The intersection of healthcare procurement and health insurance policies in Medicare and Medicaid administration

Shodimu, Oluwabanke Aminat and Balogun, Adeseun Kafayat and Alaba, Helen Ayodimeji and Udokporo, Chukwuebuka Francis and Adebayo, Kaosara Temitope (2025) The intersection of healthcare procurement and health insurance policies in Medicare and Medicaid administration. GSC Advanced Research and Reviews, 22 (1). pp. 362-372. ISSN 2582-4597

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.