Medical Arms Race – A Review Indubitably, the contemporary medicinal care has become progressively reliant on the use of the latest technology, and the newer health devices are the designated quintessence of that trend. A modern healthcare facility is a utopia of complex equipment, rationalized care, and easy accessibility of the finest physicians. Before the rise of the managed care in the 80s, the competition amongst the hospitals was limited to the availability of the finest medical technology and the association of the local physicians to that particular health facility. The high cost of care was supported by the open-ended reimbursement of the insurance system at that time and the rivalry amongst the hospitals was in regard to the provision of sophisticated medical amenities. However, with the emergence of managed care, the concept of medical arms race is not feasible in the current time zone. The …show more content…
A new medical arms race will result into an intensification of clinic costs and aggregate healthcare expenditures. The reason behind an increase in the cost is the inpatient service duplication and the supply prompted demand. It may generate monetary and service inequalities amid the community hospitals, outpatient clinics, and specialized care hospitals. For example, a specialty hospital that focuses on cardiology would provide excellent service and yield a higher market share in comparison to a local community hospital that provides a broad-spectrum of healthcare services. Furthermore, the amplified rivalry for the acquisition of general practitioners and patients will result into enhanced volume of patients which may affect the quality of the care. From the perspective of the consumers, an increase in medical arms race will result in higher costs and could subsequently result into under-utilization of the services if not fully reimbursed by the insurance
Atul Gawande is an American surgeon, professor, notable author, and writer for the New Yorker. In his 2015 article “Overkill,” he describes many of the flaws the American healthcare system holds. Throughout the article, Gawande intertwines personal stories, patient stories, and expert testimonies to make his argument stronger. Gawande argues, “Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and costs billions.” Or in many cases, he redefines over testing and “low-value” care as providing “no-value” care.
Today, the skyrocketing number of health care providers that enter the industry in both public and private organizations create a highly competitive market. For this reason, it is necessary for every provider to become competitive to attract customers and overcome the competitors in order to survive in the industry. However, the role of competition is still much debated since the pieces of evidence are mixed and contested (Goddard, 2015). The Kaiser Permanente is one of the healthcare providers that is standing still in the current competitive market since its establishment in 1945. It is established by industrialist and physician named Henry Kaiser and Sidney Garfield, respectively.
[Cost] Cost could potentially be the biggest factor of the iron triangle and perhaps the side of the model that leaves administrators most puzzled. With new technology being released quarterly, drug prices soaring, a new aging population that can't be supported by the current workforce, Medicare cutting reimbursement payments and leaning towards insolvency, and the price per service continues to rise it seems as if cutting costs down may seem impossible. Not only have hospitals and clinics began looking for more cost-efficient ways to provide care or, unfortunately which programs to cut, the political arena has been evaluating this as well. Since Obamacare has not lived up to its true potential and glory an alternative method must be identified before the nation's model of healthcare implodes from high costs.
III. Arguments for Narrow Networks While narrow network health plans are partly the result of a response to regulations in the ACA by insurers and health systems, they are also the product of changing market conditions in the healthcare industry over the past 10 -15 years. First of all, the backlash against managed care plans in the nineties led to the effects of selective contracting being eroded as provider networks were expanded and benefit design enhanced to allow members to see providers outside the network (albeit with a higher cost share). One consequence of this expansion of provider networks has been the increase in insurance premiums. Another contributing factor to higher insurance premiums has been increased consolidation as hospitals and physician groups have merged forming larger entities and as a result increased market power which in turn has enabled these merged entities to negotiate higher prices with insurance companies (Morrisey, 2009).
In recent years, there has been a shortage of primary care physicians and clinics, and the rise of healthcare cost. The supply and demand in the healthcare industry in the United States has not met the equilibrium point. Most of these issues have led to the expansion of urgent care clinics. UCCs initially started in the 1980s but were not famous due to lack of consumer interest. But that has changed due to the convenient access that it provides users.
