Rising Healthcare Cost, Book Review Example

Increased healthcare costs have become an extremely huge concern for Americans. Healthcare experts are considering if there can be an effort made to increase coverage to Americans while making insurance coverage affordable to those Americans that presently cannot afford the coverage.

Facts

1. Premiums increased 114 percent between 1999 and 2007, while workers’ earnings increased only 27 percent.

2. U.S. spending on health care—as a percentage of Gross Domestic Product—is more than six percentage points higher than the average for other developed countries.
3. Technology—not demographics or medical malpractice—is the key driver of health spending, accounting for an estimated half to two-thirds of spending growth.
4. Other important drivers of health care spending include health status (particularly obesity) and low productivity gains in the health care sector.” [1](High and Rising Healthcare Costs).
5. Doctors are ordering unnecessary testing on patients without fully evaluating the symptoms because it is simply easier to order a test rather than take time to effectively diagnose.
6. Preventative testing on patients with clean family bill of health and clean personal bill of health is becoming too extravagant.
7. The use of second opinions are not being frequently utilized enough by the American patients with regard to options for surgery when their may be other options available for treatment.

“The drivers of high healthcare costs are manifold, and include the perverse incentives associated with an insurance-based payment system, low labour-productivity growth in the provision of care, and the closely related issue of a constrained supply of healthcare providers. “[2](Chambers 2009). The United States relies on a third-party payment system whereby individuals and employers purchase insurance that allows patients to receive healthcare services that are in turn paid for by insurance providers. For the elderly and disabled, the government assumes the role of the insurer, using funds from payroll taxes (rather than insurance premiums) from current workers to pay medical providers for care provided to those currently enrolled in Medicare, Medicaid, and other public healthcare programs.  This current system sure overextends the use of medical insurance.

Solution Proposal for Patient’s Past the Age of Ninety (90)

I support placing a cap on testing and procedures for surgery to patients over the age of ninety years. This is a proposition based on the anticipation to rid the government of ‘waste less and useless treatment’.  This may appear prima facie to be cold-hearted and age based discrimination especially if proposed by the younger generation, however one should look at the average life span of American women and men.  The average man lives to approximately 70 years of age with the average woman living to the age of 82 years of age. Factors rates concerning success of surviving a major surgery of a person after the age of 90 should be accessed when considering this 90 year cap. Studies show in 1990 that patients over the age of 90 have approximately a 17% higher chance of dying in anaesthesia than those under the age of 90.  With that in mind, patients 85 years or older have a 35% higher rate than patients under the age of 85 of dying within the first ‘critical 48 hours’ after surgery. [3]“In a study of 7,306 anaesthetics administered to patients over 80 years of age by Pedersen et al., 10.2 percent developed pulmonary complications, similar to a rate of 7 percent found in our recent study of patients 80 years or older.”( Pedersen T, Eliasen K, Henriksen E. 1990).

Solution Proposal to Decrease Preventative Examinations Based on Personal and Family History

This may be a rather complicated issue to implement because who will actually decide who has legitimate factors that constitute a wellness examination. What are the legal implications related to this proposal if an insurance company give a person a ‘B’ rating and states he/she should not be considered for preventative health exams based on prior history or present personal medical history and the patient three months later catches a heart attack and dies? For this sort of proposal to be effectively implemented without any risk to the patient and doctor the patient would have to show ‘absolutely a clean bill of health and absolutely no previous history leading to believe they would need a preventative plan’.  The solution to the may be instead of completely eliminating preventative examinations but to minimize them or require a thorough history examination giving rise to the patient to be able to request a second opinion or ‘arbitrate’ the decision of the insurance company within a ‘minimal period of time’. Why do I feel this way? Simply because if it would take months or years to appeal a decision of the insurance company, a patient may die in the meantime and give rise to a legal action against the doctor, insurance company and other involved in the determination of making decisions based on preventative examinations. Preventative examinations are useful because they serve the purpose of eliminating potential high risks for surgery or other expensive measures if the condition is diagnosed quite early. Though, the abuse of preventive examinations needs to be curtailed by monitoring the use of them and by which means are they available to patients.

Solution Proposal to Require Mandatory Second Opinions Prior to Commencing Surgery Procedures

At present, this requirement of mandatory second opinion prior to surgery is already in force by some of the insurance companies but it is not mandated legislation or part of the medical reform across the board. It is certainly up to each individual insurance company if they choose to mandate this ‘discretionary’ option. The intention of this mandated procedure is to eliminate unnecessary ‘elective surgical’ procedures.  This is further known as ‘evidence based surgery’.  [4]“Studies have shown that when second opinions have been utilized a financial benefit was accomplished because in 11-19% of the cases it was found that elective surgery was not needed at all.” There have also been cases of discrepancies in diagnosis and misinterpretation of result. Second opinions are utilized to concur primary diagnosis and are an independent look at interpreting patient’s results. Whether the second opinion confirms the first diagnosis, it still serves as an objective opinion of which is needed in especially high dollar and high risk surgeries. (Toby, Gordon & Cameron 2000).

Conclusion

One of my three proposals to reform healthcare is putting an age limitation on surgeries to that of the age of 90. This would certainly exceed the normal life expectancy of Americans. Special consideration will be taken for certain case. The second proposal is highly scrutinizing the need for wellness prevention testing according to patient medical history and past family history. This of course would need some definite qualitative and quantitative basis for implementation to insure all patients are properly being accessed and to minimize the risk of legal litigation. The most advantageous and easiest of all three reforms to implement would be my third suggestion of mandatory second opinions prior to surgery. This would save the taxpayers as much as 11% based on studies conducted. This would be of an independent and non-bias nature and should be easy to implement and enforce.

Works Cited

[1] High and Rising Healthcare Costs Demystifying U.S. Healthcare Spending 2008 October.31 August 2009.< http://www.rwjf.org/pr/product.jsp?id=35368>.

[1] Chambers, Dustin What is Driving Rising Healthcare Costs 18 May 2009.31August 2009.< http://www.american.com/archive/2009/may-2009/what-is-driving-rising-healthcare-costs.

[1] Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: Risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand. 1990;34:144-55.

[1] Toby A. Gordon, John L. Cameron Evidence Based Surgeries New York:NY. PMPH-USA, 2000 657-659.

[1] High and Rising Healthcare Costs Demystifying U.S. Healthcare Spending 2008 October.31 August 2009.< http://www.rwjf.org/pr/product.jsp?id=35368>.

[2] Chambers, Dustin What is Driving Rising Healthcare Costs 18 May 2009.31August 2009.< http://www.american.com/archive/2009/may-2009/what-is-driving-rising-healthcare-costs.

[3] Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: Risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand. 1990;34:144-55.

[4] Toby A. Gordon, John L. Cameron Evidence Based Surgeries New York:NY. PMPH-USA, 2000 657-659.