As indicated by Mason et al. (2016), “From the 1970s to the present, continually rising insurance premiums and health care delivery costs have strained government budgets, become a costly expense to businesses that offer health insurance to their employees, and put health care increasingly out of reach of individuals and families” (p. 178). Explain in detail one cost-containment effort such as managed care or one financing mechanism that is impacting healthcare expenditures and delivery of healthcare services. Please identify at least two research studies or reports (report may be from a national reliable organization) that have examined the efficacy and/or comparative effectiveness of these measures. Furthermore, please discuss challenges and/or barriers in regards to implementing cost-containment efforts at the systems and/or organizational level.
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Discussion 31: Policy Advocacy and Healthcare Ethics: Cost Containment
The healthcare revolution has been based on diverse fronts, making it more affordable to people and families. The high cost of insurance premiums and care delivery costs have been on the rise, strained government financially, costly for employers making healthcare accessibility out of reach for the community, families, and individuals. This trend has led to demand for health costs containment strategies such as managed care, telemedicine or virtual care, and high-deductible health plans.
Cost containment is regarded as a reduction of the rate of increase in healthcare costs. Telemedicine provides a win-win for employee and employer cases whereby the power of technology is harnessed to redesign how healthcare is delivered (Snoswell et al., 2020). This cost containment measure offers employees lower-cost access to healthcare through virtual visits to a doctor as patients get diagnosed and treated without visiting the doctor’s office. This implies can get services conveniently and quickly. On the other hand, employers benefit as the strategy allows patients to avoid undergoing more expensive care options such as urgent care and primary and emergency rooms. However, for actual cost saving to be experienced, telemedicine must be widely used as failure to adopt the strategy would mean doctor’s visits are practiced hence little cost saved. According to Snoswell et al. (2020), telemedicine is increasingly viewed as a cost management method as it helps in delivering patient care while expanding accessibility and care quality.
The implementation of cost containment measures in the healthcare industry is meant to increase accessibility to care services for the public. However, different barriers impede implementing the strategies in care systems and or organization level due to diverse factors. One is due to the lack unified healthcare system with no single player in cost determinant. Subsequently, different stakeholders, more so private players, influence the cost of care (Shrank et al., 2021). This results in unregulated prices, hence patients being exposed to high-cost services, with little power and input from the government in cost mitigation efforts. Secondly, lack of enough patient participation or involvement in decision-making regarding the cost of healthcare services leaves them exposed to high-cost healthcare services.
Shrank, W. H., DeParle, N. A., Gottlieb, S., Jain, S. H., Orszag, P., Powers, B. W., & Wilensky, G. R. (2021). Health Costs and Financing: Challenges and Strategies for a New Administration. Health Affairs, 40 (2), 235–242. https://doi.org/10.1377/hlthaff.2020.01560
Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if Telehealth Can Reduce Health System Costs: Scoping Review. Journal of medical Internet research, 22(10), e17298. https://doi.org/10.2196/17298