improving quality of American health care system and curbing the care costs, at the moment numerous ways of restructuring care supply are being evaluated by CMS. Accompanying Medicare shared savings program, initiatives like Advanced Payment Incentive and Pioneer ACO demonstrations are being commenced. Other global health service organizations such as Cigna, Aetna and Anthem are also supporting this health reform model and endeavoring to improve health service system by acquiring health service providers to raise the level and quality of care supply. As well as this kind of health insurance companies provide other incentives to healthily systematized care provider
The passing of the Hi-Tech Act in conjunction with the Affordable Care Act (ACA) created a platform that has allowed for electronic medical records and health information system to become some of the defining factors for high quality service in health care. Both of these act have been key in pushing the standards of health care to the next level of high quality care. Before their passing, there was little to no reason for to health organizations to make such a costly switch to something that, at the time seemed, not worth the investment. Kaiser Permanente as long since been a big name in pushing the boundaries for health information. The truth of the matter was that both the Hi-Tech Act and the ACA did not have a hand in Kaiser’s decision
Medical Malpractice and Tort Reform Allegations of medical malpractice by a physician has become increasingly common in today 's society. Although the legal system supports extensive research and negotiation between the parties to avoid trial by jury (Bal, 2009), the increase of court related lawsuits involving medical malpractice continues to rise. In the year 2014, medical malpractice costs, settlements and awards totaled 3.9 billion dollars with an estimate of over 4 billion dollars in the year 2015 ("Medical malpractice payouts continue to climb in U.S.," 2015) Although several states have seen a decrease, many, especially in the south and northwest, have increased exponentially ("Medical malpractice payouts continue to climb in U.S.,"
This shifts the populace towards using the emergency room more and of course opening even more holes in the hospitals budget. What can and cannot be covered by reimbursement plans is another problem that should not only be addressed, but also something that is not just endemic to the Federal government’s payments. Because the patient does not usually see the whole bill to a visit and there are not many laws in place to protect against this, prices of care are often inflated beyond what they should (though part of this is to cover for the aforementioned holes caused by the emergency rooms). This in turn means price controls are virtually nonexistent. For those with good insurance it is not usually a big deal.
Mednax is an independent group practice in the United States specializing in the delivery of neonatal, pediatric subspecialty, and anesthesia services across the country. As one of the largest accountable care organizations of its kind, the company benefits from geographic and economic scale, enabling it to spread out administrative costs across a wide network of practice locations. Its increasing scale gives it strong negotiating leverage with hospitals, especially as the company 's intangible assets the high degree of specialization of its physician workforce are in high demand and difficult to replicate (Wisner, 2016). A network effect appears to be at play, both in the company 's widening practice base and through its own proprietary
This will shift impacts the provider’s bottom line because with the increases in drugs, supplies and salaries and the decrease in reimbursements, hospitals profit margins will
But an epidemic of aggressive medical care treatments such as too many procedures,too many blood tests provided by hospitals or clinics are costing our nation 's healthcare system billions of dollars each year. Despite being recognized to be harmful to patients and their loved ones, “aggressive care” is still administered to the majority(75%) of patients, concludes a study done by the American Society of Clinical Oncology(Johnson,2016). After watching the videos and reading the article on medical care my stance on aggressive healthcare is it is unnecessary and I am against it. What people don 't realize is that if we keep providing aggressive health care treatments to individuals suffering from serious illnesses or people living through the end of life it can take a human toll in pain, mental or emotional suffering, severe implications and even death. Most people prefer to die peacefully at home surrounded by loved ones and want care to focus on comfort, but that is not always the case for many patients who die in hospitals hooked up to hospital machines in pain and suffering to hold on for their dear lifes.
Health care cost has seen to increase gradually as years go by. This has been influenced by major factors such as political influence, emerging chronic diseases, new procedures that are coming up including the technologies being invented for treating illnesses, pricing of medicines and treatment is not regulated and when treating ailment their may arise repetition of tests or a patient gets over treated for a particular ailment. The cost of healthcare has increased due to chronic diseases such as cancer and diabetes etc. The lifestyle people are living in this generation has led to the development of diseases that are expensive to treat or has led to there being over treatment in such for a cure of a particular ailment.
Executive summary The emerging market in health care innovation Tilman Enrbeck, Nicolaus Henke and Thomas Kibasi Emerging Innovations in the delivery of health care services particularly in developing countries, offer a deep insight on how to tackle its rising costs. As health care is consuming large share of income in both developed and developing countries. Innovators from developing countries have founds ways to deliver health care effectively at lower cost while increasing both access and quality.