The hCentive Company

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

McKesson, now “the world’s largest health care services company,” has a combined customer base of about 5000 hospitals, 25,000 retail pharmacies, 35,000 physician practices, 10,000 extended care sites, 450 pharmaceutical manufactures, and 2000 medical-surgical manufacturers (Chicago tribune 1998). Mckesson has a 13.2% market share of the Health Information Technology industry and employs roughly 37,000 people. Mckesson’s hospital information system solutions includes their electronic health record system (HER, Total Coordinated Care product suite, InterQual Decision support products,

“The amount people pay for health insurance increased 30 percent from 2001 to 2005, while income for the same period of time only increased 3 percent.” (Source: Robert Wood Johnson Foundation). The rising cost of healthcare is a huge problem in America today. In this paper I will analyze the different issues and causes for the increase in cost.

Health care economics studies such issues as demand for medical care, pharmaceutical prices, competition among health care providers and insurers, and financing of health care services. Castor Collins has put together a plan which will help solve many issues facing the organization. The plan is built to maximize profit for the company and minimize the risk of poor choices provided to individuals who will cause the organization to fall.

The cost of healthcare has and will continue to rise in the United States. Some factors that contribute to those hikes are due to the consumer demanding more complex services from health care providers. Things such as new technology, equipment, research and testing procedures, along with pharmacy, and the number of uninsured are all dynamics of the increased cost in health care. The U.S. health care system relies heavily on third-party payers; these payers include commercial insurers and the Federal and state governments. According to the Centers for Medicare and Medicaid Services, or CMS, the National Health Expenditure grew 3.6% to $2.9 trillion in 2013, or $9,255 per person, and accounted for 17.4% of Gross Domestic Product (GDP). Id.

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.

HCA is a healthcare provider that was established in 1968. Their main focus is on offering cliental with a number of different services to include: inpatient, intensive care, outpatient, diagnostic and emergency services. To achieve these objectives they operate a variety of facilities such as: outpatient, psychiatric, surgery centers, freestanding emergency care facilities, diagnostic / imaging centers and comprehensive rehabilitation / physical therapy centers. They are structured to create increasing earnings for its policy and shareholders. This is achieved by contracting with private doctors to deliver services to its preferred providers members. At the same time, they receive fees from these entities and they negotiate lower group rates.

Healthcare in the United States is an interstate system that accounts for 15% of the U.S. GDP and $5,635 per capita. Nearly 45 million – or 1 in 5 – Americans are uninsured. With insurance premiums rising yearly, the number of uninsured Americans projects to continue to climb. While new technologies will increase the efficiency of healthcare, the costs of these new tests and treatments will likely outweigh the savings. As the cost of healthcare rises, many employers will be forced to eliminate health insurance benefits for their employees, further increasing the number of uninsured Americans.

With the Health Insurance Marketplace opening October 1st, insurance companies will compete as providers for individuals’ business via the Affordable Health Insurance Exchange, an online marketplace. Many health care provisions are

The changing landscape of the current health care system in the United States has caused new methods of insurance to gain in popularity. The High-deductible health plan (HDHP) is increasingly favored by employers and offered on the exchanges created under the Affordable Care Act (ACA). According to the Centers for Medicare & Medicaid Services (CMS) a HDHP is “a plan that features higher deductibles than traditional insurance plans. High deductible health plans (HDHPs) can be combined with a health savings account or a health reimbursement arrangement” (2015). In the HDHPs premiums are lower, offset by the higher deductible. The health reimbursement arrangement (HRA) the employer contributes to a fund for medical expenses while in the health savings account (HSA) which employees pay into but is not required of the employer (Shi & Singh, 2012, p. 208). The growing popularity of these plans is important as it will have effects on the healthcare costs as well as how consumers use healthcare.

Sixty percent of the population has private health insurance, which pays for a third of health care spending [1].Majority of the administrative costs responsible for higher medical costs in United States are attributable to private health insurance[2]. The estimated percentage of of health care dollars spent on administration is between 20% and 30%. These administrative costs are largely related to marketing underwriting,sales commissions,administrative functions,net additions to reserves, premium taxes and profits [3], processes that do not improve medical care. The numerous private insurance plans in the similar geographic locations is causing Hospitals to negotiate payment rates separately with each payor, thereby increasing health care providers’ costs by making processing complicated and time-consuming. Thus,inefficiencies have been raised due to billing and insurance related activities leading to a waste of billions of dollars which are paid by consumers and employers in the form of premiums to private insurance companies. The costs of insurance administration in the U.S. health care system totaled nearly $156 billion in 2007, and that figure is expected to double—to reach $315 billion—by 2018

The United States of America government’s healthcare marketplace is a large e-government initiative which was a result of the Affordable Care Act (ACA) passed in 2010. Under this act, all Americans are required to have health insurance except in the case where individuals are exempt or make a shared responsibility payment. The aims of the of the ACA was to increase the quality and affordability of health insurance, lower the

In order to control costs of providing health care benefits to workers nearly twenty major companies formed a nonprofit group called Health Transformation Alliance (HTA). This collaboration helps to share information of four million employees, particularly about health spending and final outcomes, analyzing the

As a leading insurance company, Aetna’s primary market broadens to reach those who work full time or part time based on hourly wages through its subsidiary company, Strategic Resource Company (SRC) which was bought by Aetna, Inc in 2005 (SRC: Our Mission, 2012). Aetna’s fourth subdivision target market, which is considered the biggest subdivision, is providing insurance to “employers, third-party administrators, commercial insurance companies and other health plans (Aetna Subsidiaries, 2012)”. These latter targets are aimed at through Aetna’s fourth subsidiary Cofinity which includes over 2.5 million members as of 2009 (About Cofinity, 2009). Besides targeting health insurance consumers, Aetna aimed at a target market that excludes health insurance seekers yet includes health care providers. Through a fifth subsidiary, Medicity, Aetna created another target market subdivision where it can provide health information technology in health care facilities such as hospitals and practices (About Medicity, 2012). Finally, Aetna aims at acquiring shareholders and therefore targeted a market of

The health sector is among the most important sectors in the United States economy. The government has enacted certain laws that affect the corporation’s activities and the insurance industry in general. The regulation affects competition among the health insurance companies, and the insurance industry in general.