ealth care in America can make a simple question, like asking how much seeing a specialist will cost, extraordinarily complicated. Even with the limited price transparency we now have, research suggests mixed results about whether transparency leads to reduced cost. In this post I hope to shed some light on a process—the financing of health care—that is often opaque to patients and providers.

While you may have a vague understanding of how health insurance works, my aim is to provide a better sense, at a very high-level, of how people gain access to a health system, and the specialists and other providers who work there.

Health care in the United States has been called uniquely inefficient. It is a complex system dependent on multiple actors, each with their own motivations. It is saturated with emotional elements that you don’t find in other consumer industries. And it includes much more than the patient-provider interaction. Health care financing and administration—the apparatus that, when it is working, supports and facilitates the physician-patient relationship—consists of insurers, HR departments, employers, brokers, and the health care system itself.

While already a bit complicated, let's deconstruct this enchilada to illustrate the many steps buried within that process.

Our health system, University of Utah Health, has over 1,600+ physicians spread across four hospitals and 15 clinics, not to mention the various outreach sites we have established partnerships with over time.  We have over 300 contracts with insurance companies (we call them “payers”). This means these companies have signed contracts with us, giving their customers (companies/employers) access to our services.

Those payers then create a package of offerings and sell services (for example, the ability to access our system and the healthcare providers we employ or contract with) to companies or directly to individuals.

This is not a simple process. Even this level of detail ignores the amount of work within, and between, each of the described steps. There is a lot of back-and-forth across this process, from the payers and health systems that determine rates, to employers working to refine the options (and the rates they will pay for the options) available to their employees or customers.

In short, this is just a portion of the world of healthcare financing and contracting that creates so much complication for patients and caregivers. Future posts, in an attempt to provide clarity and transparency, will show other aspects of this system in more detail.

Is there a specific component you want to learn more about? Please comment below.