Health care spending in the U.S. continues to soar to unsustainable levels. There are many strategies and views on ways to contain health care costs, while improving the efficiency and quality of health care. Hospital services, physician services, prescription drugs and technology/medical innovation and the aging population are areas that drive the high cost of health care creating an unaffordable dilemma for consumers and employers.(Cowen & Moorhead, 2011) Uninsured individuals who are unable to afford health insurance are less likely to coordinate their care appropriately, leading to poor health outcomes.
The aging of the population and the rising cost of health care would cause spending on the major health care programs and Social Security to grow from more than 10 percent of GDP today to almost 16 percent of GDP 25 years from now. That combined increase is equivalent to about $850 billion today. (“Congressional Budget Office,” 2012)
The aging of the baby boomer generation will have an impact on federal spending as well as health care costs.
(“Congressional Budget Office,” 2012) Increase in longevity due to medical advances and technology are a factor in spending growth increases. (Henderson, 2012) The second largest segment of U.S. health care spending is on physician services. (Cowen & Moorhead, 2011) Providers are paid for services rather than patient outcome. This creates little incentive to coordinate patient care with other specialist. A large portion of the aging population has multiple chronic conditions which would benefit from better coordination of care. (White, 2010) With the shortage in primary care doctors and the aging baby boomer generation consuming more care, costs for physicians services will likely increase. A new model of primary care called the patient centered medical home provides better coordination of care, helps lower cost and improve patient satisfaction. (Henderson, 2012) Hospital services account for one of the largest drivers of health care spending.
Shortage of nursing staff is one factor which influences increased wages, as well as the decrease in payment from the Medicare population. (Cowen & Moorhead, 2011) Those costs and differences in reduction of payments are then shifted over to consumers and payers. With the increase in the baby boomer generation, the federal government will need to manage the extra services being utilized through Medicare with an attempt to find ways to reduce payments to hospitals. (“Congressional Budget Office,” 2012) New and better drugs will help benefit health but may cost more. Prescription drugs are advertised on television each day. Patients are more educated on the drugs used for their conditions and are likely to request from their physician these highly advertised drugs they feel may benefit them.
Many physicians are likely to give into the demands of their patients requests leading to more costly medications used that could be avoided. Advancing technology can positively or negatively impact health care costs. Many times over use of technology, especially when there is a less costly alternative can increase health care costs. On the other hand, new technological advances in data collection for a personal health record can be utilized to coordinate care, promoting better quality of care resulting in improved health outcomes and cost savings. (Cowen & Moorhead, 2011) Disease management, Health savings accounts and Retail clinics are just a few of the solutions offered to consumers to help cost. Disease management is offered by many health insurance companies for their members with chronic health conditions such as diabetes, congestive heart failure, asthma and coronary artery disease. Nurses educate the members on their health conditions and help set health goals to help prevent hospitalizations and improve health outcomes. Studies, however, do not suggest this is a proven cost saving strategy. (Cowen & Moorhead, 2011) Health savings accounts allow people to have more control over how their money is spent. Pretax contributions are placed into the account and money can be deducted to pay for medical expenses.
There is hope that the HSA will encourage people to focus on lower cost services. Retail Clinics are a creative way to offer routine care in private stores, in large chains and grocery stores. This is a growing trend with health care being provided by a physician assistant or a nurse practitioner. Care is often more affordable and attractive for those uninsured individuals. (Cowen & Moorhead, 2011) Nursing in the future may expand to become more focused on the role of the primary care provider. With the shortage of primary care physicians states should consider easing the scope of practice restrictions. Nurse practitioners can perform the role of primary care services just as well and effective as physicians do. There are many factors involved in health care costs that the government and private sector must come together in a coordinated effort to improve. There is no single solution to solving the health care spending dilemma. All of the drivers of health care cost must be addressed in any reform or cost control discussion.
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