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Economic issues that confront the United States healthcare industry
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Health care service providers compete on four different unproductive kinds of competition. First is annual competition to enroll more subscribers for health plans. It not only restricts the network for the payer but also its goal is not to provide value for the long term as the subscription is only for one year. Second is to give deep discounts to payers or employers to have increased flow of patient population just because they are associated with large companies. It is not economical because it takes same resources and cost for hospital to treat discounted patient and a self-employed patient. These discounts merely shift the cost to small groups and provide benefits to large groups which eventually increase the number the uninsured patients having expensive treatment which has to be subsidized. Third form of incorrect competition is to become most dominant group in market which provides comprehensive collection of services. It results in mergers of the hospitals and having duplicated specialties in two departments rather than improving the quality of one department. Lastly, the argument over ‘who pays’ does not generate value for the patients because suppliers and consumers try to transfer costs to each other. Health planners either deny to pay or payers raise rates for subscribers. So the competition is …show more content…
Cost in U.S is charged on three different ways. Study suggests that the greater costs are not linked with improved medical outcomes or degree of ailment or cost of living. The major variances across regions in outcomes are due to localized competition. Competition in this system should be at regional or even national level, especially for more complex or uncommon conditions. The relationship between the local providers and wide array of leading providers speed up the quality and efficiency throughout the system but it is
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
The current health care landscape has been characterized by large scale consolidation and vertical integration of payers and providers. This has led to a handful of dominate players with substantial influence, and an increasing overlap in responsibilities between payers and providers. Although payers and providers have traditionally been on opposing sides, battling each other about quality of care versus cost-effective care, they are shifting to working together to achieve better value.
Dawson, D. (1995) ‘Regulating Competition in the NHS.’ The Centre for Health Economics (University of York.)
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
I agree with Heath’s argument that a two-tier health care system is effective as long as it does not undermine the integrity of the public insurance mechanism. The main argument against the two-tier health care system is that doctors will turn away from the public sector to pursue a higher income within a private practice. The concern arises that this will cause a scarcity of doctors within the public sector. I believe this argument is invalid and will discuss throughout this paper why the two-tier system improves upon health care systems in many ways.
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
The United States health care system is one of the most expensive systems in the world yet it is known as being unorganized and chaotic in comparison to other countries (Barton, 2010). This factor is attributed to numerous characteristics that define what the U.S. system is comprised of. Two of the major indications are imperfect market conditions and the demand for new technology (Barton, 2010). The health care system has been described as a free market in
The health care industry is positioned for the global market place. It is expected to grow exponentially in health-related services for the elderly. China’s population of individuals over sixty years old is expected to grow to one third in the next twenty-five years. Though their culture view aging somewhat differently than in United States, they are interested in the attractive senior living options established here. Senior care encompasses private care facilities, home health care, products, drugs and medical equipment. As the largest health care market in the world American companies have made significant global inroads over the last two decades. These businesses are positioned to offer additional services directed at retirees, and children who will be responsible for their parents and potentially their grandparents as well.
Throughout the years, there have been many individuals and families who have not been able to afford healthcare. Some programs have helped to provide for those in need, but they have not provided to all needy citizens. In an effort to provide more people with the healthcare and insurance they truly need, the United States government has developed the Affordable Care Act. The act’s purpose is to expand Medicare, which was originally developed to provide for the elderly and the disabled, to those who are not disabled but are in times of financial hardship. The Affordable Care Act was originally developed to ensure healthcare to all individuals who could not afford it on their own. It would seem that the increase in the number of patients would benefit hospitals, but this act does the opposite of its intended outcome. There are more patients visiting the hospitals, but the act lowers the costs of their medical bills, which in turn decreases the hospitals’ incomes. This decreased source of income causes both the patients and the employees to find new solutions to the increased amount of issues that they now endure.
6. The special characteristics of the U.S. health care market are Ethical and equity considerations, asymmetric information, spillover benefits, and third-party payments: insurance. Each one of these characteristics affects health care in some way. For example, ethical and equity considerations affect health care in the way that society does not consider unjust for people to be denied to health care access. Society believes that it is the same thing as not owning a car or a computer. Asymmetric information also gives health care a boost in prices. People who buy health care have no information on what procedures and diagnostics are involved, but on the other hand sellers do. This creates an unusual situation in which the doctor (seller) tells the patient(buyer) what services he or she should consume. It seems like the patient has to buy what the doctor tells him. The topic of spillover benefits also cause a rise in prices. This meaning that immunizations for diseases benefit not only the person who buys it but the whole community as well. It reduces the risk of the whole population getting infected. And the last characteristic is third-party insurance. Which involves all the insurance money people have to pay. This causes a distortion which results in excess consumption of health care services.
However, according to Jenna Flannigan, write at Healthline.com, America’s current for-profit system allows for competition between medical and pharmaceutical companies which drives prices up astronomically. “In countries where health insurance is government-run or nonprofit-run, there is no profit factor to drive up prices…For example, a typical bypass surgery in the Netherlands costs about $15,000 while in the United States it costs about $75,000” (Flannigan). This figure illustrates how the US’s needless competition between private, for-profit organizations make medical care unnecessarily unattainable to those who aren’t very affluent or do not have comprehensive medical care. These bloated prices do not even contribute to better care a majority of the time, as pointed out by political consultant Karin J. Robinson. “Here in Britain, for instance, we spend about 8% of the country's annual GDP on health care, compared to 15% in the US, and yet the overall health of the population is similar, with perhaps even a slight advantage for the UK” (Robinson). America’s current system is far more expensive, but for what reason? A healthcare system should be driven a will to help those in need, not for the personal gain of companies that are rife with greed. America needs to follow the path of other first-world nations and take a different approach to
towards the quality and cost of health care in the United States in the general public. In
price, quality, convenience, and superior products or services); however, competition can also be based on new technology and innovation. A key role of competition in health care is the potential to provide a mechanism for reducing health care costs. Competition generally eliminates inefficiencies that would otherwise yield high production costs, which are ultimately transferred to patients via high health service and delivery costs. The first component is comprised of individuals who provide health care (e.g. physicians and other practitioners)
Cost and Quality of Health Care It’s shocking to know that consumers are not provided with sufficient factual information that on the subject of today’s health care. The tendency in health care is that consumers assume that providers with high cost provide higher-quality care than do low-cost providers (N.A., 2013). In a research study on the basis of quality and cost, 1,421 adult respondents were least likely to select high-cost providers as high-value providers if the cost information was provided in a form of ranking (N.A., 2013).
Some economists suggest that the market for healthcare is different from other competitive industries and therefore cannot act the same way. In principles, we learn the basic assumptions of a competitive market, (1) goods offered for sale are homogenous, (2) there must be many buyers and sellers so that each has a negligible impact on the market price and (3) For markets to work efficiently there can be no significant information failure affecting the decisions of the producers and consumers. In perfect competition, product’s must be homogeneous which means that goods that individual producers cannot alter or differentiate to collect a higher price. Health care is a heterogeneous product because the patient can experience a range of outcomes. There is an ongoing battle between hospitals and insurance companies. In theory, insurance companies negotiate with hospitals for a reduced rate. One of my favorites quotes I stumbled upon is from economist Uwe Reinhardt in regards to Obama and Obamacare “I wish I had a half hour with him to explain it to him. If you pit hundreds of little insurers against each other, what makes any one think that each of them has enough market clout to bargain successfully with a hospital? So I don 't think this public health plan, adding yet one more competitor, is going to bring costs down at