Lowering the Cost of Healthcare

By Joseph Greene
Edited by Shea R., and Sophia V.
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​From Volume 1 Issues 2 on Poverty in America

    Healthcare across America is often criticized for its flaws, many of which cause a limited accessibility rate to low-income Americans. Healthcare is often considered to be a necessity, seeing as it is extremely useful and can come with many positive aspects that greatly benefit those who need it most. According to the U.S Census, the amount of people in the U.S that purchased health insurance decreased by two million people from 2017 to 2018, which presents a clear issue in how it is sold and distributed (US Census). Although healthcare is an asset many people strive to obtain, over the last few years they find themselves unable to do so as a result of the increasing cost. Healthcare organizations have identified this issue, and 29.1% of CFOs of healthcare providers are focusing on “identifying and managing cost-reduction initiatives”, the greatest of every category surveyed according to deputy editor at CFO Publishing David McCann.(McCann). The decreasing rate of insured low-income Americans has not ceased however, as this extreme issue of cost also presents moral decisions to be made between healthcare receivers. A study conducted by Corrine Lewis, a senior researcher at the U.S foundation The Commonwealth Fund, which works to improve the healthcare system, points out that many Americans below the poverty line surveyed say that an inability to afford treatment and medications lead to “tough choices between their health and the financial well-being of their family,'' which is unethical and is a pressing issue that is in need of solving(Lewis). This study builds on the findings of the Kaiser Family Foundation, a non-profit organization dedicated to an improvement in healthcare, who displays that 1 out of every 4 Americans say it is difficult to afford routine healthcare(Kirzinger). Even reasonable solutions to these problems, for example an increase in the amount of electronically distributed care, contain major flaws that cause them to be extremely difficult to implement due to low-income Americans’ limited resources. Given these findings, it is clear the unrealistic cost of modern-day healthcare is in need of alteration in order to provide health insurance to people who desperately need it. In order to provide quality healthcare to Americans below the poverty line, the federal government should lower healthcare costs by removing unnecessary services, controlling the cost of prescription drugs, and increasing the use of telemedicine and other electronic medical services.

    In contrast to the limited amount of services in the past, the field of medicine today provides a broad, and at times extraneous, amount of amenities to its patients. Patients put trust in their doctors, and expect them to do everything in their power for their benefit. Due to the increasing distrust between providers and patients with ill-advised transparency of costs and recommended procedures, this bond is beginning to tear(Lewis). As a result, more and more inessential tests are performed on unknowing patients. According to Fierce Healthcare, a science-based news outlet, “doctors still order unnecessary medical tests that rack up millions”, which in turn increases the cost of care with no benefit to the receiver(Finnegan). This view is supported by the Institute of Medicine, who agrees that an excessive amount, “30% of health spending, or roughly $750 billion, “was wasted on unnecessary services in 2009(IOM). These services and procedures prove to have no use to their receivers, while still charging patients, especially those who are below the poverty line, prices they struggle to afford. The federal government and medical institutions should decrease the amount of unnecessary tests given to patients by transparently briefing the patients themselves on the exam’s procedure and possible results, and giving them a larger say in its necessity. This would lower the amount paid by patients for their care, improving how accessible healthcare is to patients unable to pay expensive rates, as well as benefit doctor-patient trust by truly investing them in their care. A key problem with this solution is many tests can not be determined useful or not until the results are returned, where a seemingly-avoidable exam could save a life. Doctors hold this responsibility to provide the best possible care in order to save lives, and many health problems doctors come into contact with are treatable by prescribed drugs and medications.

    Prescription drugs are intended to be able to fill a patient’s needs and assist them with their health issues, but inconsistencies in their cost create issues in their availability. Prescription drugs account for 19% of all Medicare spending according to the Kaiser Family Foundation, a non-profit organization, which is significant, but not the greatest factor(Kirzinger). Considering this 19%, many patients rely on the accessibility of prescription drugs in order to maintain their health. Consistency within the cost of the drugs is paramount, because the expense determines if uninsured or low-income patients can still purchase and receive pharmaceuticals. In spite of the importance of availability of the drugs, prices often fluctuate, but steadily rise, to the expense of the consumer. Inmaculada Hernandez, a professor of pharmaceuticals at the University of Pittsburgh, published a report in early 2019 that provides evidence on the extreme increase in drug cost. According to Hernandez, the cost of “injectable brand-name drugs increased annually by 9.2 percent and 15.1 percent, from 2008 to 2016, respectively”(Hernandez). The drastic rise in its cost limit the availability of prescription drugs, and prevent people from receiving them when they need it most. The Academy of Actuaries, who deals with the measurement and control of risks in our world, often publishes articles discussing and analyzing the uncertainties of drugs. If costs of these drugs were lowered, however, additional people could take these supplements, which according to the Academy of Actuaries, would “lead to better overall health outcomes and even lower overall health care costs (A.A.O.A). In order to lower costs, improve the availability of healthcare, and implement this procedure, the federal government would need to have the ability to negotiate with pharmaceutical manufacturers. Currently this is prohibited under the Medicare Program Part D, which “is one of the largest users of medications, and taking advantage of its size by wringing out better pricing and higher rebates could help lower prescription drug costs” (A.A.O.A). Altering this program would allow the government to lower the cost of prescribed drugs, which ultimately increases both theirs and healthcare’s accessibility to those who could not previously afford it. This program might be difficult to alter, however, but with the rapid increase of both mental and physical illnesses, another form of medical care is needed as soon as possible to guarantee accessibility to care, such as electronic care.

