CHAPTER 4: Cost of Healthcare Flashcards
list of reasons for rising healthcare costs
· Waste in the healthcare system
· Unhealthy lifestyle
· Uneducated personal healthcare choices
· Social determinants
· Our desire for the latest treatments and specialized hospital equipment
· Consumer ignorance of healthcare costs
· Government mandates
- Aging population
top 3 areas identified for waste in the healthcare system
- inefficient claims processing
- wasted spending on unneeded tests
- spending on preventable diseases such as obesity
medicalization of society:
This model embraces the view that many social problems such as alcoholism, obesity, drug taking, and other addictions (e.g., shopaholic, hypersexuality, gambling problems) are conditions that require medical treatment
Magnetic Resonance Imaging (MRI)
This machine creates a strong magnetic field and combines with radio waves to form a three-dimensional image helpful in viewing the brain and other soft tissue.(more expensive)
Patient Protection and Affordable Care Act (ACA)
A health care reform law
intended to expand coverage to millions of people and move the country toward a
more primary care-based healthcare system.
Major Healthcare Expenditures
- Physician/clinical services 20% healthcare costs
- Hospital services/care (cost of labor)
- Speciality medical machines (CAT, PET, MRI)
- Facility expansion
- Dental services
- Nursing home care
- Home health care
Current procedural terminology (CPT)
guides for setting physician fees
Health maintenance organization (HMO)
A type of health insurance provided at a
lower rate and less copay. It requires consumers to go to a doctor in the network or
expenses will not be covered.
Stark Law
it is supposed to prohibit
physicians from referring Medicare and Medicaid patients to a healthcare provider or
facility with which they have a financial relationship.
ways physicians have a high cost of maintaining their practice
- malpractice insurance
- continuing education
- mortgage payments, office spaces
- physician fraud
False Claims Act
enacted so that citizens can now sue on behalf of the government to recover financial damages against people who filed a false claim for medical products and services.
main reason for high hospital costs
labor - salaries, wages, benefits
examples of speciality medical machines that are costly
- CAT scan
- PET scan
- MRI
controlling healthcare costs:
- prevention of diseases
- single-payer health care system (publicly funded and privately administered)
- controlling the cost of overpriced drugs
- avoiding unnecessary trips to emergency rooms
- lifestyle choices (balanced diet)
- using alternative health care providers (PAs, nurse practitioner)
High-deductible health plan (HDHP)
A type of insurance plan that is typically
cheaper than the other health plans, but has a much higher deductible (between
$1,500 and $5,000).
