Cost containment

Question 1

what is the trend of US health care expenditures

what about pharmaceutical expenditures

mainly because of what

Answer 1

INCREASE. so mushed that it outpaces inflation

INCREASE, even more rapidly than health care expenditures

mainly due to price increases

Question 2

WHAT ARE THE GOALS OF HEALTH CARE

Answer 2

increase length of life, and QOL

Question 3

Painless cost controls

what is it

Answer 3

wont harm the patient

Question 4

painful cost controls

what is it

Answer 4

would harm the patient

Question 5

ex of painless cost controls

Answer 5

control reimbursement

reduce price of supples (rx, etc.)

reduce administrative waste

eliminate interventions of no benefit

substitutes less costly options that are equally effective (generics)

increase preventative care (avoid costly late-stage illness costs

Question 6

financed focused expenditure control strategies

Answer 6

1. regulatory
   a. limits on taxes or premiums
   b. regulatory supply limits
2. competition in the market

Question 7

reimbursement focused expenditure control strategies

Answer 7

1. regulatory
   a. limits on reimbursement
2. competitve
3. utilization
4. aggregate units of payment
   a. capitulation, DRG,global budget
5. cost sharing
6. utilization management
7. supply limits
8. mixed controls

Question 8

utilization management

Answer 8

conducted by a group at (financial) risk

a. refusal of coverage
b. increased cost sharing (tiered formulary)
c. prior authorizations
d. step therapy (try less expensive first)
e. generic substitution requirement

Question 9

types of cost containment strategies

Answer 9

1. painful or painless (to the pt.)

2. finance-focused or reimbursement-focused