Ryan Luepke, Guest, Patient

My name is Ryan Luepke and I have been a loyal customer to the US healthcare system for over 20 years. My experiences with this system have overall been very good, however I would not say that there aren’t any problems with it. As a Wisconsin resident currently living in Minnesota while I go to school I struggle with finding reasonable healthcare options when I need them. While in Minnesota I am not covered by my parents insurance for routine things like dental exams, eye exams, and yearly checkups and physicals. This leaves me pretty much high and dry when something goes wrong. The only solution that I have been able to exercise so far is to drive back to Wisconsin every time I need anything related to my health. As you can imagine this is both expensive and inconvenient when going to school full time and working over 20+ hours a week when not in school. This past school year alone I was forced to drive over 150 miles one way at least 4 times just for routine exams and checkups. This is both directly detrimental to my finances with paying for gas to drive all those miles, and indirectly detrimental with the added cost of missing work , wear and tear on my vehicle, and missing some classes(which certainly aren’t free) to make it to these appointments. Luckily I am a person that has had very few serious health problems in their lifetime, but I cannot imagine what a hassle this would be to someone that does have health problems and needs more frequent care. It would be very nice to at least have other healthcare options available to people such as myself even if they aren’t perfect. It would be nice if I could go to any hospital in the country for routine things such as prescriptions, checkups, and exams. My current coverage has too many restrictions on payment and financing to keep me from getting the care I need and deserve. My insurance company will tell me that I can go to any healthcare provider I choose for my medical needs, which is indeed true. I do have the freedom to choose any facility I want. However, upon going to this facility I may find out that this provider isn’t on their list of places that I am covered under. This would be extremely detrimental in an emergency situation where I may get taken to the nearest hospital on the basis of saving my life, only to find out that upon my survival none of my healthcare is being covered simply because I am in the wrong geographical spot. Conditions on coverage and payment such as this are hurting those who need healthcare the most and something needs to be done.

Nicole Stearns, Guest, Nursing Student

Hi. My name is Nicole and I am currently a student at Bellin College of Nursing in Green Bay. This is my sophomore year in Bellin's Nursing program but my junior year in nursing school. I do clinicals every thursday and friday so I have an understanding of healthcare and how people are paying for it. I agree that healthcare in America is a very controversial subject and many people have their own opinions. I think that Maggie was right when saying that people need to take more preventative actions. Many people do not go into the doctor for their physicals, mammograms, etc because they think that it is too expensive if it isn't covered under their insurance. This could possibly make things worse in the long run because cancer and diseases, which are the most expensive health problems and surgery, have decreased greatly because of preventative actions, which in turn saves the client more money. I also see many patients that do not take care of themselves and rely on medications to do the work for them. I think patients need to start making important lifestyle changes because that would decrease hospital visits and they would not need to be paying so much money for it. I have noticed during clinical that about 90% of the patients I have are in the hospital for problems such as emphysema (from smoking), renal failure (from drinking/eating unhealthy food), heart disease and many other problems. These people take about 20 medications a day, costing thousands of dollars. These problems could have been prevented by making lifestyle changes. These patients also stay in the hospital for days, weeks or even months, which costs even more money. The rest of the patients I've had are in the hospital for knee and hip replacements for arthritis because they were so active. These patients usually take about 5 medications and are out in 2 days, saving lots of money. Overall, I am a little undecided about how I feel about healthcare but I do think that people can save a lot of money by making lifestyle changes and taking care of themselves, which will save money for healthcare in the government to help others in need.

Financing Reform Proposal # 2

Health care costs have been on the rise for the past several years and it’s feared that in the future health care will be so expensive that very few will be able to afford it. So what can be done to lower the cost of healthcare and increase the quality without increasing our taxes and decreasing coverage? That seems to be the million dollar question these days! I believe that access to good health care is a god given right to everyone. However, financing health care and allowing its availability to everyone becomes difficult.

