, emphasizing the need for transparency and improved patient access to essential care.
42:55
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Quick takeaways
- Insurance denials create a restrictive environment for patients and doctors, limiting access to care and provider choice.
- Prior authorization processes, while cost-effective for insurers, can lead to patients forgoing essential medications and negatively impact health outcomes.
Deep dives
The Impact of Insurance Denials
Insurance denials play a significant role in shaping treatment decisions within the U.S. healthcare system. The complexity of the system often leaves patients and doctors feeling restricted in their choices due to the bureaucratic processes enforced by insurers. Research indicates that higher rates of claim denials and the administrative burden contribute to a discouraging environment for doctors, prompting some to avoid accepting patients on Medicaid altogether. This dynamic results in limited access to care for patients, who ultimately lose the freedom to choose their healthcare providers.
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