Assignent Solutionnurs

Reply to at least two of your classmates. In your reply, include new information related to your peer’s initial post or to the topic. Each reply should be 200 to 400 words. You should cite at least one to two sources in your reply posts that add new information in response to your classmate’s post.
Discussion 1: Amy
People often complain about the cost of health care.b There are several reasons why the cost of health care is so high and those reasons are intermeshed with each other, thus there is no easy reason or solution to the cost of healthcare in the US. In my opinion, the two major reasons for the elevated cost is due to multiplayer systems and administrative costs and defensive medicine.
There are administrative costs to every aspect of the healthcare system. Shi and Singh (2021, pp. 538–539) indicate that the Centers for Medicare and Medicaid Services (CMS) average administrative costs are 12% of the premiums of a health insurance plan. The good news is that administrative labor costs are not continuing to drive up costs in healthcare, in fact, “the number of administrative and managerial positions…grew much more slowly (13.4 percent) than overall health care employment over this period (24.5 percent), such that the administrative share of total health-sector employment declined” (Tollen et al., 2020). These administrative costs are due to the market-driven healthcare system that the US has chosen. The choices belong to everyone. From the insurance companies who choose the markets, providers, and what items are priorities for them, to employers who choose what insurer they are going with and the level of benefits, to the providers who choose where and how to practice, what care to provide and what those services cost, and lastly to the patient who chooses the insurance plan, who is their provider and what procedures to have. With all these choices come the complexity to manage the details and the costs. All these choices cost healthcare payers and providers $496 billion in billing and insurance-related costs (Gee & Spiro, 2021).
Another issue associated with increased costs of healthcare is defensive medicine. Defensive medicine is when providers order additional testing, schedule additional follow-ups, and maintain vast amounts of documentation in order to decrease their risk of litigation (Shi & Singh, 2021, p. 18). This risk of litigation and malpractice suits means that at times providers are overly cautious and may order unnecessary and costly procedures.
Now the question is how do we get the cost of healthcare manageable? One way is to have a single-payer system. This type of system would standardize insurance and the cost of care by the federal government taking over, this is socialized medicine. Socialized medicine was pushed for by the Democrats in recent elections and the Affordable Care Act initially had characteristics of socialized medicine at its conception. There are some other ways to decrease costs in healthcare. Equalizing Medicare payments when it comes to the location of where a procedure was delivered. Currently, a hospital outpatient department gets a higher reimbursement than an ambulatory care center or an outpatient provider’s office. This would reduceMedicare spending by $153 billion and reduce premiums and cost-sharing for Medicare benefits by $94 billion(Three Ways to Lower Health Care Costs, 2021). Hospital prices could also be capped to control costs. Hospital care is 1/3 of all US Health care expenses and on average costs for commercially insured is more than twice as high as those with Medicare. If we capped hospital costs at 200% of Medicare we could reduce the total national health expenditure by over a trillion dollars (Three Ways to Lower Health Care Costs, 2021). It’s clear that costs are out of control and we need to start doing something, even if we have to change what we try.
Discussion 2: Amelia:
Cost of care is a significant factor when it comes to health outcomes. Half of adults in the United States report putting off or skipping some type of care in the past year due to cost (Kearney et al., 2021). Prescription drugs, which are often a part of caring for certain conditions, can also be a financial burden, and one in four patients report difficulty paying for them (Kearney et al., 2021). One reason why health care costs pose such a threat to patients is due to unexpected medical bills (Kaiser Family foundation, 2020). Two thirds of Americans report having some level of concern about unexpected medical costs (Kaiser Family Foundations, 2020). This is not just a problem for uninsured Americans, but also causes worry among those insured. These unexpected bills are often from providers that patients are not aware are out of network (Kaiser Family Foundation, 2020). In the case of an emergency, ambulances that transport patients are often out of network, resulting in high expenses that the patient must pay (Kaiser Family Foundation, 2020).
This relates to the multiplayer system, where patients have different plans and different coverage options. The administrative costs to manage this type of system is also significant (Shi & Singh, 2019). Administrators must assist with enrolment, setting up contracts, processing claims, and deal with denials and reimbursements (Shi & Singh, 2019). Because the system is complicated and not all providers are in network, administrative help is necessary to assist patients in the healthcare system, which in turn, results in higher costs. One policy that helps to solve the problem of unexpected medical bills is the No Surprises Act The No Surprise Act is a relatively newly implemented policy that protects patients from unexpected bills when receiving most emergency services, care from out-of-network providers at in-network facilities, and transportation from out-of-network ambulances (Centers for Medicare & Medicaid Services, 2022). These new guidelines apply only to individuals covered by insurance. For those who are not insured, a good faith estimate is required to be provided to the patient before the services are given (Centers for Medicare & Medicaid Services, 2022).
A second contributing factor to high medical costs in the United States is the aging population. Since 1900, the elderly population has grown as life expectancy increases (Shi & Singh, 2019). By 2030, it is estimated that one in five Americans will be elderly (Shi & Singh, 2019). This relates to health care costs, because the elderly population utilizes services at a much higher rate compared to other generations. The healthcare spending for adults over the age of 65 ($18,988) is more than double the amount that a working adult pays ($6,632) (Shi & Singh, 2019). As people grow older, they are more likely to have complications with their health, which often results in higher utilization of services (Ortaliza et al., 2021). Although the elderly individuals only accounted for 30% of the population in 2019, they accounted for 56% of total health care spending (Ortaliza et al., 2021). Certain chronic conditions are also more prevalent in the elderly population, such as emphysema, stroke, or heart disease (Ortaliza et al., 2021). Those diagnosed with chronic diseases have significantly higher out-of-pocket spending associated with their care (Ortaliza et al., 2021). Because of this significant consumption of services, the cost of care will continue to increase if changes are not made (Shi & Singh, 2019).
As discussed as a solution for many of the issues previously discussed, a single-payer system would help reduce the cost of care for the elderly population. Single payer policies have been proposed but not fully adopted. By using top-down control over expenditures, the government could establish budgets for different sectors of the healthcare system (Shi & Singh, 2019). These budgets would be determined based on need, providing higher funding to services utilized by the elderly, since they consume services at a much higher rate. Single payer systems are also associated with the Medicare for All plan (which has only been proposed), which would help increase access to care for the elderly and reduce inequities in the system.