The main reason why health care is so expensive is because of technology, prescription drugs, chronic diseases, aging population and administrative costs. The availability of new and more expensive technology and prescription drugs fuel health care spending not only because of development costs but because it generates a new consumer demand for these products. Chronic diseases are of greater prevalence in our country over the last century. It is estimated that health care costs for chronic disease treatments account for over 75% of national health expenditures. In regards to our administrative costs some people argue that the mixed public-private system creates overhead costs and large profits that are fueling health care spending.
Now that we know the reasons why health care is so expensive how do we go about fixing this mess? We can control and lower health care costs through, preventative care, increased consumer involvement, investment in information technology and improving quality and efficiency.

If there was more of a focus on preventative care such as screenings, education and even financial incentives to encourage workers to participate in wellness programs; it would help to decrease prevalence of chronic conditions and avoid incurring the long-term costs of treatment. This means that the member of our senate and house need to vote for the bills that support this idea.

Increasing consumer involvement regarding purchasing is another way to control health care costs. A “consumer driven” health care allows for more price transparency which will make consumers more price sensitive and cautious purchasers which allows for further consumer and employer savings. The idea of making consumers more responsible for their health care and health care costs can also be very impactful on the overall health care costs. Insurance payments are a third party system; most people generally don’t even pay their health care bill or even look at it. Increasing consumer involvement within paying for their health care bills will make consumers more aware of the costs of the services that they received and less likely to run to the doctor for every problem they have.

Improving quality and efficiency of health care can overall improve the health care system. In order to improve the quality and efficiency many employers in the health care system offer initiatives to employees, such as the employer giving a bonus to the doctor who has the lowest return patient rate at the end of the month. This incentive will encourage doctors to spend more time and increase the quality of care to their patients so that they will leave the hospital or doctor’s office in better overall health and will not need any more assistance. This emphasizes the need to streamline the health care system and eliminate needless spending.

Greater use of technology, such as electronical medical records will increase our ability to share information more easily and efficiently and reduce overhead costs. Investing in this information technology will allow for better organization and diagnosis and it can even decrease the administrative costs because you won’t need a person filing paperwork because the IT program will do it for you.

Everyone debates how to improve the nation’s health while affording health care reform. As a registered nurse for the past 31 years, I’ve seen dramatic positive and negative changes in health care. That spectrum ranges from the vast educational resources now available, evidence based practice and technology to the high cost, shortage of providers and services and lifestyle changes. Health care reform is a continuum that will take time. Long term solutions to health care reform include prevention, access and accountability which will provide the greatest benefit in the most cost effective model.

In my 20+ years of working in women’s health throughout central Wisconsin, at the state and national level, I became well versed in the fiscal effectiveness of prevention. As the Journal of HealthCare for the Poor and Underserved noted in 2008, for every $1 spent on publicly provided family planning services, $4.02 was saved in direct medical costs. Preventative measures of following cancer screening recommendations which lead to early detection, prevents costly treatment. Promoting comprehensive preventative exams for people of all ages, along with immunizations allows for early detection and treatment of identified conditions and prevents sequele from preventable illness.

There is proof that prevention works, but we need to be sure everyone knows and can access and utilize the appropriate resources in a timely manner to be most cost effective. With the shortage of primary care providers in Wisconsin, getting timely appointments for screenings and follow up care becomes a challenge. Mid-level providers and nurse navigators are cost effective means to connect patients with the level of care that is needed. Disease specific programs overseen by doctors with nurses, dieticians or educators meeting with patient have been successful for anti-coagulation management, diabetes, asthma and heart disease and save valuable resources while improving health outcomes. Access to health care resources by people of all ages, ethnic groups, geographic areas and economic levels is crucial. These resources range from educational materials suited to the various groups, access to screening programs, technology and providers and reducing barriers to that access. In my current position as Quality Director for a Critical Access Hospital, I hear from many families who lack the knowledge about how to navigate the health care system, where to find information related to their health-both preventative as well as disease specific and requests for financial assistance.

