Unnecessary services are provided far too often because there is little coordination across sites or among providers, yet care management, cross disciplinary care, and preventive care are often uncovered or poorly reimbursed. Notably, 45% of the U.S. population have chronic conditions requiring care management. Of this population, 60 million, or roughly half of those with chronic conditions, have multiple conditions. Current care delivery systems are not designed to support the care of these complex patients, which requires multiple providers and services.
There are many issues that are causing changings in the healthcare system. Population aging, rapidly increasing costs of healthcare and the growing burden of chronic disease are challenges to health systems worldwide. To meet these challenges will require new approaches to healthcare delivery and comprehensive population health management. Many states are not prepared to tackle this issue yet. The US has the most expensive healthcare system in the world with health status indicators that are only average in comparison
The United States healthcare system has undergone a wide variety of changes over the past few years. As the overall health of its citizens continues to deteriorate and people live longer, certain aspects of healthcare are costing an increasingly large portion of the healthcare budget. Problems such as obesity, diabetes, cancer, and substance abuse have become the most pressing issues facing healthcare providers today.
An aspect of Medicare and Medicaid that is important to look at is disease management because this affects budget and financial costs for both patient and government. Before we can look at the issue itself we need to be able to define what Disease Management is. According to Wikipedia.org (Wikipedia, 2008) disease management is “a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. It is the process of reducing healthcare costs and/or improving quality of life for individuals by preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care.” The Centers for Medicare and Medicaid (CMS) organized a study to determine if disease management programs helped reduce costs for long term care for chronic conditions. Approximately 300,000 Medicare participants took part in about 35 programs. The idea was to assist these Medicare patients with chronic illnesses such as COPD, severe heart conditions, cancer and other conditions between office visits to prevent hospitalizations. The goal was to reduce the costs that accumulate with hospital visits, help the patient to have a better quality of life and the program save money (American Journal Health Pharmacy, 2009). The program worked as follows: health care providers were supposed to work with patients in return for receiving a small fee from CMS. The
Despite the great accomplishments and many changes the United States health care payment system has made over the years, it is not a surprise that the system still continues to face serious challenges. Our country offers advanced technology and medicine, but it still has millions of Americans who do not have proper coverage to meet their medical needs or are uninsured and therefore cannot benefit from our advanced system. This raises a serious concern in population health, which makes us questions the country’s current system. The United States has commercial and government insurance options with different premiums and levels of coverage for its citizens. However, our complex system presents many flaws that lead Americans to live
Decreasing healthcare “cost” has been repeatedly debated for decades now. Despite tremendous efforts to reduce cost, the US Healthcare System is still struggling to deliver an effective and affordable level of care. Not only the cost of healthcare is higher in the U.S., there is also much waste due to unnecessary laboratory, radiology & other investigations, unwanted hospitalizations, procedures, longer hospital stay, preventable emergency room visits, and a lot of medications waste, that costs the U.S. $750 billion annually according to IOM in 2012 (Glicksman E. , 2015).
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
Cost containment is a way for the U.S health care delivery system to solve inflation in cost which will save money for the hospitals involved. According to “Health Care Cost Containment: A Contradiction in Terms?” cost inflation has many contributors including the increased cost in hospitalization, advancing medical technology, prescription drugs, professional degrees, legal settlements, and other related services (McConnell CR, 2002, p.70-71). All of these contributors are coming from different aspects of the health care delivery system but they all end up with the same results. Cost containment effort ideas can solve all of those problems as long as they are properly implemented and people really believe in helping to keep costs at a
Medicaid is a vital lifeline for some 72 million Americans. Two-thirds of all Medicaid spending supports senior citizens and persons with disabilities. Cutting Medicaid would jeopardize the quality of healthcare, long-term services, and nursing home care for tens of millions of Americans. There are significant cost issues in America’s healthcare system that must be effectively addressed, but these challenges will not be remedied by benefit cuts to vulnerable
Throughout the United States a rapidly increasing burden of chronic preventable illness is threatening the nation’s economy, government and public health (Strange and Woolf, 2008). Spending over 16% of its gross national product on health care, the United States ranks 37th in the world for effectiveness of health care (WHO, 2008). Under this model, care resources are concentrated on treating advanced disease rather than focusing on prevention. Conversely, only 2-3% of health care dollars spent are allocated for prevention (Strange and Woolf, 2008).
The nation health care system is facing significant challenges that requiring immediate major reforms. Lately close attention is drawn to the uninsured Americans, such as the most painful dilemmas of health care system. The problem of uninsured and uncompensated care continues significantly contribute to the rise of the health care cost and has been a chief topic for public debates and political campaigns for a long time. The purpose of this paper is to describe the current extent of uninsured care and provide the strategies from the nursing point of view how to change the trajectory of this prevalent issue in the USA health care system.
Health care costs have become a major issue in the United States, both socially and politically. According to the U.S. Census Bureau, 50.7 million people, or nearly one in six U.S. residents, were uninsured in 2009 (Kaiser Health News, 2010).This is because the high cost of health care has driven the cost of insurance out of the reach of many Americans.
President Obama signed into law the Patient Protection and Affordable Care Act, more commonly known as ACA, in March 2010, to reign in the excessive costs of healthcare in the United States. Three key goals of the newly adopted healthcare reform are improving quality and lowering healthcare costs, elimination of pre-existing condition clause, and increased access to healthcare (HHS, 2015). In 2015 more than 11.4 million people signed up for ACA in the second year; most of them uninsured in prior years (HHS, 2015).
The cost of health explains almost half of the budgets of the state from financing the Medicaid program to providing health care for the employees of the state and other less qualified population like the prisoners (Vanderbeaux, 2014). In America, thousands upon thousands of decisions concerning health care are made by State legislatures every year (Vanderbeaux, 2014). Some of those decisions involve how best to provide appropriate care more efficiently, and deciding on what age group of patients needs to be immunized (Vanderbeaux, 2014).
Health care is something we all must be concerned with. Costs are constantly rising and most plans demand a huge amount of money in regard to deductibles and out of pocket max. However, there are some simple ways you can begin controlling health care costs. Keep the following in mind when you are going through this process.