INTRODUCTION Themost significant aspect of a nationwide health organizations are the means bywhich it is funded.
Financing is a crucial aspect that is dominant in assistingto achieve public and private health goals and purpose (Almgren, 2017). Whilst the ultimate goal is to provide qualityservice and reduce illness, financial hindrances have become a liability inhealthcare management organizations, which are still in great need of resolutions.This research paper will discuss the brief analysis and findings of the many preliminaryfinancial complications affecting our health system here in the United States. Accordingto the World Health Organization health care financing is defined as the “functionof a health system concerned with the mobilization, accumulation and allocationof money to cover the health needs of the people, individually and collectively,in the health system.” Also stating that ” the purpose of health financing isto make funding available, as well as to set the right financial incentives toproviders, to ensure that all individuals have access to effective publichealth and personal health care” (WHO, 2010).
A health care financing structurenot only orbits around the pivotal factors of who is paying for health care,how much is being paid, and how it is paid; it also helps to determine the natureof care that is to be delivered and to whom it furnishes. DISCUSSIONMedicare has always been and remains being an importantpart in health care reform campaigns. Yet, Medicare reimbursement is an issuethat is a source of frustration for many hospitals, physicians, and otherhealthcare providers. In order to try and reign in on the high cost of Medicareand keep its trust fund, titled, “budget neutral”, congress has ordered Medicareto control payments. This has impacted hospitals and other healthcare providersin disadvantageous way. There have been decreased payments across all sectorsof the healthcare system. A way that Medicare payments are being decreased isthrough the Medicare Physician Fee Schedule; it determines how much doctorsshould be paid for treating Medicare patients based on cost-related factorssuch as inflation and geographical location.
The data on hospital revenues,expenditures, and admissions is collected from Medicare costs reports (Cutler,1998). However there have been issues of misreporting which can lead to issueson how things are calculated. Additionally, Statistical research has found thatMedicare spending’s have grown “4.5% to $646.2 billion” in 2015 alone, showinga braking “from the 4.
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8 growth percent in 2014″ (Cms.gov, 2017). Thedeceleration in growth that is clearly visible is due to a decrease in Medicareenrollment. Not to mention, every year, the threat of cuts to Medicare leads tothe uncertainty that physicians will limit or stop treating patients onMedicare. The revenue cycle management is the part of a hospital thatencounters the most challenges when it comes to handling the financialpressures that come from regulation.
One of the challenges is billing andcollection errors. If the billing process is not closely observed and correctlydone, it can either cost the hospital to lose millions of dollars or it cancause patients huge debts that they have no way of paying. Of course it isimportant that the hospital is being paid for their service, but havingpatients pay huge debts can cause them to seek service elsewhere, which canalso hurt the hospital in the long run.
Collection becomes even more difficultif the patient has left. The revenue cycle management relies on technology tokeep track of claims and to ensure that payments are collected and deniedclaims are handled. However, there are a few obstacles when it pertains tocombining technology and billing infrastructure to successfully manage claimsas well as large outpatient networks. Not all hospitals and clinics have thefinance or the framework to spend on new technology. In the end, some providershave to turn to consolidating, outsourcing, or closing down altogether.
Lack ofstaff training also plays a big role in the challenges that the revenue cyclemanagement deals with. If staffs are not trained properly and efficiently, itcan lead to errors in billing and recording patient data correctly. Codingerrors from inexperienced staff could potentially turn into medical errors, andit could end up causing the healthcare organization undeserved spending. Furthermore, healthcare machinery has contributed largely to escalating survival rates, yet healthcare expenses has also grown more rapidly than in any other country. Thoughtechnological improvements have served and will continue to better our healthindustry, technical advances alone were responsible for forty to fifty percentincrease in annual costs (Cms.
gov, 2017). The American Economic Associationstates “…U.S.
health care spending as a percentage of GDP has risen rapidlycompared to other countries because the reimbursement system encourages thewidespread diffusion of both old and new technology. This is particularly trueof the U.S. Medicare program that offers generous incentives for more intensivecare.” Whilst it is without certainty that for now the results of new medicalsystems and programs have been circumstantial to the staff and the patients,these technological improvements in the long run could judiciously increase in costsand decrease productivity, causing a greater gap and maybe even lessening thenumber of patients who could actually adapt to those prices. Appendix Ashowcases the rankings of each country with their initial share of GDP sincethe 1980’s. The United States, annual growth rate, in comparison to othercountries from the 1980’s to 2004, was lower than “Spain, Portugal, Norway, andIreland, and barely higher than in the United Kingdom” (Chandra, 2012).
