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Doctors and Plans Blame Each Other for Costs

John Commins, for HealthLeaders Media, November 29, 2012

Health plans and physicians pointed fingers at one another this week, with each side blaming the other for market consolidations that they both claim are driving healthcare costs.

However, impartial observers say both sides are to blame and consumers are bearing the cost.

The American Medical Association on Wednesday released the 2012 edition of Competition in Health Insurance: A Comprehensive Study of U.S. Markets. The physicians' association says the report shows widespread anticompetitive health insurance markets in most regions of the country for point-of-service plans, health maintenance organizations, and preferred provider organizations. The report details commercial health insurance market shares and market concentration levels for 385 metropolitan areas in 50 states and the District of Columbia.

"The broad scope of the new AMA analysis provides the most complete picture of the consolidation trend in health insurance markets," AMA President Jeremy A. Lazarus, MD, said in a media release. "The new data demonstrate that most areas of the country have a single health insurer with an anticompetitive share of the HMO, PPO, or POS market."

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3 comments on "Doctors and Plans Blame Each Other for Costs"


JosiePatrick (11/29/2012 at 3:20 PM)
Let me get this straight. Dr. cannot make enough money unless they form larger and larger provider groups and reduce duplication and overhead. And insurers don't want to enter markets because they can't make enough money. Single payer would get rid of both these concerns and get costs under control. Do healthcare consumers really want to pay for either the inefficiencies of competition or the overpricing of monopolies? It's time for insurers to rethink their business model. Time for employers to get out of the healthcare business. And time for providers to carefully consider what their career expectations are.

kerry willis (11/29/2012 at 2:46 PM)
40% of the healthcare dollar is spent on administration...How come the insurance companies only want to "save" on the 60% of healthcare spending that provides jobs and bonuses to administrators...what a joke Additionally the biggest area of spending on physicians that is increasing is with Docs employed by a hospital where the Hospital charges excessive facility fees and negotiates larger reimbursement rates than insurance companies allow private Docs......and the spending increase is whose fault again?

jkuriyan (11/29/2012 at 10:08 AM)
Because of the promotion of integrated care management & delivery ACA encourages provider consolidation so we cannot just talk about breaking up provider groups as a way to increase competition.