Cost Savings In Health Care

In principle, the insgesamten costs can be frozen or healthcare only by a combination of the following reduced: Decreasing use of health services declining reimbursement for services that are used Decreasing operating costs (reimburser, vendor or both) Some policies affect access to health care or their results others can improve the health care system. An evaluation of different strategies is difficult because the accurate measurement of patient-related health consequences (eg. As morbidity and mortality, the so-called. “Quality-adjusted life years” [QALY]) is expensive and require a large number of patients and long study periods , Thus, the majority of measures for assessing the quality of medical care specific processes and no concrete results reflect. How well these methods can predict the ultimate state of health, is not always clear. Decreasing use of health services Many strategies can reduce the use of health services. Many relate to the restriction of access to health care (because unnecessary care is to be restricted, but sometimes lacks the necessary care), while some strategies aim to less demand by improving health. Limiting access to health care Traditionally, the restriction of access to services the best strategy to limit health care costs. Insurance companies have limited access to service provision by refusing to accommodate people who probably care need (eg. As those with pre-existing conditions) and by denying reimbursement for the chronically ill (termination). In the US, the Affordable Care Act, which came into force in 2014, banned these practices. The government may tighten eligibility criteria for medical assistance programs. Reimburser can also increase the private cost, which is an economic incentive for patients to restrict their own use of health services. For example, the reimburser can limit the type and number of visits, which will be refunded (z. B. mental health, physical therapy) minimize increase deductibles and co-payments Permitted number of covered procedures However, these strategies affect probably the results disadvantageous because results out indicate that many patients avoid both necessary and unnecessary care. For example, women can no longer checkups go (z. B. Pap tests, mammograms) and then return with late-stage cancer, and risk patients not undergoing any of the influenza vaccination. With the establishment of administrative hurdles for medical Versorgng (. Eg requiring approval tests, recommendations and procedures; complex application procedures and regulations) can Paid when in fact they deny any care, reduce maintenance more and more. Government agencies can issue building permits for new facilities and laboratories limit (called “certificates of need”). Restricting access to health care can lead to problems. For example, people are often treated in a hospital as an emergency if they did not get access to treatment and their disease has progressed (which is likely if routine care is missing). This care is largely not compensated for (either by patients, insurance or other source), increasing the burden on people who pay into the health care system is more expensive than if the routine care been provided is wäre.Beseitigung unnecessary care Exaggerated care easy define (care that the result does not improve), but is often difficult to detect and even harder to remove. Among the first steps include the implementation of further and better comparative studies on the effectiveness and cost efficiency, so that best practices can be identified. Comparative effectiveness studies can evaluate areas other than drugs, such. As the impact of sport, physical therapy and various vendors, systems, conditions of medical care and compensation systems. Training and supervision of providers reduce different practices and increase profitability. The elimination of economic incentives for the provision of intensive treatment (fee for service) using prospective standard fee (s. Below) and performance-based compensation models can encourage providers to minimize unnecessary care services. Better coordination of services among providers (eg., By better communication and use of universally readable electronic health records) can make the diagnosis and treatment more efficient, eg. For example, by avoiding duplicate tests. Encouraging palliative hospice care, where appropriate, can help the use of expensive, often technologically complex, healing-oriented treatments minimieren.Verbesserung health The increased use of relatively inexpensive preventive measures (eg. As screening, diagnosis and treatment of diabetes, hypertension and hyperlipidemia; screening for breast and colon cancer), the need for expensive treatments later subsequent decrease for themselves (eg for MI, stroke or terminal cancer).. However, preventive measures can not reduce the cost of a certain private insurance company because savings are often not realized for many years; Up to this time, many patients have long since changed the insurance. In the US, people stay about 6 years at one and the same health insurance (usually because they change jobs). This time is too short to realize savings through preventative maintenance. The strategies to increase preventive measures include incentives for increasing the number of family doctors (they can arrange often appropriate screening measures and help prevent complications) Performance-based compensation models that reward the implementation of preventive measures financially elimination of co-payments for preventive services free preventive services , especially for people in need whether care programs that seek to improve compliance with treatment measures and clinical guidelines, really improve the results or to minimize the cost (. eg of potentially unnecessary hospital stays or complications), has not been proven; some studies showed no benefits. Declining reimbursement for providing the care measures Even if health services are offered, strategies can be applied to limit payments. Lower fees payers (public and private) can lower fees negotiate with institutions and providers, or simply prescribe. In the US, the reimbursement rates that have fixed Medicare and Medicaid, also affects the fees of other insurance companies, out which often leads to lower fees hat.Stärkere use of primary care measures can help to increase the use of less expensive primary care versus secondary care , For example, coordinate primary care physicians in the patient-centered medical home program all aspects of medical care, including specific and interdisciplinary care in different conditions (eg. As at home, in hospitals and long-term care facilities). Many authorities believe that this model can minimize unnecessary specialist care, double maintenance and inappropriate care (z. B. relief rather than diagnosis). Measures to GP care to heights were submitted. This includes an increasing reimbursement for primary care, moving from state funding of residency programs for primary care training and increasing the attractiveness of basic services among medical students, although it is unclear to what extent the latter are implemented soll.Prospektive payment systems In these systems, the providers paid a fixed amount no matter how much care has been provided. The amount may be based on a specified maintenance period or a fixed annual remuneration for each patient. For example, part of the Medicare reimbursement depends on the diagnosis (DRG). In such cases, Medicare pays a fixed amount depending on the diagnosis. For lump sum models providers a fixed annual amount to care for patients is paid, regardless of the actually