I’m working on a health & medical discussion question and need an explanation to help me study.
Respond as a peer to the following disscussion post with at least 150 words and 1 reference ( The 2 reasons for increased health care costs that I chose to address are the medical model of health care and the multiple-system and administrative costs of care (Shi & Singh, 2019). As previously discussed, the medical model of health care is based on medical intervention after one becomes sick, not prevention. The problem with this type of model is that often health issues are worse, incur complications or secondary conditions, and require more appointments and medical interventions to get to a stable status. This incurs a greater overall cost, then prevention of the illness in the first place. An example of this is diabetes. Routine screening for diabetes based on risk factors could provide a diagnosis and initiation of a treatment regimen. However, left undetected the patient could develop life-threatening conditions such as diabetic ketoacidosis or diabetic coma requiring an inpatient stay in the ICU, this incurs greater cost money paid out and lost wages. These costs could be controlled by routine screening, emphasis on lifestyle changes to reduce risk factors, wellness programs through an employer or medical groups, and patient education to include habit and behavior modification with the focus on prevention.
Administrative costs of care account for the management of enrollment process, contracting providers, claims processing, utilization monitoring, denials and appeals of claims, marketing, and promotional expenses (Shit & Singh, 2019). One example of this is when a provider requests additional imaging such as an MRI. The administration receives and reviews the request. Depending on the rationale for the test and policy coverage this request may get passed on to a utilization committee to determine if the test is advised. The committee may deny the test. The patient wants to appeal the denial and the requesting provider then must fill out the appeal paperwork and return it to administration for processing. This process delays patient care and costs the man-hours of the provider and the administration to process everything. During this time of waiting the patient may be out of work resulting in the additional cost of lost wages, in addition to out-of-pocket expenses. These costs could be controlled by enhancing provider autonomy to request appropriate testing, streamline the appeals process, increase the use of electronic health records and communication, and streamline enrollment and claims processing.
Shi, L., & Singh, D. A. (2019). Delivering health care in America (delivering health care in America: A systems approach) (7th ed.). Jones & Bartlett Learning