Week 8 Discussion Response- Law and Ethics in Healthcare

2

What Drives Healthcare Costs?

One of my healthcare policy issues is that prescription drug costs are high in my community because of the lack of transparency on the costs of drugs. Patients do not know what the true cost of the drugs they are buying are until they get to the pharmacy, making it difficult for them to check the cost of medications. Consequently, such a situation causes delays in filling of prescriptions as well as abandonment of treatment. According to Martin et al. (2024), expenditures on health totaled approximately USD 4.9 trillion in the U.S. in 2023, which equals 17.6% of GDP. Besides, many USA citizens endure delays in getting medical care and medications because of financial issues, as mentioned by Sparks et al. (2025). As these statistics illustrate, increasing healthcare costs continue to be a critical policy issue that demands solutions.

This issue is related to the cost of care, its quality, and accessibility. The patients who are unable to pay for their prescribed drugs are likely to suffer because they will be unable to control their disease, resulting in increased use of emergency rooms, hospitalizations, and cost of healthcare. Price transparency complicates the situation even further by not allowing comparison between drug costs. According to Zhang et al., (2020), price transparency leads to informed decision making, which can encourage competition that helps avoid unnecessary healthcare expenditures. The lack of price transparency leads to the situation when patients make decisions due to unanticipated costs and not clinical requirements.

One way of reducing the cost of health services is increasing the availability of drug pricing information and promoting the use of evidence-based generics where possible. From my experience in the clinic, there are patients who cannot pay for expensive brands once they have been told about the price at the pharmacy. Clinicians who have prescribed cheap but effective generic medications have made sure that these patients have gotten the treatment on time. This approach has enabled the patients to take the medication, thus preventing any unnecessary complications from arising.

References

Martin, A. B., Hartman, M., Washington, B., & Catlin, A. (2024). National Health Expenditures In 2023: Faster Growth As Insurance Coverage And Utilization Increased. Health Affairs, 44(1). https://doi.org/10.1377/hlthaff.2024.01375

Sparks, G., Lopes, L., Montero, A., Presiado, M., & Hamel, L. (2025, July 11). Americans’ challenges with health care costs. KFF. https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/

Zhang, A., Prang, K.-H., Devlin, N., Scott, A., & Kelaher, M. (2020). The impact of price transparency on consumers and providers: A scoping review. Health Policy, 124(8). https://doi.org/10.1016/j.healthpol.2020.06.001

Law and Ethics in Healthcare

Week 8 Learning Resources

Required Readings

· Wilensky, S. E., & Teitelbaum, J. B. (2023).  Essentials of health policy and law (5th ed.). Jones & Bartlett Learning.

· Chapter 7, “Structural and Social Drivers of Health and the Role of Law in Optimizing Health” (pp. 137–152)

· Centers for Medicare & Medicaid Services. (n.d.).  National health expenditure data: Historical Links to an external site. . https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical

· Cyr, M. E., Etchin, A. G., Guthrie, B. J., & Benneyan, J. C. (2019).  Access to specialty healthcare in urban versus rural US populations: A systematic literature reviewLinks to an external site. .  BMC Health Services Research,  19(1), 974–991. https://doi.org/10.1186/s12913-019-4815-5

· Lopes, L., Montero, A., Presiado, M., & Hamel, L. (2024, March 1).  Americans’ challenges with health care costs Links to an external site. . KFF.org. https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/

· Flood, C. M., Thomas, B., & McGibbon, E. (2023).  Canada’s primary care crisis: Federal government responseLinks to an external site. .  Healthcare Management Forum,  36(5), 327–332. https://doi.org/10.1177/08404704231183863

· Organisation for Economic Co-operation and Development. (n.d.).  Health expenditure Links to an external site. . https://www.oecd.org/health/health-expenditure.htm#:~:text=Looking%20at%20country%20level%20data,database%20OECD%20Health%20Statistics%202023

· van der Goes, D. N., Edwardson, N., Rayamajhee, V., Hollis C., & Hunter, D. (2019).  An iron triangle ROI model for health careLinks to an external site. .  ClinicoEconomics and Outcomes Research,  11, 335–348. https://doi.org/10.2147/CEOR.S130623

· U.S. Department of Health and Human Services. (n.d.).  Laws & regulationsLinks to an external site. . https://www.hhs.gov/regulations/index.html

Law and Ethics in Healthcare

Week 8 Discussion Response

Colleague 1- Emily Barnes

What Drives Healthcare Costs?

One of my healthcare policy issues is that prescription drug costs are high in my community because of the lack of transparency on the costs of drugs. Patients do not know what the true cost of the drugs they are buying are until they get to the pharmacy, making it difficult for them to check the cost of medications. Consequently, such a situation causes delays in filling prescriptions as well as abandonment of treatment. According to Martin et al. (2024), expenditures on health totaled approximately USD 4.9 trillion in the U.S. in 2023, which equals 17.6% of GDP. Besides, many USA citizens endure delays in getting medical care and medications because of financial issues, as mentioned by Sparks et al. (2025). As these statistics illustrate, increasing healthcare costs continue to be a critical policy issue that demands solutions.

This issue is related to the cost of care, its quality, and accessibility. The patients who are unable to pay for their prescribed drugs are likely to suffer because they will be unable to control their disease, resulting in increased use of emergency rooms, hospitalizations, and cost of healthcare. Price transparency complicates the situation even further by not allowing comparison between drug costs. According to Zhang et al., (2020), price transparency leads to informed decision making, which can encourage competition that helps avoid unnecessary healthcare expenditures. The lack of price transparency leads to the situation when patients make decisions due to unanticipated costs and not clinical requirements.

