Introduction
Reforms form an intrinsic part of a healthcare system and that is why the sector is continually dynamic in its practices and operations. Substantially, the stakeholders in healthcare are impacted by the changes when they occur. By the fact that well-being of every individual is important to a national government for economic planning, the policies that regulate healthcare are of great significance. Accordingly, this paper seeks to explore reform legislation in the US, the No Surprise Act (NSA), with regards to its effects on the stakeholders in the health sector.
No Surprise Act and the Stakeholders Impacted
The US federal administration has passed a law to cushion its medical service users from surprise healthcare charges. This legislation is the NSA which became effective in early January of 2022. Principally, the Act authorizes convalescents to be informed of medical costs in advance to reduce unanticipated expenses (Keith et al., 2020). There are two means in which the bill helps the consumer. Primarily, valetudinarians are safeguarded against surprise medical bills emanating from out-of-network care for emergency services and certain scheduled medical ministrations without their antecedent consent (Lucia & Hoadley, 2021). Secondly, the law gives the right to non-insured patients and those who are not using insurance to receive a scrupulous estimate of their possible physic bill when scheduled three days in advance (Lucia & Hoadley, 2021). Notably, the NSA impacts different categories of individuals who form the stakeholders in healthcare.
Stakeholders that are impacted by the NSA include patients, healthcare professionals, and medical facilities such as hospitals. Valetudinarians are the central focus of the NSA as they are the ones majorly protected by the law. Indeed, they are the major beneficiaries of the regulation (Richman et al., 2021). The second group of individuals who are impacted by the law is the medics who diagnose and treat patients. This regulation regulates the charges by a health professional in terms of either being in-network or out-of-network with a patient (Richman et al., 2021). Providers of healthcare services form the third group of stakeholders whose activities are impacted by the NSA. In the case of providers as well, the law determines the medical costs that a patient incurs depending on whether the convalescent has registered with them or not. Given these stakeholders, the NSA ties all of them towards ensuring quality health.
Financial Impacts of the No Surprises Act
The NSA has a financial impact on all the three stakeholders aforementioned. For the patients, the NSA streamlines financial expenses for receptors of healthcare services as they are made aware of the anticipated medical bills. As a result, this helps most families to save monies that would otherwise be used for medical expenses (Richman et al., 2021). Concerning the healthcare providers, they are obligated to provide good faith estimates for self-pay and uninsured patients. The financial impact of this is the standardized market rates for the medical charges which lead to leveled competition among healthcare providers (Richman et al., 2021). Remarkably, the NSA makes health professionals savvier in submitting bids to receive more reimbursements for diagnostic or medical services they offer. This is because if they lose in the arbitration between them and their patients before the Independent and Dispute Resolution (IDR) committees, they are required to pay for the expenses of all the parties (Keith et al., 2020). However, the enactment of the NSA has brought benefits to some of the stakeholders.
Benefits and Drawbacks of the No Surprises Act
In understanding the benefits that are associated with the NSA, the outcomes of the bills are viewed from a positive viewpoint. For the patients, the NSA has safeguarded them against unexpected medical bills that result from emergency and non-emergency healthcare services rendered by out-of-network providers. Besides, the law has assuaged the competition and price wars that may emanate from different providers, by setting a framework to determine applicable out-of-network payment for healthcare services (Richman et al., 2021). Clearly, NSA has its positive impacts on the patients and healthcare industry as well.
Inarguably, the NSA is the greatest reprieve for many US patients who receive emergency and non-emergency services. Nevertheless, there are two kinds of stakeholders that have been impacted by this legislation. Among the adversely affected groups are the health professionals and medical facilities or healthcare providers (Lucia & Hoadley, 2021). For instance, many small private practice amenities are being forced to join large insurance networks as their main source of their revenues, surprise billing has been destroyed. On the part of health professionals, the law has exposed them to dispute resolution mechanisms which are disadvantageous to them for two reasons. These are time wastage and heavy financial penalties in cases where they have lost a petition against a patient before an IDR committee (Lucia & Hoadley, 2021). Therefore, the NSA act is a law that has its drawbacks, more so for healthcare professionals and providers.
Conclusion
In summary, the NSA is an important law in the US by its provisions. The regulation impacts all the stakeholders in the health industry. In simple terms, the law safeguards all the consumers of healthcare services against surprising artificially high medical bills for the emergency and non-emergency services received. Since the regulation deals with finances, it is undeniable that it has a great impact on the financial decisions of both patients and healthcare professionals. As such the law is beneficial to the consumers as opposed to many medical practitioners and healthcare facilities.
References
Keith, K., Hoadley, J., & Lucia, K. (2020). Unpacking the No Surprises Act: An opportunity to protect millions. Health Affairs Journal. Web.
Lucia, K., & Hoadley, J. (2021). The No Surprises Act: A bipartisan achievement to protect consumers from unexpected medical bills. Journal of Health Politics, Policy, and Law. Web.
Richman, B., Hall, M., & Schulman, K. (2021). The No Surprises Act and informed financial consent. The New England Journal of Medicine, 385(15), 1348-51. Web.