used services. Prospective payment systems reward effective care (and usually less frequent use of services), as opposed to individual performance remuneration that rewards frequent use of care services. However, the prospective payment creates no economic incentive to treat care-intensive patients (z. B. those who have multiple diseases or are seriously ill) and can prevent providing the necessary care. Since a decrease of the maintenance services has the potential to degrade the quality of care, often are performed (eg. As a professional assessment of institutions and organizations) quality controls. “Accountable Care Organizations” The “Accountable Care Organizations” (ACOs) are integrated organizations of the service who agree on the cost and quality of health care for a specific group of beneficiaries assigned to them to be responsible. Your refund is based more on measures of quality of care and reduce costs of care for their assigned beneficiaries than on the volume of services provided. The amount of the refund to the ACO is based on the cost of the supply of similar patients who do not belong ACOs. The ACOs shares the differences in these costs (gains and losses) with the insurer. The ACO may different payment models for its own suppliers, including capitation and sometimes service charge, nutzen.Verweigerung of claims in the US, unlike in most of the developed world, insurers reject routinely from a significant percentage of claims for services for patients. In a study in California the average rate of refusals in 2009 was over 30%; some of the claims were paid by a complaint, but such action is both time consuming and costly for patients, providers and payers gleichermaßen.Wettbewerb The competition for patients among providers and health insurance was meant to contribute to a reduction of fees (eg . as if a society is more expensive than another). But the end user (ie, the patient) usually know not in advance how the fees of the providers are, and if they know it, they can often not act on this knowledge (eg. As because patients often at certain vendors are bound and limited in their ability to assess the quality of care are). Also, because the cost of medical care for most consumers are subsidized (eg., By a paid by the employer health insurance tax deductions and flexible spending accounts or Medical Savings Accounts), consumers have less incentive to compare prices than other products. So the competition is in large organizations is most effective when it comes to reducing costs while maintaining quality. For example, health insurance can order agreements with employers such. compete as corporations or government agencies; Providers such. As medical organizations and hospitals may compete for contracts with insurance companies. However, competition has some drawbacks. It leads to multiple systems of grant applications and judgments, resulting in a longer processing time for the provider. In addition, processes such as the determination of eligibility, transfers, payments and coding must be coordinated among a large number of incompatible insurance company systems. Thus, the competition increases the official (administrative) burden on the entire Gesundheitssystems.Verringerte cost of drugs with generic or, if appropriate, less expensive brand-name drugs drug costs can be reduced. Strategies include information the provider cost medications restriction of drug marketing introduction of formularies and pharmacy consultants permission for the government to determine drug prices for patients who are covered by the state insurance Allowing the import of drugs from other countries Negative impact on medical research in many academic medical centers allows the income from clinical practice physicians and institutions to engage in research. Similarly, the income from the sale of drugs supports pharmaceutical research. Therefore, a reduced income for the pharmaceutical companies can lead to decreased research activity. If other sources (eg. As government or private grants) will be used to fund research, these funds must be considered as health care costs and thus same savings from decreasing reimbursement from. Lower operating costs Operating costs are health care costs that are not paid to medical providers (eg. As administrative costs, professional liability, corporate profits for commercial hospitals and insurance companies). Lower operating costs for payers The state health services in developed countries (including the US) and private health systems outside the United States are the operating costs typically 3-5% of the total cost (ie, ? 95% of all health care funds go to the providers of health care ). However, private insurers had, in part because these insurers need more staff in the US operating costs by about 20-30% in order to carry out the comprehensive administration (to get sick to identify and rejection of applications for costly treatments, including those with pre-existing conditions or a high probability ) to judge actions for a rejection and edit appeals of vendors. You must make a profit in the rule. There is no evidence that these activities and their higher administrative costs improve clinical care or the results. “The Affordable Care Act” is now writing before that insurers 80% use (for individual or small group insurance) or 85% (for large group insurers) of “premium dollars s” for health costs and claims, so that only 20% each or remain 15% for administrative costs and profits. Strategies that help the operating costs must be minimized: Increased use of standardized electronic health records Increased use of government plans and may not commercial measures that lower operating costs have to run as commercial activities Competition between payers was meant to increased administrative efficiency but it reinforces to refuse the incentives, claims and payments, which in turn to an extensive bureaucracy führt.Sinkende operating costs of the provider Each payment reform that reduces the need for the many settlements and the large amount of personnel, of the administrative statements of several payers are needed, reducing operating costs of the providers. For example, some countries in which several insurance in competition are (eg Germany, Japan.) The following conditions: the amounts and rules for all insurance companies alike. In many cases, the insurance companies are obliged to pay all the bills of the provider. The costs for the same services are the same everywhere in the country. Although the costs account by malpractice only a fraction of the total cost, these costs for certain doctors can consume a significant portion of their annual income. Reforms that reduce the number of complaints and processes would lead and over time to lower insurance premiums doctors benefit; Such reforms can possibly reduce the use of unnecessary measures that characterize a defensive medicine. Key points Because of health care reform, is the limited access to health care, the cost carriers have traditionally carried out in order to contain costs, are in the US is likely to reduce. Unnecessary medical care is easier to define than to eliminate and even recognize. Whether improving health can reduce health care costs is unknown. Many strategies to reduce reimbursement for health care (eg. B., promote sinking provider charges by prospective payment systems that deny claims to greater competition, lower drug costs) have significant disadvantages. Theoretically, decreasing overheads of payers and providers, as well as the reform of laws for misconduct could significantly reduce the cost.

Health Life Media Team

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