Evidence-Based Project, Part 3: Critical Appraisal of Research

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OTK1O570S0789711XDevelopingOrganizationalPoliciesandPractices.docx

2

Health Care Costs

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Introduction

Healthcare is significantly growing and that is why there exist significant issues or stressors. Improving healthcare services requires an emphasis on critical aspects such as the health care costs, leadership, technology, service delivery and patient management practices (Kanavos, 2019). The national healthcare issue addressed is the high healthcare costs.

Identify and describe at least two needs impacting high health care costs

The continuous rise in the costs of healthcare in the United States has made healthcare unaffordable to the citizens. They have also put an economical strain on businesses and the government. The increase in the intensity and prices of healthcare services are among the needs that lead to an increase in healthcare costs.

There is an increase in the number of people covered by the national government health insurance programs. This has become a challenge to the government on how to cater for the healthcare needs of the citizens. Although there is an increase in monetary investments, the manpower is low and cannot catch up with the rising number of people needing healthcare services. In most cases, this is because of the increase of the aged population qualifying for the government health insurance programs (Howrigon, 2018).

The complexity in the United States healthcare system also leads to administrative waste in the provider payment systems and insurances. The US has numerous healthcare insurers and all of them have different plans. If all these are reduced to a single insurer, we would be able to save some of our healthcare costs.

Describe a relevant policy or practice in your organization that may influence the rise in healthcare costs

The policy in my organization that will influence the rising costs of healthcare is providing and maintaining transparency in the prices of healthcare services and cost-sharing. Health insurance programs should provide an estimate in terms of cash of the total costs to be paid by the insurer and those cost-shared by the patient. This includes all the services and items covered. This information should also be easily accessible and understandable to the patients thus allowing them to be able to anticipate the total cash they will pay before receiving services thus allowing them to evaluate and gauge the value of care they will receive. This will help reduce healthcare costs because patients will make decisions based on the services they can afford. Apart from displaying the healthcare costs to patients, they should also be displayed to physicians and other healthcare service providers. This can lead to a reduction in healthcare expenditures because they are the ones that prescribe the healthcare services offered and they should be cost-conscious while prescribing.

This policy can also negatively impact healthcare services. It will lead to a reduction in the quality of care offered to patients because once the patients are aware of the costs of services offered to them, they might be compelled to choose cheaper services or services they can afford. Some might refuse to receive certain health care options given to them. For example, if a doctor recommends a CT scan for a certain patient but once the patient is aware of the cost of a CT scan, he or she might opt for a cheaper option such as an MRI. The doctor may not get all the details using the results of an MRI as compared to those of a CT scan. This has led to a reduction in the quality of care given to the patient.

Critique the Policy for Ethical Considerations

Various ethical considerations should be regarded before displaying the prices of healthcare services. These include autonomy, non-maleficence, transparency and fairness. In autonomy, the patient should be informed about the displayed costs of services and assured that those displays will be used. This will enable the patients to make informed decisions of whether or not they will get the healthcare services depending on the costs. In non-maleficence, patients should be protected against the risk of not receiving beneficial services. In transparency, the reference source of the displayed healthcare costs should be shown alongside. Among the strengths involved in promoting ethics is fairness. Fairness ensures that the displaying of the healthcare costs does not disadvantage some patient groups such as the ones not insured. Displaying the same amount of healthcare costs can help ensure that all patients are treated fairly. However, some challenges are the inability to fully disclose the reference source of the displayed health costs.

Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers and patients while addressing the ethical shortcomings of the existing policies

The policy I would recommend is to allow health plans to be flexible and provide additional coverage of services such as managing chronic diseases before fulfilling the amount to be deducted (Guarin, 2020). That way patients don`t have to incur a lot of charges out of their pocket.

Insurance plans should be flexible and include applicable services such as transportation, psychosocial and social services. For example, if patients need ambulance services, they don`t have to pay cash but the insurance will cover it.

Another policy I would recommend is focusing more on disease prevention and health promotion services rather than treatment of diseases. Treatment of diseases requires a lot of interventions and treatments thus requiring the use of a lot of resources. By promoting health, many people will not have to use healthcare services thus reducing healthcare costs.

Cite Evidence that informs the rising in healthcare costs

Lyford, 2019 summarized the “America`s healthcare cost crisis”. In this article, it is understood that there has been an upward trajectory of healthcare costs making healthcare unaffordable for most families in the United States. He argued that this issue needed immediate action in the whole healthcare sector whether private or public. He provides strategies for lowering healthcare costs, which included adopting value-based healthcare and transparency in the costs of healthcare.

Fulton, 2017 summarized “The trends in healthcare market concentration in the United States”. Although the healthcare system relies on competition of the provider and insurer to lower the healthcare costs, the market concentration of insurer and hospitals remains to be a concern. Public policies that can enhance this competition are needed. These policies include strictly enforcing the antitrust laws and restricting behaviours that reduce competition.

Conclusion

In conclusion, there are a lot of discrepancies in the cost of healthcare services. For uniformity to happen, various measures have to be adopted such as reducing the number of healthcare insurers. Transparency can help minimize the costs of healthcare.

References

Fulton, B. D. (2017). Health care market concentration trends in the United States: evidence and policy responses. Health Affairs36(9), 1530-1538.

Guarin, D. F., Chavez, R., Trujillo de Hart, J. C., Graham, N., Boers Trilles, V., & Martin De Bustamante, M. (2020, May). COLLABORATIVE APPROACHES TO ATTAIN HEALTHCARE SUSTAINABILITY IN LATIN AMERICA. In Value in Health (Vol. 23, pp. S302-S302). STE 800, 230 PARK AVE, NEW YORK, NY 10169 USA: ELSEVIER SCIENCE INC.

Howrigon, R. (2018). A Brief History of Healthcare and Insurance in America. The Journal of Medical Practice Management: MPM34(3), 139-141.

Kanavos, P., Parkin, G. C., Kamphuis, B., & Gill, J. (2019). Latin America Healthcare System Overview. A comparative analysis of fiscal space in healthcare.

Lyford, S., & Lash, T. A. (2019). America's Healthcare Cost Crisis. Generations43(4), 7-12.