One way of reducing the cost of health services is increasing the availability of drug pricing information and promoting the use of evidence-based generics where possible. From my experience in the clinic, there are patients who cannot pay for expensive brands once they have been told about the price at the pharmacy. Clinicians who have prescribed cheap but effective generic medications have made sure that these patients have gotten the treatment on time. This approach has enabled the patients to take the medication, thus preventing any unnecessary complications from arising.

References

Martin, A. B., Hartman, M., Washington, B., & Catlin, A. (2024). National Health Expenditures In 2023: Faster Growth As Insurance Coverage And Utilization Increased. Health Affairs, 44(1). https://doi.org/10.1377/hlthaff.2024.01375

Sparks, G., Lopes, L., Montero, A., Presiado, M., & Hamel, L. (2025, July 11). Americans’ challenges with health care costs. KFF. https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/

Zhang, A., Prang, K.-H., Devlin, N., Scott, A., & Kelaher, M. (2020). The impact of price transparency on consumers and providers: A scoping review. Health Policy, 124(8). https://doi.org/10.1016/j.healthpol.2020.06.001

Colleague 2- Tia Sturdevant

One significant healthcare policy issue affecting many communities is the lack of healthcare price transparency. Despite federal regulations requiring hospitals to publish standard charges, many patients still struggle to obtain clear, understandable pricing information before receiving care. As a result, individuals often delay treatment, accumulate unexpected medical bills, or are unable to compare healthcare providers based on cost. Healthcare administrators play an important role in implementing policies that promote transparency while balancing cost, quality, and access to care (Wilensky & Teitelbaum, 2023).

Healthcare spending in the United States continues to increase at a rate that exceeds many other developed nations. According to the Centers for Medicare & Medicaid Services (CMS, n.d.), national health expenditures reached $4.9 trillion in 2023, representing approximately 17.6% of the nation's Gross Domestic Product (GPD). Additionally, a national survey conducted by KFF found that approximately half of the U.S. adults report difficulty affording healthcare costs, including insurance premiums, prescription medications, or unexpected medical bills (Lopes et al., 2024). These statistics demonstrate that healthcare affordability remains a major concern for many Americans. 

The issue of price transparency directly affects healthcare costs, quality, and access. When patients cannot determine the cost of services in advance, they are less likely to seek preventive care or may postpone treatment until their condition worsens, resulting in higher healthcare costs and poorer health outcomes. Limited access to affordable care is especially problematic in rural communities, where shortages of specialty providers already create barriers to timely treatment (Cyr et al., 2019). The "Iron Triangle" of healthcare emphasizes that cost, quality, and access are interconnected. meaning improvements in one area often influence the others (van der Goes et al., 2019).

A lack of price transparency contributes to increased healthcare costs because patients cannot make informed financial decisions. Without knowing the cost of services beforehand, consumers cannot compare providers or identify lower-cost alternatives. This reduces market competition and allows significant price variation for identical services. Wilensky and Teitelbaum (2023) explain that healthcare markets differ from traditional markets because patients frequently lack the information necessary to function as informed consumers.

One strategy I would propose to decrease healthcare costs is expanding the use of transparent pricing tools combined with patient financial counseling before non-emergency procedures. Providing patients with clear estimates of out-of-pocket costs, insurance coverage, and available payment options would improve informed decision-making while helping reduce unexpected medical debt. Healthcare organizations can also encourage preventive care and chronic disease management programs, which are generally less expensive than treating advanced illnesses. Improving transparency not only helps patients but also encourages healthcare organizations to compete on both price and quality.

Although I do not currently work directly in healthcare administration, I have personally experienced the frustration of receiving medical bills that differed significantly from the estimates initially provided. The lack of clear pricing created confusion regarding insurance coverage and delayed financial planning. Experiences like this illustrate how greater transparency could improve patient satisfaction while reducing unnecessary administrative costs associated with billing disputes and payment collections.

Overall, improving healthcare price transparency represents an important policy strategy for reducing costs while maintaining high-quality care and expanding patient access. Healthcare administrators who implement transparent pricing practices and strengthen patient education can support better financial outcomes for both healthcare organizations and the patients they serve.

References:

Centers for Medicare & Medicaid Services. (n.d.).  National health expenditure data: Historical.  https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical

Cyr, M. E., Etchin, A. G., Guthrie, B. J., & Benneyan, J. C. (2019). Access to specialty healthcare in urban versus rural US populations: A systematic literature review.  BMC Health Services Research, 19(1), 974–991.  https://doi.org/10.1186/s12913-019-4815-5

Lopes, L., Montero, A., Presiado, M., & Hamel, L. (2024, March 1).  Americans' challenges with health care costs. KFF.  https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/

Organisation for Economic Co-operation and Development. (n.d.).  Health expenditure.  https://www.oecd.org/health/health-expenditure.htm

U.S. Department of Health and Human Services. (n.d.).  Laws & regulations.  https://www.hhs.gov/regulations/index.html

van der Goes, D. N., Edwardson, N., Rayamajhee, V., Hollis, C., & Hunter, D. (2019). An iron triangle ROI model for health care.  ClinicoEconomics and Outcomes Research, 11, 335–348.  https://doi.org/10.2147/CEOR.S130623

Wilensky, S. E., & Teitelbaum, J. B. (2023).  Essentials of health policy and law (5th ed.). Jones & Bartlett Learning.