Low Reimbursement Rural Insurance Reimbursement

¶ … Low Reimbursement Rural

Insurance reimbursement as a term represents the amount of money paid (n most cases) directly to a care provider or provisional institution for services rendered by patients. In the case of private insurance as well as Medicare (that provided for the elderly with state and federal funds associated with employee tax withholding) the patient is then required to further compensate the provider with co-pays. While in the case of Medicaid (often called by other names in different states) has very limited or no patient liability as the service is provided on a low income or income earning potential basis, in the case of disability or limited income, and often both. Research over the years has indicated that rural communities are more affected by the outcomes of low reimbursement plans, and especially Medicaid plans as the low reimbursement with no matched percentage coming from patients on a scale that is determined by the level of care received, as well as the level of credential carried by the provider. (Mechanic, 2006, p. 186) This disproportion is felt in a myriad of ways which are briefly discussed in this work.

The development of reimbursement plans by both Medicaid, Medicare (other state and local insurance assistance systems) and private insurance have always been different. The reality being that in the case of Medicaid, the insurance available via state administration and paid for by both state and federal match contributions has had the lowest reimbursement rates available. Additionally, disproportionate numbers of low income peoples, often due to limited opportunity, live in rural settings, where available health care resources are limited where they exist at all. The disproportion of availability has always been an issue in rural/urban research, yet it is also clear that low reimbursement offered by Medicare and Medicaid (where the patient frequently pays no or very small co-pays and has no further responsibility for expenses) further limits the ability of individuals to find and receive adequate care in rural settings, where they are already limited. (Showalter, 1997, p. 75) (Romzek & Johnston, 2002, p. 423) (Havighurst & Richman, 2006, p. 7)

Low reimbursement causes reduced numbers of care providers and care providers with limited credentials who also receive even lower reimbursement, limited opportunity and limitations on how many perceived low reimbursement patients they will treat at all. In addition it has been shown in some cases to cause providers to commit fraud by billing for services not provided to make up the difference caused by low reimbursement and similarly and possibly even worse provide unnecessary medical care to patients to increase reimbursement per patient receiving low reimbursement coverage. (Mechanic, 2006, p. 11) (Sparrow, 2000, p. 9) Lastly, low reimbursement may be a the center of concerns about cost shifting to private insured persons, private insurance reimbursement contracts and those with the least bargaining power private pay patients, though there is good evidence that this is limited in rural provider offices and institutions as compared to those in urban settings. (Kula, 2004, p. 490) This phenomena known as cost shifting effects both urban and rural settings, on an economy of scale, as well as by the sheer fact that rural communities are then afforded more limited care. (Kula, 2004, p. 490)