ANALYSIS OF A PERTINENT HEALTHCARE ISSUE5
Analysis Of A Pertinent Healthcare Issue
Jamie Mazzi
Walden University
NUR 6053: Interprofessional Organizational and Systems Leadersuip
Dr. Velasquez
June 11, 2023
Analysis Of A Pertinent Healthcare Issue
Introduction
Rising healthcare costs is one of the major national healthcare stressor in the US. Many Americans have reduced access to healthcare due to the high costs. Notably, the escalating medical costs have a negative impact on the facility. This paper also discusses the strategies other organizations apply to manage the undesirable implications of high healthcare costs.
Escalating Costs and their Impact on the Organization
Being the country with the biggest healthcare costs in the developed world, the US experiences high rates of delayed or avoided medical care. Therefore, with lower access to care, the facility receives fewer patients. The most commonly avoided or delayed medical services include regular checkups, dental care, surgical procedures, non-emergency medical care, diagnostic tests, and treatment for ongoing illnesses (Ratnapradipa et al., 2023). Delaying and avoiding healthcare results in acute symptoms, worsening illnesses, and development of chronic conditions. The facility’s emergency care unit becomes overcrowded when patients who avoided primary care develop acute symptoms. Emergency department overcrowding overwhelms nurses and physcians while increasing waiting time and adverse events. Moreover, the avoidance of routine screenings and medical tests leads to preventable chronic conditions and late diagnosis. Worsening health issues from delayed care raises the need for inpatient care, readmissions, morbidity and mortality risks. All these problems associated with delayed care escalates the cost of medical services even further for the patients and the organization.
Summary of the Articles and How Other Organizations Address the Issue of Escalating Costs
Shrank et al. (2021) noted that the cost of health care in the US such that delay or avoidance of medical care occurs in about 50 percent of Americans due to unaffordability. Furthermore, the costs are not only rising among those with Medicare and Medicaid, but also among Americans with private insurance. The high costs hinders equal access to care especially among racial and ethnic minorities and low-income Americans. The situation is expected to worsen, as it is projected that by 2028, 10.6 percent of the US population (37.2 citizens) will not have any healthcare insurance coverage (Shrank et al., 2021). Another article by Smith et al. (2018) pointed out that patients are failing to purchase prescription drugs, utilize preventative care, or ongoing care for chronic diseases because of increased out-of-pockets and high deductibles. Additionally, though there are no out-of-pocket expenses to access preventative care under the ACA, low health insurance literacy hinders many Americans from using the service.
Although federal and state government policies are the major ways of addressing the costly care, facilities can still take action at the organizational level. Other organizations are addressing trying to make care affordable by reducing expenses through enhancing continuity of care, embracing value-based care, and having optimal staffing, scheduling, and patient flow. They also support the healthcare professionals to manage care costs.
Strategies to address the organizational impact of Escalating Costs
The organization can make care more affordable to its patients through provision of home-based primary care, acute care, postacute care, and mental health services. Home-based care and telehealth are more patient-centered and cost-effective compared to traditional facility care (Shrank et al., 2021). Using value-based payment models increases quality of care and cost savings (Shrank et al., 2021). Unlike fee-to-fee payment model, value-based model focuses on patient-centered outcomes linked to care continuity, contact, comprehensiveness, and cordination (Park et al., 2018). Currently, most patients want value from the healthcare serices and affordability (Pittman & Scully-Russ, 2016). The organization should also require the healthcare staff to educate patients on ACA provisions to ensure they utilize preventative care. Higher usage of preventative services would reduce the development of chronic illnesses or severity of the conditions and associated deaths.
The above strategies will have positive implications, as they will encourage patients to utilize timely care and enable the organization to contain expenses and pass the cost savings to the consumers. However, the current reimbursement and financing models for home-based care and telehealth have unfavorable payment rates, which could affect the orhanization’s finances negatively. Additionally, the organization will have to get new infrastructure, technical competencies, and tools to implement the value-based care payment model.
Conclusion
Escalating healthcare costs makes patients delay or avoid medical care resulting in overcrowded emergency departments, overwhelmed healthcare staff, development of chronic diseases, increased inpatient care, readmissions, mortality and more care costs. The organization can play its role in the reduction of costs of health care. It can adopt strategies including implementing the value-based payment model, provide health insurance literacy to patients, and deliver telehealth and home-based care.
References
Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary care and its impact on the Quadruple Aim . Journal of the American Board of Family Medicine, 31(4), 588–604.
Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health, 14(1), 56.
Ratnapradipa, K. L., Jadhav, S., Kabayundo, J., Wang, H., & Smith, L. C. (2023). Factors associated with delaying medical care: Cross-sectional study of Nebraska adults. BMC Health Services Research, 23(1), 118.
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 (Project Hope), 40(2), 235–242.
Smith, K. T., Monti, D., Mir, N., Peters, E., Tipirneni, R., & Politi, M. C. (2018). Access is necessary but not sufficient: factors influencing delay and avoidance of health care services. MDM Policy & Practice, 3(1), 2381468318760298.