However,progressively, we note that the United States continuously stands out due torapid increases in “the share of health spending” (Chandra, 2012). Emergencydepartment overemployment is another financial liability in health care management.It is an issue that has become worrisome among hospitals, healthcare providers,and policy makers over time. The number of people that use the hospitalemergency departments for nonessential care that could have been treated bytheir primary care provider has increased to a distressing rate. This in turnhas caused excess costs in healthcare since emergency room visits are now moreexpensive than receiving care in a primary care facility.
Shockingly enough, emergencyvisits are now two to five times more costly than receiving care from a primarycare provider. Appendix B coming from areport conducted in 2010 by Medica Choice Network shows the comparison of whatpatients would typically pay in difference between urgent care and emergency roomvisits for non-emergent conditions (PaladinaHealth, 2016). M.D, James Adams was,also, able to find that the estimated spending on emergency department overuseis approximately $38 billion on an annual basis. By tackling the problems ofemergency department overdo, it is notable that there can be a decrease inhealthcare disbursements and rise hospital revenue and expenses significantly. Subsequently,another area that is suffering vastly and can use improvements is pricing andprice transparency. Full comprehension of costs for health care services can beconfusing for patients.
Prices of services vary and depend on where service isbeing provided, what kind of insurance the patient has, and other factors.Essentially, it becomes problematic for patients to know how much they will bespending for specific tests and procedures. According to the Robert Wood JohnsonFoundation, the lack of clarity regarding health care prices is believed to bea big contributor that inhibits a more operative functioning of the health deliverysystem as a whole. SOLUTIONSThereare various solutions that can be used to tackle the high expenses of healthcare costs. One way could be an improving price transparency in health care;allowing patients to know how much a service would cost and how much they wouldbe paying out-of-pocket before receiving attention.
It can help to lower costsin the long run and can serve as an educational tool for patients that want to compareprices so that they can make more knowledgeable decisions about their ownhealth care. It could also serve as a way for them to have a contingency plan,in case they feel the need to save their funds and allocate their sources toreceive proper care. Moreover, another resolution to limiting costs could be reducingadministrative costs. Cutler et al, found that a physician on average spends 43minutes a day dealing with health plans about payment, dealing withformularies, and obtaining authorization for procedures. They also have to hirecoders that can translate clinical records into billing forms, as well assubmit and monitor reimbursements. All of this involves spending a lot of timeand money that can be used on more pressing matters.
To reduce administrativecosts, adjustments and affordable computer systems and programs should beincorporated in various healthcare facilities, not all, interconnecting withanother to reduce the time and activism physicians spend allocating such authorization.Although training can be time consuming and expensive, it is important thatstaff are efficiently well trained so that errors can be avoided. Besides, inthe long run it would save health care services a great amount of money. Codingstaff could complete sixty hour training sessions so that they can properlylearn how to code effectively. Coding and billing errors would be avoided, thereforemaking the billing process more effective and effortless. CONCLUSIONHealthcare expenditure is greater than it was over the last twenty years due to notonly the unjust absolute terms the United States seems to be driven by but alsothe gross domestic product. These increases are not necessarily attributable toa particular reason specifically; rather it is a wholesome system that seems tolack improvement as of now.
Apart from being one the leading countries, one ofthe most advanced as well, the United States lines poorly in terms of its healthstatus. We can conclude that while the prices are remaining to graduallyincrease, services rendered are still very poor. In the United States, costsare clearly a source of unmet needs; in need of consecration to better providethese unsuccessful services that are considerably too high and graduallyincreasing.
