Term Paper on "Health Care Cost Containment Techniques"

Term Paper 8 pages (2462 words) Sources: 5

[EXCERPT] . . . .

equal access to a comprehensive package of health care has been the theoretical goal of the American health care system for some time (Epstein 2004). It has been debated extensively in many forums including the U.S. Congress but until very recently no such program has been enacted. One of the goals of the Obama administration upon entering office was to initiate such a program and one was eventually enacted and signed into law but it failed to solve the problem. The debates continue and the bill that was enacted, the Affordable Care Act (H.R. 3590-111th Congress 2009), is currently under attack in the U.S. Supreme Court so it is quite possible that the debate will continue for some time in the future.

Part of the debate surrounding any attempts at establishing a comprehensive health care bill is that not everyone agrees that it is the state's responsibility to guarantee the right to health care to all citizens. Presently, the United States is the only Westernized nation that does not have a comprehensive health program guaranteeing coverage to all citizens. Every European nation, Canada, and Mexico provide some form of coverage to all its citizens. The form of coverage and the specifics of administration differ between plans but the essential fact is that the plans are available. The United States, prior to the enactment of the Affordable Care Act, was lone wolf in the woods when it came to health care.

One of the problems in implementing any health care plan is designing a plan that provides the citizenry with specific benefits and choices which are consistent with the resources of society. Health care choices are influenced by a variety of factors including the state of art in medicine, the ability of individual society members to afford health care, and the policy commitments of the government. The high cost of health care has spawned a debate on issues such as how to determine treatment priorities, the indispensability of certain forms of health care, and minimizing entitlement programs. In the final analysis, the debate centers on cost containment and it is the purpose of this paper to examine how present cost containment measures affect the overall right to health care in the United States.

As noted, the status of the Obama administration's Affordable Care Act is still in limbo and aggressive attempts at overhauling the American health care plan in an effort to contain spiraling costs are still necessary. Many of these attempts will likely fail and some will be more successful than others but the state of health care in America, both from the standpoint of cost and quality, demands that action be taken immediately. The actions that are taken must be tested against the individuals who provide the health services and against those receiving the services. Because of the poor state of the present system, what is required is an entirely new attitude by both groups.

The acrimonious nature of the debate that took place in Congress during the attempts at enacting the Affordable Care Act is indicative of the fact that there is no concerted bi-partisan movement to correct the nation's health care problems. Instead, the nation remains split along largely party lines in addressing the problem and no unified point-of-view exists as to where the solutions might lie.

Neither side of the health care debate will openly admit that their ultimate goal is to expand coverage. The problem lies in determining how this can best be done. The bottom line in the debate is how this coverage can be expanded at the lowest possible cost and how it can be done in an industry that has a track record of being highly inefficient and unable to control its own costs.

For many years it had been hoped that the health care industry might adopt its own measures in an attempt to control costs. This has proved to be a major failure and even attempts by those outside the industry to find a way to minimize the cost spiral have failed as well. The problem is so severe that it is difficult for anyone, inside or outside the industry, to quantify how and why the costs keep rising. Opinions vary as to the cause and range from the cost of the delivery system, the cost of new technology, or the use of defensive medicine. Agreements as the cause may vary but there is universal agreement that the costs are out of control (Bodenheimer 2005).

As there is no consensus on what is causing the spiraling of health costs in America, attempts at cost containment are understandably varied and many cost containing measures overlap. Although there may be considerable overlapping, there are a number of specific areas that are repeatedly mentioned (Davis 2007).

The first area of concern as to cost containment involves the cause of chronic care. Chronic illnesses, such as diabetes and heart disease, account for nearly 75 per cent of all health care costs in America. Interestingly, the cause of these forms of illness are often caused by poor dietary habits, smoking, and lack of exercise and this cost could be minimized substantially by changes in health habits but so far attempts using this approach have proven unsuccessful. Americans continue to forego exercise, eat fast food, and smoke their cigarettes and so other solutions must be found to limit the costs due to treating the chronic illnesses caused by these activities. Some of the suggested measures include providing incentives to encourage individuals to adopt healthier lifestyles. Many employers have begun to offer health programs for their employees and some insurance companies are beginning to offer discounts for their insured who can demonstrate improved health.

Beyond the costs expanded for chronic illnesses, the second major area of cost concern is in the treating of conditions involving end-of-life care. Although the percentage of costs in this area are much less than the costs related to chronic illnesses, end-of-life care is highly costly for the nation's Medicare program. End-of-life care is a highly emotional issue and evokes strong feelings from nearly everyone. Part of these strong feelings were evident during the course of the debate surrounding the process of enacting the Affordable Care Act when the Obama administration was accused of encouraging the creation of death boards as part of the Act's provisions. This suggestion was ludicrous but it does confirm the emotional nature of the issue. Universal acceptance of palliative care for the terminally ill elderly would alleviate costs in this area but adopting such a position is foreign to American culture. Other solutions will have to be found.

Solutions in the end-of-care medical treatment are not a dollar and cents problem and cannot be resolved in an empirical manner. Society has to address this matter on a philosophical level and make some hard decisions in an ethical manner. No one wants to pull the plug on the elderly but the costs of not doing so is becoming increasingly more burdensome for the health care system.

For nearly as long as the health care debate has been going on there has been a related debate ensuing regarding tort reform (Avraham 2009). There is a school of thought that the plaintiffs' bar and its perceived aggressiveness in pursuing malpractice actions against medical practitioners have contributed to the high cost of health care. The theory is that doctors and other health care professionals have adopted a program of over-treatment in an effort to avoid costly law suits. The logic of this approach, like many other health care issues, has been debated extensively and no clear answer has been reached.

Over treatment occurs for other reasons as well. Like all professions, the medical field has practitioners who are more interested in profits than in providing quality health care and this results in testing and procedures being performed that are unnecessary. These unnecessary treatments and procedures contribute significantly to the increase in health care costs and monitoring these type of actions is difficult. Doing so would require the establishment of a bureaucracy to monitor the unscrupulous physicians that would likely be as expensive to establish as allowing the unnecessary treatments and procedures to continue. Another solution that has been suggested, however, to minimize the over treatment problem is the establishment of a voucher program where physicians provide annual care for patients at a fixed price. The adoption of such a program would eliminate the incentives inherent in the fee-for-service system that currently exists. The medical profession does not favor this approach but it may be necessary if over treatment continues to be a problem.

The solution for the over treatment problem related to the medical professions' fear of lawsuits has been as hotly debated as the issue of whether this fear has led to the rise in health costs. The medical profession favors a radical change in our nation's tort system while the legal profession opposes such reform. Attempts in this area are progressing but, to date, there has been little… READ MORE

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