HLTH 4115 Week 7 Price and Access Discussion Post Example

Week 7 Discussion: Initial Post

Who the Easy Plan Leaves Out: Price, Medicaid and the Northside Clinic's Second Segment

The easiest plan for our proposed walk-in injury clinic would be built around commercially insured youth sports families. They are concentrated in a few northern ZIP codes, reachable through league sponsorships and school newsletters and well paid for by their insurers. A plan built only for them would leave out the roughly one resident in four in the area who is on Medicaid or uninsured (illustrative figures for a composite county), and in particular the families on the two Medicaid plans that the orthopedic group's clinic does not accept. Those families now take a child with a broken wrist to the emergency department and wait.

My position is that the clinic should contract with every Medicaid plan in the county from opening day, post a single self-pay price for a visit and an X-ray, and apply the hospital's financial assistance policy at the front desk rather than after a bill arrives. This will lower the clinic's average payment per visit. I think it is still the right plan for three reasons. First, it is what the charter asks: a nonprofit hospital must keep a financial assistance policy and publicize it widely (26 U.S.C. § 501(r)), and a new clinic is the place where that publicity reaches people. Second, it fills a real market gap rather than splitting an existing one with the orthopedic group. Third, community benefit spending at tax-exempt hospitals has been criticized for varying widely and for putting little into services aimed at community health needs (Young et al., 2013); a clinic designed around an access gap is a visible answer to that criticism.

I am not claiming the clinic can serve everyone equally. Older adults with falls are deliberately out of scope, and the clinic cannot offer surgeon visits on site. The tension between price and access is real, and the plan resolves it by choosing access for one named group and accepting the cost, rather than by saying the clinic serves all. The course text makes the point that pricing in health care is also a statement about whom a service is for (Berkowitz, 2017).

Reply to Megan H.

Megan, you argued that a clinic that loses money will close, and then it serves no one, so the hospital should open with commercial plans and add Medicaid once the clinic is established. That is a serious point. My concern is that later rarely comes, because a clinic that opens without Medicaid builds its schedule, staffing and reputation around the patients it has. I would rather open with all plans and set a break-even target that assumes the payer mix the market assessment found. If the clinic cannot meet that target, the hospital should know it before opening, not discover it by dropping patients a year in.

Reply to Andre J.

Andre, your proposal for a sliding-scale self-pay price based on income is more generous than my single posted price, and I like the intent. My worry is practical: a sliding scale needs income documents at a walk-in front desk on a Saturday evening, which slows care and may embarrass families. Your post did change one part of my plan. I would combine the single posted price with a one-question screen at check-in, asking whether the family would like information about financial help, and process the hospital's assistance application afterward so it applies to the visit already given.

References

Additional requirements for certain hospitals, 26 U.S.C. § 501(r) (2023).

Berkowitz, E. N. (2017). Essentials of health care marketing (4th ed.). Jones & Bartlett Learning.

Young, G. J., Chou, C. H., Alexander, J., Lee, S. Y. D., & Raver, E. (2013). Provision of community benefits by tax-exempt U.S. hospitals. New England Journal of Medicine, 368(16), 1519-1527. https://doi.org/10.1056/NEJMsa1210239