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Out-of-Network Costs: Impacts on Patient Experience and Health Outcomes

Nielsen, Matthew Stanley (2022) Out-of-Network Costs: Impacts on Patient Experience and Health Outcomes. Master Essay, University of Pittsburgh.

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The issue discussed throughout this paper is the influence of out-of-network costs on the healthcare system. In-network and out-of-network charges are something that most people with insurance have heard of. Networks were created to reduce the overall cost of healthcare, but they also have come with several side-effects. These side-effects include increased cost when services are considered “out-of-network” and decreased access for patients that have to go farther to reach an “in-network” provider. These side-effects can negatively impact a patient’s life just as much as a medical side-effect. Networks also makes it more difficult for physicians to be able to effectively treat and refer their patients. While in most cases physicians know where to refer their patients within their networks, that does not mean the referral is the best physician for their patient to see or the physician their patient would prefer to see. Networks take advantage of the value of volume at the cost of patient experience, by funneling volume to specific physicians or hospitals the cost is discounted. This discount is often passed along to the patients in the form of cost reduction but comes with the disadvantage of certain restrictions. Networks have their benefits but, they can also lead providers to overcharge “out-of-network” patients for the same services they provide to “in-network” patients. We need to create a system that prevents providers from overcharging for their services without decreasing the value of those services.
All change comes with consequences whether intentional or unintentional. We must continue seeking cost-effective ways to improve the patient experience and overall healthcare system. Networks are meant to reduce the price physicians charge. There are many potential opportunities to reduce the negative effects of networks that effectively maintain the cost reduction seen from networks without creating barriers to access for patients. A policy change like this would result in other consequences, and more planning is necessary for such an initiative be successful. With the correct leadership and research, this could make a significant impact in the long-term effectiveness of the U.S healthcare system.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Nielsen, Matthew Stanleymsn21@pitt.edumsn21
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairPerri, Angelaangelaperri@pitt.eduangelaperriUNSPECIFIED
Committee MemberSalter, Cynthiacys6@pitt.educys6UNSPECIFIED
Date: 16 May 2022
Date Type: Completion
Submission Date: 13 April 2022
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 39
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: MHA - Master of Health Administration
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: n/a
Date Deposited: 16 May 2022 18:27
Last Modified: 16 May 2022 18:27


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