HCS 552 Week 4 Health Care Issue Outline

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Description

Health Care Issue Outline

Names

Date

University of Phoenix

HCS/552 Health Care Economics

Professor

Issue Statement

For many years, people debated about health care reform. Unless the nation changes health care delivery services, the nation will continue to have out of control health care costs and decreased access to health care. The nation must accept the evolution of health care reform and the economics associated with the change.

Health Care Issue Outline

Slide 1 Introduction

A. National Health Care System

  1. The current national health care system is inadequate. The nation must change the delivery of health care services to accommodate health care reform.

B. Health Care Reform

  1. Health Care Reform is designed to increase the number of Americans with access to health care services while decreasing costs associated with the delivery of care.

C. Analysis of Current Procedures

  1. This presentation will provide an analysis of the effectiveness of current procedures and the economic issues associated with the delivery of health care.

D. Improvement Strategies

  1. This presentation will also provide improvement strategies that can be implemented.

Slide 2 Economic Changes with Health Care Reform

A. Reimbursement

  1.  Pay for performance and value based purchasing will change the way health care organizations/providers receive reimbursement.

B. Exchanges

  1. Consumers will purchase health care coverage through exchanges.  Some exchanges will open in the fall of 2013. 

C. Increased Americans with Coverage

  1. Many more Americans will have health care coverage with health care reform.

D. Accountable Care Organizations

  1.  To maintain viability, with health care reform,  health care organizations must evaluate their current structures and possibly restructure to some form of integrated system.

Slide 3 Basic Analysis of the Effectiveness of Current Procedures in Place

A. Fee for Service

  1. Fee for service will no longer drive reimbursement. Fee for service has been a downfall of the health care economic situation.

B. Uninsured and Underinsured

  1. Currently many Americans are uninsured or underinsured. This is another reason for the health care economic crisis.

C. Out-of-Control Spending

  1.  Out-of-control spending is not an effective procedure.  The way the nation spends money for health care services must change.

D. Defensive Medicine

  1.  Providers must move away from defensive medicine.  Unnecessary tests and procedures account for large health care expenses.

E. Treatment versus Prevention

  1.  The nation must focus on healthy living and prevention.  The costs to treat preventable chronic illness are astronomical. 

Slide 4 Evolution Affecting Financial Decision-Making Process for Health Care Reform

A. Health Care Expenditures

  1. This area will discuss the billions of dollars it takes a year for individuals and families to pay for health care. It will also examine how much money comes from the government and other areas.

a. GDP with graph (a graph will assist in presenting the bigger picture)

B. Strengthening Medicare

  1. This area will discuss how A-D lead to the financial decisions to implement a better need for checks and balances and how this will improve the overall reimbursement

a. Adding new benefits - no pre-existing conditions

b. Fighting Fraud - payment will received for better care and services

c. Cutting Costs - bundling payments (specific procedures will include the pre-operation, surgery, after-care visit, therapy in one payment)

d. Improving Care for Patients - facilities and physicians that abide by the set standards will receive 5 stars and this will be transparent to the public

Slide 5 Evolution of Health Care Affecting Financial Decision-Making in General=

A. Building a Balanced Economy

  1. This area will discuss the need to focus on the economy and how creating jobs will assist in security

B. Secure Middle Class Not an Economy from Top-Down

  1. This area will focus on implementing health care reform in a smart and non-bureaucratic way that works for the middle class which in turn makes middle class strong and secure

C. Even Playing Field

  1. By creating secure middle class jobs and an economy built to last where hard work and responsibility are rewarded, everybody gets a fair shot, pays their fair share, and plays by the same set of rules

Slide 6 Financial Decision-Making Affected Health Care Reform

A. Benefits to Health Care Reform

  1. This area will discuss how the A-E will be a financial benefit through health care reform

a. Impact on GDP - this will decrease spending

b. The Deficit - will assist in lowering the deficit

c. Unemployment - by offering preventative services will keep individuals from the possibility of having critical illnesses that could have been caught early on

d. Standard of Living - everyone has the right to care

e. Labor Market - insurance will have to be provided

Slide 7 Policies and Regulatory Environment

A. National Deficit

  1. America has reached the end of their rope

a. The nation is in debt, something must be done to improve the course of healthcare and how this country funds it.

b. Healthcare; one way to decrease deficit and assist the nation in decreasing the over costs associated with healthcare

B. Environment of Care

  1. Raised to maintain funding

a. HCAHPS Scores, in recent years it has become very important for hospitals to focus on pleasing their patients. The medical field has become customer driven which is the right thing for our patients

b. Patient surveys after each discharge, Patients are encouraged to fill out their surveys so that hospitals can improve on the patient care experience

c. Decreased reimbursement, hospitals will receive less money if scores are not adequate it has been determined that hospitals need to raise the bar and make sure patients are satisfied with the care they receive.

