Article

The rise in health care spending and what to do about it

Department of Health Policy and Management, Rollins School of Public Health, at Emory University in Atlanta, Georgia, USA.
Health Affairs (Impact Factor: 4.32). 11/2005; 24(6):1436-45. DOI: 10.1377/hlthaff.24.6.1436
Source: PubMed

ABSTRACT Reforms for slowing the growth in health care spending and increasing the value of care have largely focused on insurance-based solutions. Consumer-driven health care represents the most recent example of this approach. However, much of the growth in health care spending over the past twenty years is linked to modifiable population risk factors such as obesity and stress. Rising disease prevalence and new medical treatments account for nearly two-thirds of the rise in spending. To be effective, reforms should focus on health promotion, public health interventions, and the cost-effective use of medical care.

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    • "As the costs and outcomes of health care in industrialized countries were compared, it also was recognized that the US was maintaining a costly system that yielded poor health outcomes for our citizens (Commonwealth Fund, 2011). In addition, the cost of health care was increasingly tied to health conditions brought on by modifiable risk factors, such as obesity and stress (Thorpe, 2005). Thus the context for the idea of a wellness focus was building. "
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    ABSTRACT: Currently the United States health care system is responding to the Patient Protection and Affordable Care Act (PPACA) and the vision it contains for health care transformation. Along with sweeping changes in service delivery and payment structures, health care reform has championed concepts such as patient-centered care, integrated care, and wellness. Although these are not new ideas, their adaptation, in both ideology and service design has been accelerated in the context for reform. Indeed they are reaching a tipping point; the point where ideas gain wide acceptance and become influential trends. Although psychiatric mental health (PMH) nurses have been active in wellness, patient-centered care, and integrated care, at the current time they seem to be situated peripheral to these national trends. Increased presence of PMH nurses will facilitate their contribution to the development of these concepts within service structures and interventions. To increase knowledge and appreciation of PMH nurses’ practice and unique perspective on these issues, leaders are needed who will connect and effectively communicate PMH nursing efforts to the broader health care arena. This article outlines the events that created a context for these three concepts (patient-centered care, wellness, and integrated care), and I suggest why they have reached a tipping point and discuss the need for greater PMH nursing presence in the American national dialog and the role of nursing leaders in facilitating these connections.
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    • "The lessons learned have not yet been widely applied. Most projections of " health care costs " do not carefully address the disparity between micro and macro estimates, and may not even explicitly acknowledge that such a divergence exists (Lee and Miller, 2002; Seshamani and Gray, 2004; Stearns and Norton, 2004; Goldman et al, 2005; Thorpe, 2005). For example, the Rand Health Insurance experiment, considered a " gold standard " for testing the effects of price elasticity and insurance coverage on individual expenditures, is often misused to create estimates of aggregate regional or national spending, a purpose for which it was not designed, for which it is ill-suited (Finklestein, 2005). "
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    ABSTRACT: This paper examines the effects of economic and demographic trends upon the costs and provision of health services among countries at different stages of development, and in particular how different financing methods lead to different roles for the Ministry of Health—and the likelihood they create of a public health system crisis. First, the trends in Medical Technology, demographics and national health spending as projected by the OECD, the WHO and the Society of Actuaries is presented. The analysis proceeds to examine divergences between sub-sectors (elderly v. young, poor v. rich, urban v. rural, hospital v. clinic or doctor). Special attention is given to the question of whether a widening gap between groups (urban v. rural, rich v. poor) will cause average per capita expenditures to rise more or less rapidly, and the extent to which it may cause of result from public v. private financing. The ability of financing mechanisms to promote or disrupt harmony in response to two major challenges (1. Rising Costs 2. Biologic Catastrophe) are then discussed. Careful attention is given to the differences in the causes of individual health expenditures and national health expenditures, and the relationship of each to income of the person, or of the national as a whole. This provides a foundation for a typology of Ministry of Health and Ministry of Finance responses to (a) Long Term Trends and (B) Public Perceptions.The economics of budgeting is shown to be a task that is both inherently technical, and also political, relying ultimately on public support. It is concluded that it is up to the people and the political process to determine the amount of money in total available to pay for health care costs, and the task of the national health authority to use that funding wisely to obtain the best health outcomes, satisfaction with care, and trust between patients, physicians and hospitals.
    Procedia - Social and Behavioral Sciences 01/2010; 2(5):7137-7144. DOI:10.1016/j.sbspro.2010.05.066
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    • "Certain reforms have a potential to improve cost, particularly if healthcare systems are oriented toward prevention and consumers become habituated to developing healthy lifestyles. Thorpe (2005) notes that nearly two-thirds of the rise in US healthcare spending has been linked to the rise in certain diseases (such as diabetes) and to expensive innovations in treatment. Behavior such as over-consumption of food, lack of exercise, smoking, and stress is related to approximately 40-50 percent of morbidity and mortality. "
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