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Healthcare Costs Must Be Controlled by Patients

The debate on healthcare reform today revolves on how they could fix the waste in hospitals, doctor delivery, etc. But there is evidence to suggest that nothing is going to get fixed till the people who are requesting healthcare, the patients, have a direct stake in how much costs. The very best evidence of this I heard was from Steve Forbes (wouldn’t you know). Now I do not agree with Steve Forbes all the time but this is simply an observation he made. There are at least 2 healthcare areas where people have to pay as they go and shop by price and value.  One of the areas is plastic surgery and one is Lasik. I did the research on Plastic Surgery and low and behold the average procedure had an inflation rate between 2001 and 2007 is around 2%. That’s right 2% during a period where standard healthcare costs are rising annually over 10%.  I’ll bet you will find the same low inflation rate in Lasik.  Why are these two areas cost controlled so well? The main difference from your family physician is that the patient has to pay directly for these two procedures out of their own pocket.  Because of this people vote every day with their dollars for better outcomes with less cost. And MOST of the outcomes of the 1000′s of procedures done every day are just what the patient wanted.

There is a second significant difference between those to areas of medicine and the mainstream illness areas, those two items are fully discretionary.  You don’t have to have them to survive.  It is for that reason that we have the desire to fund healthcare for everyone.  It is also for that reason that I am not advocating we should go to a fully personal pay healthcare system.  What I am advocating, from the evidence, is somehow creating an individual stake in the cost.  Patients need to CARE how much it costs when they select a Doctor, Hospital or procedure and make good value decisions on that basis.  Patients can be trusted to make good decisions most of the time. And the collective intelligence of our entire country will then be turned to fixing the problems because everyone needs healthcare and every time they need it they will be focused on getting the most efficient and effective care.

Here is the evidence:

From http://www.ineed2know.org/plastic-surgery-costs.htm I got the average 2002 costs.

From www.boardcertifiedplasticsurgeon.com/cosmetic_surgery_costs.html for the 2007 costs.

I selected just a few of the very frequently used procedures, reported are the Doctors cost.  There are far more of all of the procedures done in 2007 than in 2002. One of the issues reported as a cause of the tremendous healthcare cost rise is much more demand stressing hospitals and doctors. Well, there’s lot’s more demand here and the average inflation of these procedures appears to be just about what the average national inflation rate has been.

2002 Eyelid Surgery was $2,455 average cost and in 2007 it was $3,134, an annual inflation of 4.6%.

2002 Breast Augmentation was $3,436 and in 2007 it was $3,816, a mere 1.8% inflation rate.

Botox in 2002, $422 in 2007, $501 an annual increase of 3.1%.

Breast Implant Removal, $2,084 vs. $2,380 for 2.4%.

Finally a Face Lift actually showed a negative 1% inflation, 2007 cost was more than 6% less than 2002.

Again I’m not saying that we should completely go to a no insurance pay as you go but I am saying that if we all had a stake in the cost of our healthcare we would vote EVERY DAY for better outcomes and less money and low and behold we would get it.

Measuring Against Healthcare Degrees Salary Scale

Individuals working in health care facilities are opportune to improve their current positions by sporting an extra qualification or two. Perhaps employees in the medical billing department feel the urge to break out of their menial roles as there must be more to life than generating patient bills and insurance claims. By matching their current field of work with relevant healthcare degrees, salary hikes are a potential occurrence in their future. As one is empowered to expand his scope of work, opportunity to ascend to a higher plane of experience justifiably follows.

To run a better medical office, it is essential to hire professionals trained in this area. Otherwise, a group of lowly clerical staff continues to perform the expected role of a paper pusher. If a staff shows some potential in taking up more responsibility, it may be ideal to encourage said staff to pursue further education in the administration of a medical office. The investment may be paid off by greater efficiency in the running of the business at the hands of better trained workforce. As these reliable employees are awarded with healthcare degrees, salary adjustments are commensurate.

The urban legend regarding advanced degree holders drawing higher salaries continue to remain firm and true. As such, one wishing to see higher numbers on the pay slip had better be willing to invest in some elbow grease and hit the books. Although experience contributes greatly to one’s value for working in health care, education still remains as the brass tacks which most employers measure their employees against. If one is intent on pursuing a specific field of health care, it is to his advantage to obtain an advanced degree. A doctorate may be too high a goal as it better suits those aiming for the instructional arena. Hence, a master’s degree is sufficient to serve one’s purpose in achieving the best of healthcare degrees’ salary potential.

Healthcare Costs – Prevalence and Prosecution of Healthcare Fraud

In August 2009, the American Medical Association reported that a study conducted at the George Washington University Medical Center reveals that nearly 10 percent of all healthcare costs estimated to be $2.3 trillion in 2007 — are fraudulent. The problem was called systemic and found to affect both private and public insurers who service individuals, employers group policies and public aid programs.

The most common fraud practices that drive up healthcare costs are false billing, referral kickbacks, wrongfully coded services, and bundling of services not delivered. The report attributes 80 percent of the healthcare billing fraud to health care entities, 10 percent to consumers, and the remainder to a mix of insurers and their employees.

The incidence of healthcare fraud in the private sector is less widely known and recognized by the public than that which occurs in the Medicare and Medicaid programs because the government is obligated to publish this information.

One flagrant example of healthcare fraud detailed in the report were allegations that one large insurance company manipulated its billing practices for out-of-network physician reimbursement to drive up healthcare costs by up to 28 percent. The report also uncovered large financial settlements made by several pharmaceutical companies and hospital systems for fraudulent billing of the Medicare and Medicaid programs.

The federal government is taking steps to stem systemic fraud in healthcare. The Departments of Justice and Health and Human Services have formed a joint fraud prevention and enforcement committee to pursue and root out healthcare fraud.

President Obama also recently signed new law amendments that broaden the government’s ability to leverage the False Claims Act to prosecute healthcare fraud. In addition, the Obama administration’s proposed budget for 2010 includes the allocation of $311 million — a 50 percent increase over the previous year to beef up Medicare and Medicaid healthcare fraud prevention efforts. It is estimated that reducing healthcare fraud in these public programs will save the government $2.7 billion in healthcare spending over five years.

Obama’s proposed fiscal 2010 budget also calls for infusing an additional $311 million — a 50% increase over 2009 funding — to strengthen Medicare and Medicaid fraud-fighting programs. The government reports that working with law enforcement officials to prosecute healthcare fraud recovered $1.1 billion in 2008.

Some of the initiatives the Justice Department is taking to reduce healthcare fraud include:

Specialized training in technology for investigators.

Careful data analysis of Centers for Medicare and Medicaid Services.

Delivery of training and resources to health care entities to enable better detection and prevention of fraud and billing errors.

Stronger supervision of Medicare Advantage and prescription medication plans.