C. Money Wasting

  1. Preventive care

a. Healthier nation, the focus for our Nation will be in prevention and how to make sure we are stopping illness before it starts.

b. Healthy America 2020 has goals for achievement and outlined ideas for improving the nation's health.

Slide 8 Improvement Strategies

  1. Decreased Cost

a. Health care coverage affordable, all Americans will have access to coverage and be able to prevent serious illness and disease.

b. Improved outcomes, Healthier patients will lead to decreased costs associated with healthcare

  1. Improved Access to Healthcare

a. Proactive decisions for changes in access to care and healthcare delivery. Changes from acute to outpatient care areas will increase utilization and provide for lower costs associated with healthcare

  1. Healthier Americans

a. Health benefits for all Americans will improve our Nation's health. Increased patients calls for increased utilization

b. Decreased number of hospital stays and improved care, best practice and result driven care.

Slide 9 Economic Concepts

A. Inflation of Medical Costs

  1. According to the Bureau of Labor Statistics (2012), inflation the health care industry continues to increase every year with the current rate at 3.21%. It is estimated that this rate will continue to increase for a long term average of 5.55%.

B. Aggregate Demand

  1. The increase in health care demand will also increase in the next five years as the baby boomer generation begins to qualify for Medicare benefits. It is estimated that medical spending on workers increased 3.3% in 2010 as well as the overall U.S. spending on medical care ($2.6 trillion in 2010).

C. Markets and Prices

  1. The average cost of medical care has risen throughout the years in pharmaceuticals and hospital costs. Prescriptions drugs increased 3% while inpatient and outpatient admissions also increased by over 5% in 2011.

Slide 10 Economic Theories for Containment of Health Care Costs

A. Increase Cost Sharing for Consumers

  1. To cover much the increased in medical spending, it is expected that there will be an increase in taxes to cover federal and state Medicaid and Medicare programs. One plan is an excess tax for high priced insurance plans. Out of pocket costs are also expected to increase. Furthermore, more non-profit hospitals are increasing over for-profit industries.

B. Price Discrimination in Pharmaceutical Companies

  1. Negotiations with pharmaceuticals to charge prices closer to marginal costs through government contracts. Negotiations with international pharmaceutical companies to bring costs down should also be explored.

C. Creation of Cost Effective Insurance Plans and Efficient Insurance Coverage

  1. Insurers will have to better design coverage that provides ample coverage for consumers and limit areas of coverage. This will increase efficiency in the health care industry and help to decrease inflation.

Slide 11 Conclusion

A. The cost of health care in the United States is growing at a rapid rate that surpasses the country's economic growth.

B. The goal of federal government is to slow the growth rate of health care cost through policies which support cost containment.

C. Some cost effective measures such as increasing taxes and out of pocket costs, increasing health coverage efficiency, and bargaining for lower prices are useful.

References

Bhanji, Shaira. "Bullying the Boss? Compulsory Licensing for Antiretroviral Drugs in Brazil and Thailand." Harvard College Global Health Review. Harvard College Global Health Review, 21 Oct. 2011.

Bureau of Labor and Statistics. (2012). Retrieved from http://www.bls.gov.

Danzon, Patricia M. "Price Discrimination for Pharmaceuticals: Welfare Effects in the US and the EU." International Journal of the Economics of Business 3.3 (1997): 301-21.

Getzen, T. E. (2007). Health, economics, and financing (3rd ed.). Hoboken, NJ: John Wiley & Sons.

Health Care.Gov. (2013). Retrieved from http://www.healthcare.gov/

Healthy people. (2012). Retrieved from http://www.healthypeople.gov/2020/default.aspx

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