The Declines and Rises in Healthcare Costs

The Declines and Rises in Healthcare Costs

There has been a decline in healthcare costs the past few years, but not enough for people to actually pay the bills. Healthcare costs have begun to slow when compared to the late 90s and early 2000s, but not enough for most Americans to revel in the act of using healthcare. According to KaiserEDU there have been some troublesome realizations that have been realized in the past decade. "Since 2002, employer-sponsored health coverage for family premiums have increased by 97%, placing increasing cost burdens on employers and workers. In the public sector, Medicare covers the elderly and people with disabilities, and Medicaid provides coverage to low-income families.  Enrollment has grown in Medicare with the aging of the baby boomers and in Medicaid due to the recession. This means that total government spending has increased considerably, straining federal and state budgets"[1]

What I find to be interesting is the current way which Americans use our healthcare system. A report for 2011 complied by the Healthcare Cost Institute broke down the spending trends for 2011.[2] (It should be noted that the report is based on people under the age of 65 with employer sponsored or private insurance). The three points from that report that I found most poignant were;

1. Rising prices drove spending increases for ALL major health care service categories.

This means that because medical suppliers, pharmaceutical companies, hospitals etc. were increasing their prices, the cost for services rendered increased in every single major healthcare service. Therefore the cost went up across the board from a strep throat test to a heart transplant.

2. Out of pocket spending increased by 4.6% to $735 in 2011.

The already crushed middle class is spending even more money out of pocket from their own paycheck than the year before.

3. Spending on children ages 0-18 has risen 7.7% to $2,347, continuing a trend observed in 2010.

This statistic can be taken in a few ways. One, is that healthcare providers are lessening their coverage for children, and thus parents have to foot more of the bill. Or it may also mean that our children are getting more unhealthy and that the healthcare coverage previously afforded to children just isn’t able to keep up with the declining health of our youth.

After reading these reports I found a conflict. The Health Cost Institute reported that there were rising costs for kids, rising costs for out of pocket spending and for rising costs for all health services. But other reports I had read had reported a decline in healthcare costs over the past few years. So what’s the truth? The truth is, we don’t quite know yet, with many governmental changes that have been in the works the past few years, it has not yet become clear if the decline in healthcare costs is valid, or due to a major legislative overhaul of the system which has caused healthcare management to shift their game plan. While healthcare management and the government gets their new plans in action, it seems the American people are paying for the changes, changes that seem to be leaving Americans with the same healthcare but with a higher bill.

What do you think of Healthcare Management and Governmental changes in healthcare?  Please comment on your experiences and thoughts.

Thank you to Baylor University Healthcare MBA for a wonderful education that has helped prepare me for the future of Healthcare!

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[1] http://www.kaiseredu.org/issue-modules/us-health-care-costs/background-brief.aspx

[2] http://www.healthcostinstitute.org/files/HCCI_IB3_Spending.pdf

Medical Tourism: A MBA Healthcare Tutorial

Medical Tourism:

A MBA Healthcare Tutorial

Medical tourism I thought involved black market dark alley surgeries and stolen organs. But apparently my Hollywood based assumptions were for the most part fictional. In fact Medical tourism in the medical world is becoming more and more appealing to highly respected physicians in the United States and motivated patients. I asked myself WHY?

1.      Why are patients choosing to leave the United States where we have the best and most well trained doctors to go to other countries to have procedures completed?

2.      Who are the doctors completing these procedures and what are their credentials?

3.      What procedures are available in other countries?

4.      What are the risks involved in leaving the United States to have a procedure done in another country?

1. a. One of the reasons people have begun to travel for medical procedures is due to the high cost of medical care and inaccessibility to comprehensive care. Patients are not as they were in the past, traveling for non-elective surgeries such as plastic surgery, but patients are now traveling for non-elective procedures such as hip surgery, heart surgery and even brain surgery.

    b. Also in conjunction with the lower costs, the patients are often getting the same care with the great physicians but in a different country.

(The costs are lower due to lower wages and less structured or demanding health coverage and governmental restrictions, these add to absorbent costs. There are also lower costs due to lower malpractice insurance costs for physicians who work in developing countries.)

2. The doctors that are completing procedures may have been trained in the United States or any other country that offers medical training. When traveling abroad to receive medical treatment it is explicitly important to DO YOUR RESEARCH! There are plenty of qualified doctors who work outside of the United States but as a patient going into a new situation it is important to familiarize one’s self the countries standards of care as well as the doctor’s certifications and training. Familiarizing yourself with the types of surgeries and the number of surgeries they have done is also a good indicator of the qualifications of the physician.

3. There are a lot of procedures offered in other countries the more common surgeries are those that are not covered by medical insurance in the United States. Such as stem cell procedures, weight loss, spinal surgery, cancer surgery/treatments or any alternative type treatments that the United States has not yet accepted as appropriate treatments meaning they are still often considered ‘experimental’.

4.  There are risks when getting medical treatment anywhere. However medical tourism to some can add a bit of extra anxiety since a person is going to a new place and seeing a physician that they have usually never met before. While medical tourism can be a wonderful option for many to receive cutting edge treatments and/or lower cost medical care it is of the utmost importance to do research and feel comfortable with the country, hospital, and physician before receiving any procedure.

