Recommendation : Risks Of Control Expenses

It is no secret that the cost of American healthcare is becoming increasingly more expensive. However, the issue of the rising cost of healthcare and its severity needs to be recognized as a major problem. Health prices are steadily increasing in the United States, and there is no sign of it stopping. Since 1970, spending on American health care has grown 9.8%, which is a rate that is growing faster than the economy (“New Technology”.) Furthermore, health insurance premiums are also increasing at a rate five times faster than American salaries, which makes it difficult for families to afford health care coverage (Zuckerman 28). Therefore, it has become an obligation to address why the cost of American health care is soaring and to seek out a solution to lower the cost. Many would jump to the conclusion that the United States simply charges too much for their medical services, but there are deeper influences that need to be analyzed. The causes of the rising cost of health care are people not using preventive health care, the development of modern technology, and the treatments being overprescribed. A possible solution is to have preventive health care services available in clinics of low-income areas.

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

Rising health insurance premiums have made healthcare unaffordable in the United States. Health insurance premiums in this country have undergone a steady rise over the past few years while incomes have remained the same. More than 50% of individuals with low incomes holding private insurance in the United States are unable to afford their healthcare costs (Collins, Gunja, Doty & Buetel, 2015). In addition, costs related to healthcare are equally unaffordable to 25% of working-age individuals who hold private health insurance policies (Collins et al., 2015). According to the Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) survey on employer health benefits, employer-sponsored health insurance plans have also had moderate rises in premiums in 2013 for both individuals and family coverage (Claxton et al., 2013). While

The Affordable Care Act has made many positive changes for uninsured and underinsured citizens. With the addition of a program called Health Insurance Marketplace, it is now possible for uninsured people in every state to purchase private insurance plans, those making under 400% or less of the Federal Poverty Level will be able to have tax credits making insurance more affordable (Lathrop & Hodnicki, 2014). Insurance companies are no longer allowed to cancel a policy or raise rates when a client gets sick. Insurance companies cannot refuse coverage to individuals with preexisting conditions such as cancer (“Quality Improvement,” 2015). Insurance companies now must cover preventive care and screenings allowing diseases like cancer to be caught early (“Quality Improvement,” 2015). Research has shown that through health screenings

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

Another downside to High Deductible Health Plan (HDHP) is the apprehensiveness to use the insurance, even the benefits that are free or at a low cost. “Enrollees in high-deductible health plans are likely to reduce the preventive care use and are largely; because they are unaware of the fact that preventive care benefits are free or at a low cost (Dolan February 2016).” Recent analysis showed that low-income workers were more likely than higher earners to avoid certain kinds of care when they were enrolled in high-deductible plans coupled with savings accounts. The analysis from the Employee Benefit Research Institute, found that low-income people even skipped free preventive services like flu shots and cut back on doctors’ visits. Primary and preventive

For those Americans not covered or find their work coverage too expensive, there is a new way for them to buy insurance on their own called Health Insurance Marketplaces. Some states have named these marketplaces something else. The Health Insurance Marketplace is like a virtual insurance megamall where private insurers compete for American’s business. Americans can pick out how much coverage they want, how much they want to pay for it, from cheaper high deductible plans to more expensive plans. Regardless what plan is chosen, all plans will cover a complete set of services like hospital visits, doctor visits,

Most working class Americans get healthcare insurance through their employer and or purchase their coverage through a private insurance. What most of us don’t know is how the premiums we pay for our coverage are calculated. Cost of premiums area a direct reflection of the costs associated with our consumption of medical services. Cost of medical services includes doctor visits, hospital stays, and medical devices as our consumption of these services increase premiums also increase. (“America’s Health Insurance Plans - Premiums 101 – How Are Health Insurance Premiums Determined?,” n.d.)