So where does accountability figure into health care reform? Our society has focused on the quick fix of prescriptions and placed our hopes on emerging technology to take care of our ailments. It is time for each of us to be accountable and work with the healthcare system on our individualized health plan. Patients need to be networked with the array of services and providers that are readily available and take the initiative to be proactive. Providers need to work across systems for the good of the patient. We’ve allowed the electronic medical record systems used at our hospital and clinics to share data with providers at neighboring referral centers. This sharing of records improves timeliness of care in emergent situations like stroke, traumas and heart attacks where the accepting facility can view the data and be ready when the patient arrives. This also reduces the cost of repeating tests. We need to share best practices among providers and patients and then make the effort to improve our health. Healthy diets, exercise and routine health care monitoring are effective measures to reduce health care costs and at the same time, dramatically improve our health.

We need to realize that prevention is a process versus a quick fix. As we incorporate prevention strategies, we will need to continue with the treatment of conditions. Over time, increased prevention strategies such as knowledge sharing, screening, maintaining good health by ongoing monitoring and access to services, along with improved patient involvement will decrease the need for treatment and the associated costs. The long term effect will be reduced treatment costs so that those allocated treatment funds can be utilized to increase access to preventive care programs. Knowledge is power, but we need to harness this knowledge and use it responsibly by be successful in health care reform.

Financing Reform Proposal

Everyone is talking about health care. One of the main issues with health care is the cost and financing of it. Where does the money come from? How can we improve our system and our health without raising costs to a price that is only affordable by few? These are important questions to ask when determining a better financing agenda for our health care system. It is hard to have high quality and low cost; these are two factors that usually have an inverse relationship. The simplest way to keep costs down and improve health is to use preventative measures and prevent disease and illness rather than trying to counteract it once it has already set in. It is financially beneficial to engage in healthy behavior and to maintain health than to treat problems after they have set in and have manifested and create even more problems for the individual. Prevention measures are also easier to carry out, relatively speaking, than many treatment measures for chronic diseases such as heart disease. Treatment of diseases has many different facets that increase costs throughout our health care system from surgery to expensive medication, therapy, etc. Preventative measures include things such as healthy eating programs in schools, educational programs and wellness programs in communities that are specified for their needs. Programs must differ to meet the needs of the community and will vary throughout the nation; they cannot be generalized for the entire nation or they will not be effective in preventing and managing health issues that are specific to certain areas. Many health related programs should be implemented in the earlier stages of life such as grade school level so healthy habits are formed at a young age and then can be reinforced throughout schooling. Many habits form at a young age and are hard to change as people get older; the sooner that programs can be implemented the better. The government can allocate money to support programs such as this and as people become healthier due to these programs less money will need to be allocated to health care because it will not need to be accessed as frequently.

The government can also allocate a lot less money to pharmaceutical companies for drugs that are not necessary. There seems to be a drug for the simplest of inconveniences rather than for real problems; many things that people dealt with and managed with a simple Tylenol now needs an expensive drug. Reducing our reliance on expensive drugs can dramatically reduce our health care expenses by not having to produce the drug, market it and sell it. Along these same lines of expensive treatment methods we could start with primary care practitioners and avoid resorting to high priced testing equipment and specialists. Catching illness at the beginning of its cycle rather than waiting until it has manifested and needs to be treated by a more expensive specialist is preferred. Using expensive testing and treatment could be avoided if yearly physicals were obtained, people were more educated on how to maintain their health and knew what signs and symptoms were worth having checked over by a general practitioner to avoid chronic illness. In accordance with primary care there should be incentives for return of patients with good health to create more of a desire for doctors to keep costs down, educate their patients and thoroughly examine patients to be sure that they are in good health or if they are not in a state of good health be sure that they receive the proper treatment method to return to an optimal state of health.

When it comes to the system itself we need to work on making it an interoperable system that has all different aspects of health care working together rather than being segmented. We also need the records system to be an interoperable system so that patients’ records can be accessed and are comprehensive so there is no confusion between different hospitals or doctors. Overall costs are reduced by avoiding repeat testing which saves time, money and resources that could be used elsewhere.

It is hard to say exactly from where financing for something as large as our health care system will come from. By reducing costs and preventing conditions that are expensive, financing can be shifted from treatment to prevention which will in turn save more money that can be invested back into prevention, wellness programs and incentives for primary care physicians to promote health.

