Makingthe Provider the Payer
Thehealth care industry is by far the largest in the USA with a sixth ofthe active workforce of our country. As a country, we have beenspending a lot of cash to finance our health sector. For instance, in2014 we spent 3 trillion dollars in the health care sector that is byfar much compared to what these countries spent combined Australia,Germany, the U.K, Canada, Italy, Spain, China Brazil and France(Sarpatwari, Avorn, & Kesselheim, 2016).
Thisis a topic which has and is still being hotly debated by ourpresidential aspirants as it has greatly affected our society. But, Ihave a solution, which I can propose in our health care organizationand can perhaps be implemented in others too. I believe that we canreduce the cost of health care by eliminating the middlemen andmaking the owner or our hospitals, the providers of not only theheath care but also insurance services.
Thereis a great population in the United States that is in need of medicalattention. When we observe our country’s health statistics, we willdiscover that our nation is in a health crisis(Institute of Medicine, 2004).If our people are not struggling with cancer, it is diabetes,hypertension, osteoporosis, kidney failure, stomach ulcers and manyother ailments. Treating these illnesses has become so expensive toour nation and its citizens. But, if we made our hospital theinsurer, we will be able to control hospital expenses which makehealth care cost expensive.
Hospitalsand doctors will not have any incentive to inflate the treatment costas the bill will ultimately reach their bosses who are also theinsurer. Also, we will reduce monopolies in the hospital servicedelivery, which has played a big role in making the health costexpensive. This would mean that hospitals and all doctors under themwould be a subject to pricing and service delivery standards (Emerick& Lewis, 2013).Those people who are not insured will be charged no more than what acompeting insurance would have been charged. In the long run, thiswill make the hospital systems to be effective as people will be ableto compare insurance and health services of the hospitals.
Let’sassume that people have insured themselves in a particular hospital,the pool of risk will have a lot of premiums making it easy forhospitals to carter for patients’ problems. For instance, if I hadinsured myself against a heart attack, there would be other patientswho also have done the same. So when am being treated, the cost willbe catered from the premiums that have been paid as not all of uswill get sick at the same time. Also, another important factor aboutbeing insured by a hospital is that they are well conversant withmany illnesses that affect people, and that knowledge will help themto structure premium payments effectively. This plan will save a lotof administrative cost including vetting claims. Furthermore,hospitals will not be burdened by the urge to make profits anddistribute them to shareholders as insurance companies do (Emerick& Lewis, 2013).
Wewill incur the extra cost of establishing insurance department,employing actuaries, managers, accountants, and salespeople. Also, wewill incur costs in purchasing new machines and setting up serversfor insurance records operations. For a start, a million dollar canbe used in setting up the structures and new offices withoutconsidering the recruitment process and employees. But eventually,more cost will be incurred to run a fully functional insurancecenter.
Ourline of work has never been motivated by money, but the desire tohelp people. By establishing in-house insurance services, we willhelp touch the lives of many people who could not afford expensiveinsurance covers as the organization that provides these services arein business. Thus, they charge a high figure than hospitals would. In the long run, if the idea is adopted by hospitals across the USA,we might cut the health expenditure by twenty percent, which mightboost our economy as resources previously used in the hospital can bea channel in other fields(Emerick & Lewis, 2013).
Theprogram will be evaluated on the cost that was incurred in itsestablishment and the benefits that will be derived from it.Furthermore, the insurance cost of the hospital can be compared withthose of private insurance to evaluate its effectiveness in thesociety and which system positively impacts the lives of patients.Also, the project will be evaluated based on the principles of theAmerican Nurse Association and the hospital’s mission and vision.
Ibelieve that hospitals should provide health care services coupledwith insurance services as this will significantly reduce medicalcosts. Our country has been making the big allocation of the budgetfor this venture, something that has caught the attention of manypeople such that it has become a campaigning policy in 2016presidential elections. However, if this project were adopted, wewould be able to shift some of the money to other profitableventures. The project will be cheap, cost effective and easy tomonitor as it is under the same roof and management or owner.
Emerick, T.,& Lewis, A. (2013). Crackinghealth costs: How to cut your company`s costs and provide employeesbetter care.Hoboken, NJ: Wiley.
Instituteof Medicine (U.S.). (2004). InsuringAmerica`s health: Principles and recommendations.Washington, DC: National Academies Press.
Sarpatwari,, A.,Avorn, J., & Kesselheim, A. S. (2016). Stateinitiatives to control medication costs — can transparencylegislation help? TheNew England Journal of Medicine, 374,2301-2304. doi:10.1056/NEJMp1605100