Role that Government Agencies Play in Healthcare Issues

Discuss the role that government agencies must play in order to overcome the obstacles and address the issues your peers identified.

 

PEER 1-AK

I consider the high cost of healthcare to be one of the most important issues that needs to be addressed. The Affordable Care Act was a step in the right direction when it comes to trying to contain the cost of healthcare but more needs to be done. National healthcare spending is projected to rise by almost 18 percent of the economy to almost 25 percent. But the federal increase is going to rise from 25 percent to almost 40 percent. I think there are many obstacles that keep us from reducing the cost of healthcare.

I’ll give you a few of the barriers that we face when it comes to reducing the cost of healthcare. Using fee-for-service payment in payment “reforms”, physicians compensation being based on volume, not value, impacts hospitals negatively, and lack of patient engagement. When it comes to fee-for-service payment reforms is only causing for another layer of incentives to be added to a system that already has problems. The changes have made a small impact on cost but not enough to account for anything. Trying to patch a broken system is an obstacle that needs to also be addressed to move forward. One solution for this obstacle is to use episode-of-care payments and global payments as well. These payment reforms would allow for flexibility and accountability in reducing the cost of healthcare.

Another obstacle to reducing healthcare costs are physician’s compensations that are based on their volume, not their value. If we change the payment systems than we must change physician compensation so that they align. The federal and state can make this change a challenge because of laws that prevent fraudulent or abusive conduct under the current guidelines of the payment systems. But if changes are made to these laws then the change can be made to the compensation for physicians. These barriers can cause a negative impact on hospitals as well and since they represent the largest percent of healthcare cost this could be another obstacle. But they can fix this by trying to reduce their fixed costs and improve efficiencies within the hospital. They can also change payment levels for hospitals to reflects higher costs per admission this may cause for lower admission rates.

Lastly, lack of patient engagement is an obstacle we face in reducing the cost of our healthcare. Some payment reforms are requiring that patients be “assigned” to providers which can cause many problems for both patient and provider. It causes the patient to not know which payment model is being used until after the care has been delivered to them. Some of the ways to overcome this is by asking patients to choose a primary care physician rather than assigning them one. They could also implement a value-based benefit program to encourage patients to improve their health. These are only some of the obstacles that we face in reducing the cost of healthcare, but it is a place to start.

Resources

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https://www.coursehero.com/file/33279913/Discussion-7-1docx/

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Cutting Health Care Costs. (2014, November 05). Retrieved April 16, 2018, from

https://www.americanprogress.org/issues/healthcare/news/2012/08/02/11970/cutting-health-care- costs/

Miller, H. D. (2007). Ten Barriers to Healthcare Payment Reform[PDF]. Commonwealth Fund.http://www.chqpr.org/downloads/overcomingbarrierstopaymentreform.pdf

 

PEER 2-KB

Healthcare costs in the United States have increased dramatically over the past several decades. According to the Centers for Medicaid Services, in 1962, the percentage of healthcare expenditures equaled just over 5% of the Gross Domestic Product.  That number has tripled to 18% in 2018.  CMS projects that by 2028, that cost will represent approximately 20% of the GDP, which equals 6.2 Trillion dollars (Peter G. Peterson Foundation, 2020).  The rising cost of healthcare is what I consider to be one of the most important issues to address currently.

One of the reasons that healthcare costs are rising is due to the increasing number of the older Americans.  People over the age of 65 typically spend more on healthcare than any other age group.  According to the U.S. Census Bureau, this sector of the population is projected to exceed 20 percent of the U.S. population by 2030.

Other possible causes of rising healthcare prices can be attributed to hospital mergers.  Lack of competition, or a monopoly, gives hospitals the ability to increase prices without the free market forcing them to be more competitively priced.  Couple that with new technology constantly being introduced, equaling more expensive procedures being performed.  The rise of healthcare costs have exceeded the rise of inflation on average by 1.4 percent per year (Peterson, 2020).

So what are some obstacles to overcome to address this issue?  Healthcare reform in the way that federal programs pay for healthcare is a start. Encourage better care from providers, and eliminate unnecessary waste is a start.  The cost of healthcare should also be made more visible and easier for enrollees to understand.  These are just a tip of the iceberg for changes that can be looked at in order to reduce healthcare costs.  There is no one easy answer, but perhaps with even a few changes, these costs can begin to be reduced.  Keeping healthcare costs from rising uncontrollably is imperative for our nation’s long term economic health.

 

Peterson Foundation. (2020, April 20). Why are Americans paying more for healthcare? Peter G. Peterson Foundation. https://www.pgpf.org/blog/2020/04/why-are-americans-paying-more-for-healthcare.