Works Cited

Arvantes, James. "Daschle Calls for Greater Primary Care, Prevention Efforts -- AAFP News Now -- American Academy of Family Physicians." Home Page -- American Academy of Family Physicians. 14 Jan. 2009. Web. 06 Apr. 2010. .

"Reforming Our Health System." Prevention Institute. Web. 06 Apr. 2010. .

History and Overview of Health Care Financing in the United States

One of the biggest concerns regarding health care delivery in the United States is the complexity of financing. Health services financing helps pay for the medical costs of individuals and/or families receiving health care.

Financing in this sector is also a means of cost control. Looking at the commonly used equation E = P x Q, we observe that expenditures of health care equals payment multiplied by utilization. Knowing this, there are several factors that help keep these costs down including insurance, access, supply and demand, all factors of health care financing.
The main function of insurance in any situation; be it health care or other, is to protection an individual against risk. In this case, its function is to protect families and individuals against the costs of utilizing the heath care system.

Two main types of health care financing include public and private. The difference between the two can be looked at as follows. Private health insurance is often known as “voluntary health insurance” where as public financing for health care is helped paid for by the government. Looking closer into private financing, different types of private insurance include group insurance, self-insurance, individual private health insurance and managed care plans. Private insurances, or beneficiaries, such as these commonly use concepts like premiums, cost sharing, indemnity and service plans and covered services. Probably the most commonly known forms of public financing include Medicare and Medicaid. Medicare is a publicly funded program for those who fit in to one of the following categories: 1) Those over 65 years of age 2) Those under 65 years of age with certain disabilities and 3) Those of all ages with End-Stage Renal Disease. The program has three main subcategories of which include Medicare Part A, for hospital insurance, Medicare Part B, for supplementary medical insurance, and Medicare Part D, for prescription drug coverage. Medicare as a program was passed into law on July 30th of 1965, and has made many progressions and changes since then. Medicaid is a program designed for low income individuals and families who fit into a specific group as recognized by federal and state law. Within Medicaid programs, each state sets their own laws and standards as to the rules, regulations, and coverage of Medicaid patients. Medicaid was initiated the same day as Medicare was under the Social Security Act, also known as Title XIX.

Under the Balanced Budget Act of 1997, two programs were added to the public sector which include PACE and SCHIP. PACE stands for Program of All-inclusive Care for the Elderly. Though it is not available in all states, the PACE program provide community based care for those over the age of 55 who do not qualify for placement in a nursing facility. SCHIP, or the The State Children’s Health Insurance Program, started as a response to an increase in number of uninsured children. It offers additional funds for children under the age of 19 years whose families do not qualify for Medicaid.

Amongst the numerous programs that the public sector now has implemented, some of the main ones include The Military Health Services System, the Veterans Health Administration, Indian Health Service and Workers’ Compensation, all of which are fairly self explanatory.
A growing concern in today’s society are national health care expenditures, which are “An aggregate of the amount the nation spends for all health services and supplies, public health services, health-related research, administrative costs, and investment in structures and equipment during a calendar year.” (Shi & Singh, 2008). Recently the ratio of private financing to public financing has held steady at about 55 to 45. This was not always the case. Prior to 1960, private financing held a much greater piece of the expenditure pie. A large reason the ratio shifted was because of the implementation of Medicare and Medicaid, both public financing that affect millions of people.

Every health care system and its subcategories have their downfalls and financing within the United States health care system is no exception to the rule. There are seven main problems/issues facing insurance and financing today which are Insurance Portability and Continuity, the Erosion of Private Insurance Coverage, Community Rating and Adverse Selection, Favorable Risk Selection, Cost Shifting, Financing for the Uninsured and finally, Fraud and Abuse.

Financing is an integral segment of our health care system. It determines who has access and coverage amongst other important factors. Without a doubt, revamping of financing health care will be a long and difficult process.

U.s. department of health and human services. (n.d.). Retrieved from http://www.cms.gov/MedicaidGenInfo/

U.s. department of health and human services. (n.d.). Retrieved from http://www.cms.gov/MedicareGenInfo/

Shi, L, & Shingh, DA. (2008). Delivering health care in america: a systems approach. Sudbury, MA: Jones and Bartlett Publishers.