Pay For Value In Healthcare

In Japan, prices for every procedure and drug are negotiated every two years between the physicians and the government. The prices are fixed and the same regardless of where you go in Japan for treatment (Reid, 2008). In the United States, different healthcare plans offer a variety of coverage for medications but some prescriptions can be denied by the insurance company based on your type of insurance plan. Drug companies are very competitive in the United States and prices are expensive. Frequently, insurance companies might cover a similar or generic form of medication rather than the brand name medication and insurance co-pays differ depending on which drug is prescribed.

“The Bitter Pill: Why medical bills are killing us” written by Steven Brill delves into the question as to why medical bills are so high. As Brill begins his research he analyzed bills from hospitals, doctors, and drug companies. Additionally, he interviewed doctors, Medicare and insurance administrators, and gathered patient stories across the nation. He found that the United States spent more money on healthcare than any other developed countries, he stated “We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy, [however], we spent almost that much last week on healthcare” (Brill 2013). He also noted “yet in every measurable way, the results our healthcare system produces are no better and often worse than the outcomes in those countries” (Brill 2013). From the charts and graphs that Brill provided shows that the sixty percent of personal bankruptcy filings per year are related to medical bills. Life expectancy in the United States is the lowest amongst the countries that spend most on healthcare, our infant mortality rank is fiftieth in the world, and that one pill cost as much as seven pills in other developed countries such as France. Brill found that in many similar cases, like that ones he presented in the article, Medicare would have at least paid for a small portion of the bill. However, those who don’t qualify for Medicaid and don’t have insurance are often asked to pay excessive prices.

Now a statute, the physician/hospital pay for quality, not quantity, public law number: 114-10 signed April 16, 2015 also referenced as H.R.2 —1st Session of 114th Congress (2015-2016), sometimes called the “Permanent Doc Fix” 04/14/2015 : Passed Senate; 03/26/2015 : Passed House (Medicare Access and CHIP Reauthorization Act of 2015, 2015), which defines the payment and reimbursement reform to doctors treating patients with Medicare. This extensive reform includes the CHIP program insuring children and those families that don’t qualify for Medicare but are unable to afford private insurance and is funded by the federal government and individual states.

The High Cost of Healing Barbara Bauman HCS/440 April 21, 2014 Dr. David Moody The High Cost of Healing The cost of health care has been at the forefront of politics for years. It is one of the most talked about topics not just in political venues but also country wide.

Prescription Drug Prices in the U.S. The prices of prescription drugs in the United States are by far the highest in the world. [1] On average, Europeans pay 40% less than Americans for the same medications. [2] Consumers have been resorting to several ways, sometimes putting themselves in harm’s way, to alleviate the burden of high prescription drug costs. Some buy their medications online or cross the borders to neighboring countries so they would be able to afford buying their needed medications. Others have resorted to the illegal act of selling their unused medications in online forums just to recover part of their expenses. Many factors contribute to the increased drug prices in the United States including research and

patient care. In addition, the main clinical decisions are made not by doctors, HMOs are not the only answers to cost control. Most physicians practicing in the United States consider their profession to be very much a form of art (Kleinke). The definition of art infers that within its sphere there are many variations and preferences. After all, one should not ask Picasso to carve like Michelangelo. Physicians too differ in their methods of treating patients. However when needless tests and procedures are done the treatment will cost more. This is waste. Many suggest that cutting waste will lead to a cut in quality. This is not necessarily true. Consider the following: an otherwise healthy forty-year-old male

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

Hill Physicians The U.S. spends more resources on healthcare than any other nation. Yet, the The Commonwealth Fund (2014, para. 1) claim the U.S. health system consistently ranks last or near last relative to other industrialized nations regarding health outcomes. Consequently, insurance companies are adopting a value-based reimbursement system

There are so many different health care providers and types of health care services that we as consumers can receive. All those different services or facilities are going to have competitive prices for our medical care. I think a patient as a consumers are going to benefit from this. Not only do medical facilities have competitive prices but also insurance

Assignment 1: Value Proposition in Patient Care Tabitha Christina Trisvan HSA 501 Management in Healthcare Dr. Judy Jean January 25, 2015 1. The meaning of value-added service Responsible Reform for the Middle Class stated, The Patient Protection and Affordable Care Act will ensure that all Americans have access to quality, affordable health care and will create the transformation within the health care system necessary to contain costs. One part of the transformation is the creation of value proposition. Value proposition is a promise of value to be delivered. Value is defined as “a fair return or equivalent in goods, services, or money for something exchanged; the monetary worth of something; market price; or the

Besides, the financial incentives for hospitals and physicians that belong to ACOs, Jaffery & Golden 2013, asked and then answered the question “why would providers join this program? One reason is to prepare for the future”. Fee-for-service reimbursement, which has been how hospitals get paid for their services rely solely on the volume of patient seen without taking into consideration the quality of care provided. Payers today, such as government, commercial insurers, employers, and individual consumers are now requesting on value -based-payment, which consist of delivering the highest level of care at a lower cost. The volume based system even though the traditional way of how payments are made is not a viable long-term option (Jaffery and Golden, 2013, p.98).

Anyone who has purchased prescription medications has probably wondered why they cost so much, and rightfully so. Medication prices in the United States have been on a steady increase for decades, however, prices have been drastically increasing as of recent. Pharmaceutical companies have tried to justify these price increases due

“In effect, fee-for-service is open-ended: It's like going to an auto mechanic and agreeing to pay for whatever services he deems necessary, at whatever price he chooses, with no penalties to the provider if the service is poor” (Pecore & Doherty, 2009). A reason given to the skyrocketing cost of healthcare is to protect clinicians from malpractice lawsuits. A name given to it is defensive medicine, in which providers do extensive tests, repeat tests, and in some cases over prescribe medication to avoid malpractice suits in the case of any big risks procedures should be done to the patient (Pecore & Doherty, 2009). The more services they provide the more money they get paid. Basically, at the end of the bill, the patient is still over paying for unsatisfied/unnecessary

Influence of Cost on the U.S. Healthcare System When talking about the United States healthcare system, it seems any conversation centers around cost. Whether it is corporations or employers talking about rising healthcare premiums that are out of control, to American families discussing getting less coverage for the amount of the premium they pay, or the soon to be retired person who wonders how they will make it with the high cost of Medicare premiums and prescription drugs. The challenge continues to be delivering world class healthcare at an affordable cost to all stakeholders. The cost of healthcare continues to impact the dominating delivery system of Managed Care here in the United States.

Since the NHS is a publicly funded healthcare system, healthcare costs are rising and the NHS foundation trusts are facing a deficit of £321m, a policy that assesses the cost-effectiveness of interventions is highly important. (NHS foundation trusts, 2015) Cost-effectiveness looks at drugs and treatments through an economic lens: how