Health Plan For Increase Expenditure

More and more people with medical insurance are relying on the health care system as new technologies and treatments become available. This leads to a grater number of claims for payment by insurance companies, the costs of which are passed back to health care consumers. The baby-boom generation is entering its peak health-care using period. Over eighty million Americans will turn 50 in the next 10 years. The cost of providing heath care for these individuals will be staggering

The U.S. health care system faces challenges that indicate that the people urgently need to be reform. Attention has rightly focused on the approximately 46 million Americans who are uninsured, and on the many insured Americans who face rapid increases in premiums and out-of-pocket costs. As Congress and the Obama administration consider ways to invest new funds to reduce the number of Americans without insurance coverage, we must simultaneously address shortfalls in the quality and efficiency of care that lead to higher costs and to poor health outcomes. To do otherwise casts doubt on the feasibility and sustainability of coverage expansions and also ensures that our current health care system will continue to have large gaps even for those with access to insurance coverage.

Employers are continuing to face rising health benefit costs and are constantly looking for alternatives to control these escalating costs. Health benefit premiums continue to increase at a double digit pace for employers and employees (Poor, Ross & Tollen, 2004). This escalation is putting environmental pressures on all impacted stakeholders. Companies and insurance providers are squeezing this industry to get a handle on cost while still providing an appropriate level of care. This cycle puts the patient front and center as the ultimate stakeholder who incurs changes in health benefits. This mandate of cost control, efficient operations and market share has facilitated a constant analysis of the dynamic health

Health and human services policymakers expressed the need to move from single –disease solutions to population health interventions. The need is due to a growing public health concern- almost 1 in 3 Americans is diagnosed with multiple chronic conditions and more than 65% of health care spending is for care given to this group. (Kangovi peer research October 2017).

Overall healthcare quality has been improve the overall health of the population under these insurance plans candidates receive free preventative care. With many preventative treatments available it’s essential for healthcare field to shift from treating chronic disease to taking preventative measures beforehand. These programs has been able to improve the financial status of the Medicaid and Medicare programs by creating awareness among enrollees of the importance of preventive health and reduce the impact of obesity.

Regulations that prevent insurance companies from participating in interstate commerce have caused competition to grow stagnant in the United States. This lack of competition has allowed the adoption of wasteful procedures by healthcare providers, which in turn passes the increased expenses back to the insurance companies. Therein, insurance costs increase, crippling consumer’s cash flow and quality of life. While healthcare costs continue to rise, people must scrutinize the current healthcare system.

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

Preventable causes of illnesses like smoking and obesity were left unaddressed, depleting precious resources and increasing costs of care. From the patient perspective, cost sharing measures for preventive services like deductibles, copayments, and coinsurance deterred individuals from undergoing essential preventive services like cancer screening, immunization, and counselling. Ultimately, $277 billion dollars were spent on treating illnesses which could have been prevented by broad based prevention programs, and we incurred a loss of $1.1 trillion dollars due to lost productivity as a result of chronic illnesses.

In the new exchanges, the price and quality of a health plan will be more important than ever for consumers who are trying to get the best value for their money. Insurers who can find ways to reduce claim costs can offer more attractive premiums. One problem that contributes significantly to health care expenses is the overutilization of services. The chief danger of overutilization is that it results in higher medical costs without any accompanying improvements in quality. To be competitive, health plans must ensure that their expenses actually improve quality. Sound benefit design and a focus on providing high quality care can help diminish this problem. Even for plans where overutilization is not a problem, higher quality care can reduce complications, errors, readmissions, and other unnecessary costs. Better

Employers are continuing to face rising health benefit costs and are constantly looking for alternatives to control these escalating costs. Health benefit premiums continue to increase at a double digit pace for employers and employees (Poor, Ross & Tollen, 2004). This escalation is putting environmental pressures on all impacted stakeholders, including insurance and health care providers. Companies and insurance providers are squeezing this industry to get a handle on cost while still providing an appropriate level of care. This cycle puts the patient front and center as the ultimate stakeholder who incurs changes in health benefits.

To reduce chronic disease across the nation, we must rethink our health care system. It is essential to have a coordinated, strategic prevention approach that

Preventive services are only used about half the recommended rat in the U.S. Low utilization has been contributed to cost-sharing, such as co-pays. Chronic diseases are responsible for approximately seventy (70%) percent of deaths in the U.S. each year and seventy-five (75%) of health care costs. These diseases are by and large preventable through proper screening and early detection. At any age, preventive care can avoid or delay the onset of a disease or prevent worsening. Such precautions can lead to long, healthy, productive lives. (Preventive Health Care, 2013).

As we all know, the cost of medical coverage has been the same and not gone down for a while. As it right now, the premiums that we have been paying to cover the health benefits have increased an excessive percentage and that is why we need to find a way to cut overall costs.

Many insurance companies run a for profit business. This requires insurance companies to bring in revenues in excess of their cost. When running a business these companies incur a number of general and administrative costs. These costs are required to ensure day to day operations function. A concern of this for profit model is that insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. The cost of health care continues to rise and those receiving benefits from insurance companies want to ensure the premiums paid are used in support of providing health care to those in need. To understand this division of spending, the Affordable Health Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR).

Hello class. I’m sure everyone knows someone with a chronic disease or conditions like heart disease, stroke, cancer, type 2 diabetes, or obesity. It may be your parents, sibling, best friend, or coworker. In any case, what if there was not a high prevalence rate on any of these chronic diseases or conditions. What if our healthcare system focused on prevention rather than treatment and by doing this saving money. According to Escape Fire, “75% of healthcare cost go to treating disease that are largely preventable” (Heineman & Froemke, 2012). The Centers for Disease Control and prevention also known as the CDC, stated that in 2012 approximately half of all adults had one or more chronic health conditions (CDC, 2017, para. 2). A potential solution to cutting healthcare cost on treatment is having a workplace health program.