Discussion 3: Containment in healthcare Paper

Discussion 3: Containment in healthcare Paper

Discussion 3: Containment in healthcare Paper

Cost-Containment in Healthcare

Cost containment in healthcare is a practice that helps enhance expense levels to avoid unnecessary expenditures that may negatively impact healthcare’s long-term goals. Hence, the US healthcare cost containment goals involve engaging in cost-saving practices without affecting patient care. An example of healthcare cost containment in the United States concerns end-stage renal disease dialysis costs. The cost containment for dialysis costs is essential considering the catastrophic nature of the end-stage renal disease (ESRD) to the health plans and the patients (Brewer, 2021). Hence, the containment goal will be to protect assets and members by identifying the main risks associated with end-stage renal disease and ways to avoid its future risks. For instance, there are approximately 786,000 ESRD with 29 percent kidney transplants and 71 percent patients on dialysis. To contain the costs of ESRD treatment, the federal government implemented a Medicare program for ESRD, which plays the role of the national health insurance program for people with ESRD. The program emphasizes the need to encourage ESRD patients concerning kidney transplantation and self-care dialysis (Grubbs, 2018). The program also clarifies the most effective reimbursement procedures for the most appropriate cost control.

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The main barriers associated with ESRD cost containment mainly concern the patient-level social risk issues like educational attainment and income. That is because most studies that deal with value-based payment programs suggest that any outcome measures and performance on quality are determined by social risk factors (Gupta & Wish, 2020). Most social risk factors like the patient’s income have led to most hospitals in the US being penalized due to patients’ readmissions, yet these factors are beyond the hospital’s control. According to Qi et al. (2019), it will always be essential for the Medicare program to critically evaluate social risk factors and how they interact with performance measures when carrying out cost containment for effectiveness purposes.

References

Brewer, E. D. (2021). ESRD Policies and the Delivery of Pediatric Long-term Dialysis Care in the United States. American Journal of Kidney Diseases, 77(2), 264-267. https://doi.org/10.1053/j.ajkd.2020.08.006

Grubbs, V. (2018). ESRD and hospice care in the United States: are dialysis patients welcome?. American Journal of Kidney Diseases, 72(3), 429-432. https://doi.org/10.1053/j.ajkd.2018.04.008

Gupta, N., & Wish, J. B. (2020). Are dialysis facility quality incentive program scores associated with patient survival?. American Journal of Kidney Diseases, 75(2), 155-157. https://doi.org/10.1053/j.ajkd.2019.09.013

Qi, A. C., Butler, A. M., & Joynt Maddox, K. E. (2019). The role of social risk factors in dialysis facility ratings and penalties under a Medicare quality incentive program. Health Affairs, 38(7), 1101-1109. https://doi.org/10.1377/hlthaff.2018.05406

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“From the 1970s to the present, continually rising insurance premiums and health care delivery costs have strained government budgets, become a costly expense to businesses that offer health insurance to their employees, and put health care increasingly out of reach of individuals and families” Explain in detail one cost-containment effort such as managed care or one financing mechanism that is impacting healthcare expenditures and delivery of healthcare services. Please identify at least two research studies or reports (report may be from a national reliable organization) that have examined the efficacy and/or comparative effectiveness of these measures. Furthermore, please discuss challenges and/or barriers in regards to implementing cost-containment efforts at the systems and/or organizational level.