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Overhauling the US health care payment system

  • The hugely inefficient US health care payment system is ripe for transformation.
  • The inefficiency is concentrated in the $250 billion that consumers pay doctors and hospitals and the $1.3 trillion that insurers send to these providers. The heart of the problem is a mix of high transaction-processing costs and the lack of an efficient way to make consumer-to-provider payments.
  • Over the next five years, rapid innovation may lead to a restructuring of the value chain of health care payments and to a shift in the sector’s balance of power. Financial institutions have an opportunity to take on a more prominent role, while payers risk losing influence to new entrants. Providers stand to benefit as fewer dollars are wasted on transaction-processing inefficiencies.
This article contains the following exhibits:
  • Exhibit 1: Inefficiency in the health care system is concentrated in the payment flows to medical providers from consumers and insurance companies.
  • Exhibit 2: The health care payment system is more complicated and less efficient than payment systems in the retail sector.
  • Exhibit 3: Consumer bad debt is already a significant problem for providers and is growing fast.
  • Exhibit 4: Transactions between payers and providers are numerous and complex.

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