     Telemedicine and other electronic medical services provide convenience and ease of use that is not present in face-to-face healthcare, and its sky-rocketing availability is now able to lower healthcare costs. The wide-spread use and increasing affordability of technology has caused it to be a beneficial alternative to common practices. Himanshu Kansal, a high-level associate at high point, a company focused on solving world-wide problems, often discusses new ventures in the medical field. Kansal notes that on average, an “appointment via telemedicine costs $79, as compared to $146 for a doctor’s office visit, and $1,734 for an emergency room visit” (Kansal). Unnecessary visits to the emergency room causing patients thousands of dollars is impractical, but can be avoided through telemedicine. Many patients below the poverty line are unable to repeatedly pay for visits to the doctor’s and at times are unable to even transport there, which is an area telemedicine can greatly improve on. As telemedicine has proven itself useful, it prevented “27.9% of parents in a Florida healthcare study from visiting the emergency department” and is projected to save “the Florida healthcare system approximately $113.9 million” according to healthcare-oriented media platform Healthleaders(Healthleaders). By saving both patients and healthcare organizations money, electronically distributed assistance can lower the cost of healthcare. The main limitation to this study is the assumption that Americans with a below average income have access to this technology. Monica Anderson, a director of research at Pew Research Center states “46% of U.S adults with below a $30,000 income do not own a computer”, and as they are the main demographic for this solution, distribution of care may be limited(Anderson). Telemedicine would need to be more readily available to low-income Americans in order for it to be applicable and increase the accessibility of healthcare to all.
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     Americans below the poverty line are continuing to suffer from the inability to pay for healthcare, and as income inequality is increasing to “the top 10 percent owning as much as 9 times the bottom 90 percent,” the poor are even more restricted from care(Anderson).  The government needs to take action now by removing medical exams that provide little to no use or information to the patient, so they can put more money toward more significant things. In order to alter Medicare Program Part D, the federal government should attempt to negotiate with pharmaceutical companies. In addition, increasing the amount of telemedicine distributed is vital to decrease the expensive costs to the E.R. Any person can also sign the change.org petition for free to lower healthcare costs to raise awareness; but in order to have a meaningful impact, the federal government must commit to these actions now to solve this crisis and give Americans the accessibility to healthcare they deserve.

Sources
A.A.O.A,“Prescription Drug Spending in the U.S. HealthCare System.” American Academy of Actuaries, www.actuary.org/content/prescription-drug-spending-us-health-care-system#targetText=In many situations, use of,may have a negative effect.

Anderson, Monica, and Madhumitha Kumar. “Digital Divide Persists Even as Lower-Income Americans Make Gains in Tech Adoption.” Pew Research Center, Pew Research Center, 7 May 2019, www.pewresearch.org/fact-tank/2019/05/07/digital-divide-persists-even-as-lower-income-americans-make-gains-in-tech-adoption/.

Finnegan, Joanne. “Doctors Still Order Unnecessary Medical Tests That Rack up Millions, Study Found.” FierceHealthcare, 13 Feb. 2018, www.fiercehealthcare.com/practices/doctors-unnecessary-tests-washington-health-alliiance.

HealthLeaders. “4 Ways Telemedicine Is Changing Healthcare.” 4 Ways Telemedicine Is Changing Healthcare | HealthLeaders Media, www.healthleadersmedia.com/innovation/4-ways-telemedicine-changing-healthcare.

Hernandez, Inmaculada, et al. “The Contribution Of New Product Entry Versus Existing Product Inflation In The Rising Costs Of Drugs.” Health Affairs, 1 Jan. 2019, www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05147.

“IOM: 30% of Health Spending Was Waste.” IOM: U.S. Health System Wasted $750B in 2009 - The Advisory Board Daily Briefing, www.advisory.com/daily-briefing/2012/09/07/iom-report.

Kansal, Himanshu. “Telemedicine: The Cost-Effective Future of Healthcare.” HighPoint Solutions, 17 June 2019, www.highpointsolutions.com/telemedicine-cost-effective-future-healthcare/#targetText=An appointment via telemedicine costs,to a RAND Corp. study.

Kirzinger, Ashley, et al., “Data Note: Americans' Challenges with Health Care Costs.” The Henry J. Kaiser Family Foundation, 10 June 2019, www.kff.org/health-costs/issue-brief/data-note-americans-challenges-health-care-costs/.

Lewis, Corinne. “Obstacles for Low-Income Patients.” Obstacles for Low-Income Patients, 1 Dec. 2017, www.commonwealthfund.org/blog/2017/listening-low-income-patients-obstacles-care-we-need-when-we-need-it.

McCann, David. “Hospital CFOs Struggle to Keep Up With the Times.” CFO, 4 Jan. 2018, www.cfo.com/operations/2018/01/hospital-cfos-struggle-keep-times/.

US Census Bureau. “Income and Poverty in the United States: 2018.” Income and Poverty in the United States: 2018, 17 Sept. 2019, www.census.gov/library/publications/2019/demo/p60-266.html.