Health Care Expenditures

Rising health care costs became an issue after the Medicare and Medicaid programs were formed in 1965 and have continued to be a factor in the United States economy since then. “By1970, U.S. government expenditures for health care services and supplies had grown by 140%, from $7.9 billion to $18.9 billion.”() By the 1990s the annual increase in the government health care expenditures was finally brought under control and has fluctuated between a 5% and 8% increase each year since then. This essay will discuss the different factors contributing to the rising costs of health care in the United States, as well as how the cost of health care affects the accessibility and quality of medical care throughout American history.

Health care costs have been rising for several years. Expenditures in the United States on health care surpassed $2.3 trillion in 2008, more than three times the

The purpose of this paper is to review and discuss the current level of national healthcare expenditures and to determine if we as Americans are spending too much on healthcare. The author of this paper will provide examples and solutions where we as a nation should add or cut from the healthcare expenditures. This paper will also detail how the general public's healthcare needs are being paid for, the biggest economic healthcare challenge, why the challenge should be addressed, and how this challenge to be financed.

| Prospective Payment System (PPS) first began in 1980 with a small number of hospitals partitioned into three groups according to their budget positions---breakeven, surplus, and deficit--- prior to the imposition of DRG payment (Diagnosis- related group). The PPS as DRG’s had been designed to limit the share of hospital revenues derived from the Medicare program budget, and in spite of doubtful results in New Jersey, it was decided in 1983 to impose DRG’s on hospitals nationwide.

Another factor that has contributed to the over-utilization and increased treatment charges is the fact that providers set the prices for services. Patients were free to seek any type of healthcare services that they thought they required for their well-being, while providers set the costs for each service that was billed to indemnity insurance companies (Shi & Singh, 2015). Insurance companies had little control on the types of services that the patient received and prices billed for each service. The fee-for-service model encourages excessive and unwarranted procedures and offers no incentives to utilize economical services

The method in which healthcare services are funded has gone through many changes over the past fifty years. The country has seen the expansion of insurance from paying medical bills for hospital stays, to the creation of managed care, and the passing of the Affordable Care Act (ACA). In order to prevent future issues with financial options for healthcare services, healthcare administrators must analyze past funding systems to understand the oversights and misinterpretations. This paper will investigate fee-for-service practices and how this practice led uncontrolled utilization.

The Inpatient Prospective Payment System is based on CMS (Medicare) standards because it is the largest reimburser. It was created to control rising healthcare costs by determining reimbursement prospectively. The costs of inpatient acute hospitals stays under Medicare Part A are fixed so that each patient case aligns with a Diagnosis Related Group (DRG).

Today, health care issues within the United States are still a major concern in regards to where people of our communities do not always agree with what is being done and what is not being done. The three major issues with health care spending is how much is it going to cost and where is the money going to come from? The amount of per-patient costs have doubled more in the United States than other nations around us. The last issue is the amount of Americans that has no health care at all. This paper will discuss the healthcare expenditures that is necessary for our entire population.

Based on the political and economic environments of states and the federal government the methods of health care reimbursement have been required to evolve. With the introduction of the Patient Protection and Affordable Care Act (PPACA) new laws have been set into place that has caused a stringent review of spending on health care. All care provided is being examined for effectiveness, quality, and the actual need of the service. Unnecessary health care functions are being screened and eliminated. The government and other insurance providers have begun to place cost containment measures in place only paying for those procedures that are deemed medically necessary for the illness that the patient is currently afflicted with. This has a direct impact on the monies that the government and insurance providers will reimburse for services. The following paper will look at the major types of reimbursement activates currently in place. The writer of this paper will also speculate on the future of health care reimbursement and how it will affect his current organization.

In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals had to manage efficiently the treatment provided to a client and reduce the client’s length of stay (Jacob & Cherry, 2007). Case management, or internal case management “within the walls” of the health care facilities was created to streamline costs while maintaining quality care (Jacob & Cherry, 2007).

Healthcare spending growth rate trends show astounding estimates. Since 1960, spending has risen from $27 billion ($143 per capita, 5.1% pf GDP) to amazing $1,678.9 billion ($5,670 per capita, 15.3% of GDP, 2003 data) (HHS, 2005). Recent research estimated that by 2013, healthcare spending will be as high as 18.4% of the Growth Domestic Product. It is important to note that the gradual move from hospital to ambulatory setting has resulted in much higher spending on outpatient hospital services and prescription drugs. The spending growth for these two trends is much higher than the overall healthcare cost growth, which, in fact, increases faster than such important economic indicators as GDP growth, inflation growth, and population growth rates.

According the Department of Health and Human Services, total health care spending in the U.S. reached $2.3 trillion in 2008, or $7,681 per person. As a share of GDP, healthcare expenditures set a new record of 16.2 percent. That’s double the 8.1 percent share of GDP in 1975, and it is triple the 5.2 percent share of GDP in 1960. (Perry, 2010) Last year in 2012, total U.S. health care spending hit $2.807 trillion, or $8,948 per person. (Geisel, 2013) Its rate of increase has been relatively low since 2009, at

“The biggest problem with health care is not with insurance or politics. It is that we are measuring the wrong things the wrong way” (Kaplan & Porter, 2011, p. 46). Total healthcare expenditures and expenditures as a percentage of GDP have been considerably higher in the U.S. Hospital care, physician and clinical services, and drug prescription expenditures have been the principal components contributing to growth in healthcare expenditures in the U.S. compared to other countries. The study also analyses and compares the growth of healthcare costs. Three different perspectives on the health care “cost crisis” are understanding the value of health care, most health care costs are fixed and healthcare cost covered by health insurance program. In this paper share ideas to help solve the cost crisis in healthcare.

The payment rate for inpatient stay is determined by a system called inpatient prospective payment system (IPPS). This system was created by Center for Medicare & Medicaid Services (CMS) to pair up the extent of the patient’s health position in line with the payment received for those inpatient services. This system organizes the severity of the patient’s visit in the hospital along with a method called “medical severity-diagnosis related group” and is used for the basis for that payment. The basis for the rate of payment is determined by the resources used during the patient’s hospital visit and is assigned one diagnosis-related group. To come up with this payment rate a set dollar amount is used with this calculation. This plan is performed

Prospective Payment Systems (PPS) determines the payment a medical facility will receive by evaluating preestablished criteria. The reimbursement amount will only be based on the preestablished criteria (glossary). PPS helps decrease health care spending because the health care facility knows that they will only receive a reimbursement amount that is based on PPS's preestablished criteria. Implementation of the PPS has proven to be a success towards reducing hospital costs, especially for Medicare patient. The health care facility will have limits on spending due to fewer inputs coming in.