Logo Rethinking Healthcare Final 2-01
Logo Rethinking Healthcare Final 2-01


 The complexities and challenges in the health insurance industry include:

  • Understanding insurance requirements.
  • Managing charges and obligations.
  • Record-keeping.
  • Administrative burdens.
  • Tackling factors such as claim rejections and medication coverage disputes.

Insurance companies are indifferent to the escalating costs of healthcare and are interested primarily in maintaining a stable loss ratio, which affects their bottom line. Another problem is the ownership of healthcare data and the right of patients to negotiate care prices. This is a potential liability for healthcare providers who diverge from insurance-fixed prices. 

Contributing to the complexity is the trilateral relationship framework introduced by insurance companies, which alters the traditionally bilateral connection between patient and provider.