This article discusses about the impact of Medicare coverage expansion under the Affordable Care Act (ACA). In 2011, the Medicare coverage was expanded to fully cover preventive care visits; the annual wellness visit for the Medicare beneficiaries (Chung et al., 2015). The wide range of preventive services such as a review of the patient’s medical and family history; the measurement and recording of biometrics such as blood pressure and body-mass index; screening for cognitive impairment, depression, functional ability, and level of safety; planning end-of-life care; and education, counseling, and referrals for other personalized preventive services are covered under the annual wellness visit. Chung and colleagues conducted a study to determine the use of preventive care visits among older adults, who live in the Northern California. They looked at the data from 2007 through 2013, to assess the utilization of preventive services before and after the expansion among the Medicare fee-for service; also known as Medicare Part B enrollees. In addition, the usage among Medicare Part B enrollees were compared with the Medicare health maintenance organization (HMO) plan; also known as Medicare Advantage and private insurance.

Many other glaring needs of health care reform were addressed through the ACA, but I want to focus on three main ripple effects that I believe need to be tackled in order to create a more well-balanced, consumer friendly health insurance market. 1) The amount of quality health insurance plans in America is dramatically decreasing: Health insurance used to be readily available in tiers; the highest tier, being the most comprehensive, had the highest monthly premium, but a low deductible (a patient’s out-of-pocket costs for surgeries, emergency visits, etc.). While the lower tier, which offered basic health care for routine visits, had a higher deductible. Today, insurance companies are being forced to offer “more affordable” plans,

Within the previous four years, the number of uninsured Americans has jumped to forty five million people. Beginning in the 1980’s, the American Academy of Family Physicians (AAFP) has been trying to fix this problem of health insurance coverage for everyone with a basic reform. The AAFP’s plan imagined every American with insured coverage for necessary improved services that fall between the crucial health benefits and the surprising costs. (Sweeney) They expect by fostering prevention, and early prevention, with early diagnosis with treatment, the program would result in decreased health system costs and increased productivity through healthier lives. The way to achieve health care coverage

The element of “choice” needs to be incorporated back into healthcare equation. American citizens have the right to choose, control and carry out their own plans for health care. Under the current system, individual liberties are slowly being stripped away while health care spending continues to spiral out of control. The following legislative plan eliminates waste and encourages enlightened, responsible choices made by businesses and individuals. Programs like Medicaid need to be streamlined and modernized to meet patient-centered goals (The Heritage Foundation, 2013). Another element of choice involves the promotion of alternative ways to seek portable healthcare including the utilization of health savings accounts and offering incentives such as pay-for-performance and rewarding progression from government assistance to employer-based care (The Heritage Foundation, 2013) The integration of Auto-enrollment technology into employer based-care statistically show to improve registration rates. (The Patient’s Choice Act of 2009, n.d.).

Many employees must designate a health plan through their employer. These days, as HMOs (health maintenance organizations) and managed care plans continue to proliferate, that means a choice between bad and worse. As employees line up in the lunch-room for a process called open enrollment, they may be surprised to learn that managed care rates have gone up — again. The mirage that managed care is cheaper care is finally fading. And, for the first time in years, employees may also have the promise of free choice in medicine in the form of a new method of financing health care. Consumers are already aware of horror stories involving HMOs, but cheap rates persuaded many that managed care is less expensive. Recent

The higher cost of affordable Health care is also eroding the ease with which to afford other insurance that covers about 30 percent of Medicare enrollees ‘expenses. In 2005, about 89 percent of beneficiaries obtained such additional coverage, including through former employers (33 percent), medical policies (25 percent), Medicare advantage plans (13 percent), Medicaid (16 percent), or other programs (1 percent) (MedPAC). These supplemental insurance programs were all very helpful at the onset, but with the passage of time and as health care costs continued to rise, employers are finding it difficult to support these programs and as a consequence, a greater number of these employers are either reducing the benefit or eliminating these benefits especially those that affects their retirees thereby increasing the cost of these supplemental insurances.

Offer financial incentives for people to adopt healthier behaviors and to obtain recommended clinical preventive services. Individuals and families may be more motivated to give up unhealthy behaviors and to obtain recommended tests and immunizations if there are financial incentives. These can include lower premiums for health insurance and other insurance products and cash rewards when appropriate. For example, offer families between $100 and $200 per member for obtaining preventive health screenings. A growing number of employers and health plans offer members lower premiums or other financial incentives if they are non-smokers or maintain healthy body weights. Universal health care coverage, access to basic medical services, particularly