Reforms Will Alter Health Care, Insurance in 2011

According to a report by PriceWaterhouseCoopers, four major trends in 2011 will sharply redefine the health care industry in America, largely in response to the Affordable Health Care Act.

One thousand adults were surveyed online to gauge their perspectives on reform measures, health care usage, and payment for health care. Every effort was made to create a representative cross-section in terms of age, gender, income, geographic location, and social status.

The results indicated that Americans will make fewer visits to doctors’ office in 2011 in an effort to avoid paying deductibles. In employer-sponsored health care plans, deductibles rose 77 percent from 2003 to 2009, with family coverage premiums going up 41 percent, according to figures compiled by the Commonwealth Fund. Consequently, the average deductibles in 2010 fell in a range of $400-$999.

In 2011, the industry itself will be most focused on the medical loss ratio or MLR. By law insurers must now spend 85 cents per dollar on either medical care or “activities that improve healthcare quality” for large groups and 80 cents for small groups and individuals.

At the same time, hospitals and physicians will be spending record amounts on health information technology to meet new federal requirements for record keeping and patient access to information.

Finally, during the second quarter of 2011, federal grants will become available for the establishment of insurance exchanges, which will likely intensify the debate over what qualifies as a health insurer. Individually and collectively, these shifts in emphasis will redefine insurance “business as usual” in the United States