 As we become more developed medically across the globe we have opportunities to discover what options and discoveries are being made. As a MBA healthcare student at Baylor University understanding how healthcare is spreading around the world is fascinating and leaves a lot to be learned and investigated. 

Everyone gets Healthcare but How do We get it?

Healthcare Reform: What Do I Do to Get Insurance?

A Healthcare MBA Tutorial

Simply, keep it simple. This is the idea behind helping Americans sign up for insurance. The Affordable Care Act has not been praised for being straight forward however it was made clear that the process of signing up for healthcare should be as easy as possible for everyone to use. This tutorial will explain all the steps that go on behind the computer screen. (Since I am obtaining my MBA in Healthcare at Baylor University in Texas I will use Texas’ Insurance Exchange in this tutorial.)

A.      The user will input some different information, including social security number, date of birth and other demographics.

B.      The demographic information then moves to the Texas Exchange almost directly sent away

C.      The demographic information is then sent to the Department of Health and Human Services, a Federal Organization the demographic information is then sent to be confirmed

D.     The demographic information is then sent to the IRS (Internal Revenue Service)

E.      The IRS then sends a request to provide income history to the Department of Health and Human Services (DHHS)

F.       That request of income history filtered through the DHHS is then sent to the Texas Exchange

G.     The Texas Exchange takes the inquiry of income history and sends a request to other states and third parties. For example to check unemployment, child support, credit bureaus etc.

H.     After the Texas income history, other state and third party organization data has been collected it is sent back to the Texas Exchange where it is aggregated and reconciled.

I.        The compiled data is then sent back to the consumer, the American signing up for the insurance. They need to confirm the information.

J.        The consumer then must offer any information available about employer health insurance programs available to them.

K.      This information about employers from the consume is sent to the Texas Exchange

L.       The Texas Exchange then takes the employer information and sends it to the consumer’s employer for confirmation.

M.   The employer than confirms the employee and verifies if the employer is using insurance options. The employer also verifies any tax credit and/or Medicaid eligibility. This information is then sent to the Texas Exchange.

N.     The Texas exchange takes the employer information and sends insurance plan options and premiums with the consumer.

O.     The consumer then can choose from the available plans afforded to them their selection is then finally sent to the Texas Exchange, where it is recorded.

The purpose of this tutorial is to help Consumers, Health professionals and MBA Healthcare students understand the process of applying for and receiving insurance through the Affordable Health Care Act. With all the changes in healthcare it has given me a lot of interesting and applicable information to study and share while gaining an MBA in Healthcare from Baylor University. 

Supreme Court Decision & Health Insurance Consequences

This week it is expected that the United States Supreme Court will decide whether to eliminate the ‘individual mandate’ which would require all Americans to buy health insurance or be fined for noncompliance. It is most likely that the Supreme Court will overturn the mandate. But what does this mean for the Healthcare Reforms? To many in support of healthcare reforms, it is a total stripping of all President Obama’s plan had to offer, and weakens the plan, perhaps the entire healthcare economic system.

As the plan stands currently, without being overturned, all Americans must purchase health insurance. Since that is the directive, it was written into the plan that insurance companies must charge the same amount to all people whether they are healthy or sick, since it may have seemed unfair to demand people to have to get insurance and them have to pay a lot more money because of preexisting conditions compared to a person who has to get insurance but is a lot healthier. In the past, insurance companies would reduce costs to a person who is in better health to those of lesser health. But as the Health Care Reform Act requires insurance companies are required to charge all people the same amount for coverage regardless of their current or past health history. So how do these two items relate 1. ‘Individual Mandate’ being overturned and 2. Health Insurance Costs being the same to all people of differing health status? Well, overturning the ‘individual mandate’ only overturns the portion of the Healthcare Reform Act that requires all Americans to have purchase health insurance; it doesn’t change the fact that insurance companies have to give flat rate costs for coverage to all Americans. Now, this sounds good right off the bat, but there are some huge consequences lingering in the background. Since it doesn’t matter what your health status is when you get insurance why would you get insurance until you actually needed it? Sounds good right? Maybe, not. The analogy that has been recently used is this, if the only time people bought car insurance is when their car was totaled and laying in the middle of the road, people would have no incentive to purchase car insurance. Healthy people would have no incentive to keep giving money to insurance companies and health insurance companies would be bleeding out costs due to only receiving money when people are in need of health care assistance, resulting in adverse selection. Healthcare companies would have to raise premiums to those who actually needed care and most health economists believe the entire system could crumble quite rapidly. So what is the answer? Healthcare Reforms? Keep the system the way it currently is? These type of nationwide problems and debates as well as healthcare economic discussions are what students at Baylor University in the MBA of Healthcare talk about in class. I want to know what the Nation outside of Texas thinks about these issues, because we need to have a lot more national discussions to be able to paint a more forthcoming, complete and honest picture.

Sources:

1.      http://www.nytimes.com/2012/06/20/business/economy/a-health-care-mandate-that-might-not-matter-economic-scene.html?_r=1

2.      http://www.washingtonpost.com/business/health-care-overhauls-plan-to-expand-coverage-leaves-millions-behind/2012/06/19/gJQA5yaanV_story_2.html