Health Care Case Study

An efficient health care system is one that treats illnesses in the most cost-effective way. When a patient is given a choice between therapies, an efficient system will use the less costly of the two, other things being equal. But, as of right now the U.S. health care system, meaning, patients and their doctors do not always choose less costly therapies because they face distorted incentives. On the average, every time a patient spends a dollar on medical care, only 21 cents comes out of

For patients with chronic conditions, costs, even with insurance, can add up very quickly with numerous doctor’s visits, emergency room visits, and hospital admissions. The CDC (2016), states, “Treating people with chronic diseases accounts for 86% of the nation’s health care costs” (Center of Disease Control and Prevention, 2016). Despite the amount of time and money spent preventing and treating

Critics of traditional system of volume-based payment, highlighted problem areas like inappropriate emergency department use, low generic prescription drug utilization, and redundant high-cost imaging studies (Jaffery and Golden, 2017, p. 99). Every year in the U.S patients make 1 billion visits to physician offices with an estimated cost of about 600 billion dollars each year (Ganguli, Wasfy, & Ferris,2015). Routine health visits for adults is schedule every 3,6, or 12 months, the frequency does not translate into efficient care being delivered (Ganguli et al., 2015). In the

To answer your question, in some cases, patients with limited coverage, we try to adjust the payments. Hence, we give the specific amount that patient could afford and still receive a high quality

Do you think insurance companies will pay for this type of treatment? Why or why

A key step in clinically integrated networks collaborates physicians will bargain with payers or insurers on behalf of patients.

that delivers better outcomes that is more cost efficient and value to the patient's medical needs.

There are greater benefits to the quality of life and effectiveness of medical treatments through this approach.

Financial Incentives in CDHPs: The principle behind CDHPs is that they increase the premium that patients have in their choices about utilization of therapeutic care. Patients who devour medicinal care and exhaust their PHA could be using the resource that they can keep and use their benefit in the future. Contrasted with patients with traditional insurance arrangements, in any event for spending beneath the

While the basic metal tier system may cover a good portion of the general care, there is a serious gap in the coverage for medicine. 54% of the silver health plans offered have a separate drug deductibles. In addition, 72% of those plans require coinsurance after that deductible for the highest tier drugs. The price for any treatment also varies significantly by plan and by state. This presents special difficulties for cancer patients who lack the information to compare different plans. Unpredictable prices for treatment exacerbate the financial burden of trying to pay for their medicine. One of easiest ways mitigate costs for cancer patients is to amend the way in which drugs classified. Under the essential benefits provision, all health care

This action means that people will not receive some drugs or treatment if the cost of providing the services is higher than the benefits. In one occasion, a man with terminal lung cancer received free cancer treatment for many years. However, when a new promising cancer treatment emerged, he could not receive the treatment because the benefit was marginal compared to the cost of the treatment (Silberner, 2008). Such decisions only apply in a system whereby the government provides care to all citizens but on a limited budget. Britain also provides some types of care less frequently than the US. These care services include dialysis and coronary artery surgery. This only shows that Britain has a health system that focuses on providing basic care and limits costs by only allowing care that has adequate value. On the other hand, the US has no mechanism of restricting care that has little or no value most of which is unnecessary. Despite the higher spending in health care, US adults are less healthy than adults from other industrialized countries like Britain and Canada (Commonwealth Fund, 2008).

This should help lower all over cost. This introduces mental health parity. What is Mental Health Parity? The Substance Abuse and Mental Health Services Administration website explains that Mental health parity “describes the equal treatment of mental health conditions and substance use disorders in insurance plans…it means that if you are provided unlimited doctor visits for a chronic condition like diabetes then they must offer unlimited visits for a

4. The service does not cost far more than a treatment that is just as likely to work for the problem.”

Healthcare payers are focused on cost-effective measures. Payers prefer providers treat with fewer visits and reduce the number of tests conducted by following a clear evidence based diagnostic plan.

Another factor contributing to the decision of a patient is insurance. According to William Collinge of the American Holistic Health Association, only a few insurance companies in a few states offer coverage for just a handful of the