The intersection of healthcare procurement and health insurance policies in Medicare and Medicaid administration
1 Department of Business Administration, Washington University in St.Louis, Missouri, USA.
2 Department of Human Development and Family Science, University of Central Missouri, Warrensburg, Missouri, USA.
3 Department of Business Administration, School of Business, University of Sunderland, London, United Kingdom.
4 School of Medicine, St.George’s University, St. George, Grenada.
5 Department of Psychology, University of Ilorin, Ilorin, Nigeria.
Review Article
GSC Advanced Research and Reviews, 2025, 22(01), 362-372.
Article DOI: 10.30574/gscarr.2025.22.1.0030
Publication history:
Received on 22 December 2024; revised on 28 January 2025; accepted on 31 January 2025
Abstract:
This comprehensive review examines the complex relationship between healthcare procurement processes and health insurance policies within the Medicare and Medicaid systems in the United States. The study analyzes how procurement strategies influence healthcare delivery, cost management, and patient outcomes while considering the intricate policy frameworks governing these public insurance programs. Through analysis of existing literature, policy documents, and administrative data, this review identifies key challenges and opportunities at the intersection of procurement and insurance administration. The research reveals significant variations in procurement practices across states and their impact on healthcare access, quality, and cost-effectiveness. Notable findings include the critical role of value-based purchasing initiatives, the influence of formulary management on pharmaceutical procurement, and the evolving landscape of managed care contracting. The study also highlights the importance of data integration and technological infrastructure in improving procurement efficiency and insurance administration. The findings suggest that optimizing the alignment between procurement strategies and insurance policies could significantly enhance healthcare delivery efficiency while maintaining program sustainability.
Keywords:
Healthcare procurement optimization; Medicare administration; Medicaid policy framework; Value-based purchasing; Insurance policy integration; Healthcare cost management
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Copyright information:
Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0
