The billing and payment system in healthcare is an economic joke and is indefensible. Given all that occurs in medical billing, it is impossible to make sense of pricing, thus the value proposition is incomprehensible.
Determining patient responsibility is not the same as knowing the price. Why should any payer (if they are paying the majority or all of the bill) pay more for strep throat in the ER than if treatment was rendered in a doctor’s office? It is precisely the low cost of entry to high cost venues for non-serious problems that allows this to happen, which is a direct result of the way we bill and pay for care.
In the ideal world, the advent of innovative payment models would arise out of the quest to find the “sweet spot”. That spot would seek to align incentives while balancing risk, maximizing efficiency, increase quality of service & outcomes and control costs. Our current system looks NOTHING like what I just described and it can never achieve those goals. So why do we put up with it?