This document discusses healthcare reform and cost control in the United States. It notes that the US spends a large portion of its GDP on healthcare but ranks lower than other countries on quality, access, efficiency and health outcomes. It identifies several ways to reduce costs such as reducing risks for certain conditions and increasing competition. It also discusses the Affordable Care Act and how it aims to expand access to insurance coverage and emphasizes preventative care. Recommendations include implementing preventative health education and care process models to improve outcomes and reduce costs.

1. Running head: HEALTHCARE REFORM AND COST CONTROL 1
Health Care Reform and Cost Control
Michelle Deak
South University
Financial Management
6305
Dr. Barakat

2. HEALTHCARE REFORM AND COST CONTROL 2
Healthcare Reform and Cost Control
Introduction
The United States spends a large share of its gross domestic product (GDP) on healthcare
than any other industrialized country and in 2000 13% of the U.S. GDP was spent on healthcare
(Health Care Costs, 2013). The United States ranked consistently ranks lower or underperforms
compared to six other nations (Australia, Canada, Germany, the Netherlands, New Zealand, and
the United Kingdom) and scored next to last in five dimensions: quality access, efficiency,
equity, and healthy lives (Davis K., Schoen C., and Stremikis K., 2010).
Controlling Cost
The Agency for Healthcare Research and Quality continues to research ways to reduced
healthcare costs and have identified several key components to decrease cost such as: reducing
the risk of stroke for elderly patients with atrial fibrillation (irregular heartbeats), employers can
reduce cost by offering multiple insurance plans and making the same dollar contributions each
month, more competition among health maintenance organizations and changing care plans for
nursing home residents with pneumonia and other respiratory infections.
Other areas that the AHRQ have identified that can reduce cost are widespread use of
Acute Cardiac Ischemia Time Insensitive Predictive Instruments. This is new software approved
by the Food and Drug Administration that can identify those patients who are having a heart
attack, therefore allowing physicians to decide if a patient will need thrombolytic therapy (Health
Care Costs, 2013).
Callahan speaks of various strategies to overcome some of our healthcare cost and access
to care but also mentions obstacles that present such as pressure from the drug and device
industries and some physicians groups who are responsible for “crippling our healthcare system”

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via high costs. According to Callahan, scheme theories such as medical devices that a doctor
may recommend to patients, only to profit and not for the patient’s best interest.
Solutions recommended by Callahan are as follow: direct and naked which means
offering important health benefits and life extended treatments, with no hidden agendas, The
second is indirect and veiled rationing, referring to the use of copayments and deductibles, which
the price can be set high enough to discourage if not needed but affordable if needed (2011). The
third, which was recommended by British policy leader, Rudolf Klein is rationing by dilution.
For example, this framework will enforce providers not to order expensive lab test or to
minimize unnecessary staffing levels (Callahan, 2011).
Other suggestions offered by Callahan are gradually to raise taxes and expand the roles of
government duties for the U.S. healthcare system. Many people in the United States will not be
satisfied if any of these rationing theories are implemented, but Callahan stresses the need for
policy makers to step up and apply intelligent judgments when making new changes to our
healthcare system (2011).
Qualifications and Costs
According to Families USA.org, Medicaid covers over 58 million families in the U.S.
and 26 million are children (2012). For new recipients the PACA will cover 100 percent of costs
for 2014 and from 2014-2016 the federal government will cover 90 percent of costs. Medicaid
and Chip work close together and currently 8 million children in the U.S. are without health
insurance.
The ACA will help increase coverage to those children without health insurance and
various programs such as outreach programs to identify those adults with children whom do not
have health insurance (Medicaid and Chip, 2011).

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North Carolinas Data & ACA
The following information was retrieved from www.factfinder2.census.gov and was a
survey conducted by the 2012 American Community Survey which is implemented by the U.S.
Census Bureau. The data represents is noted on a sample population and has a margin of error
(noted by plus or minus signs).Total: (9,752,073) Population in North Carolina 2012), children
under 6 years of age with health insurance are 383,250 +/-5,471, No health insurance coverage
18,239 +/-2,811 6 to 17 years:781,389 +/-6,500 With health insurance coverage709,119 +/-7,184
No health insurance coverage 72,270 +/-4,659 18 to 24 years:456,701 +/-5,019, With health
insurance coverage322,223 +/-6,228 No health insurance coverage134,478 +/-5,395, 25 to 34
years:572,027 +/-5,297 With health insurance coverage356,868 +/-6,036 without health
insurance 168, 188,which represents the highest uninsured age group.
The following information relates to how much a 42 year old individual living in
Raleigh, North Carolina will have to pay under the Patient Affordable Care Act from the Health
Insurance Market Place. For example: Projected Obama care Rates for an Individual, Age 42, in
Raleigh, North Carolina as follow:
Lowest Catastrophic Plan = $127.74/mo
Lowest Bronze Plan = $203.82/mo
Lowest Silver Plan = $279.51/mo
Second Lowest Silver Plan* = $280.54/mo
Lowest Gold Plan = $317.15/mo
Recommendations

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.
Policies to Improve
According to the American Lung Association, smoking cost the United States over $193
billion in 2004, including $97 billion in lost productivity and $96 billion in direct health care
expenditures, or an average of $4,260 per adult smoker (Smoking, 2013).
In 2009, the American Academy of Pediatrics recommended that all pediatricians counsel
patients as young as age 5 years against initiating tobacco use and provide counseling on tobacco
cessation. The academy also recommends that pediatricians advise all families to make their
homes and cars smoke free (Mitka, 2013).
In 2004, 2006, and 2007 reports were published by the Commonwealth Fund that the
U.S. fails to achieve better health outcomes than other countries, therefore the focus for the U.S.
will be to close the gap in healthcare which will lead to improving disease management, care
coordination and overall better outcomes overtime (K. Davis, C. Schoen, and K. Stremikis,
2010).
Policies for Controlling Cost
The American Recovery and Reinvestment Act signed by President Obama in 2009
increased funding by 19 billion to expand the use of health information technology and the
Patient Protection Affordable Care Act of 2010 will promote access to care and preventive health
issues but more healthcare problems will need addressing and continuous assessing overtime.
In 2010, the Netherlands was included in the study for the first time and ranked first
overall and for subcategories the United States ranks first on preventive care but weak on access
to care. These rankings are based on national mortality and patient surveys.

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Conclusion
Having access to affordable health insurance for many Americans will be an opportunity
for providers to implement preventive health plans to many new patients, especially children. In
my opinion, recommending that all primary care physicians implement teaching and education
on obesity and the dangerous effects to one’s overall health as it relates to smoking.
The AHRQ suggest implementing care process models. For example, implementing an
evidence based care process model (EB-CPM) for treating feverish infants up to 3 months of age
at pediatric hospitals or clinics can result in better diagnostics, shorter hospital stays and
antibiotic treatments. In 2008, data revealed that utilizing an EB-CPM, reduced cost by
approximately 1 million dollars. In addition other care plan models on pneumonia (geriatric-
nursing home) patients have also demonstrated controlling the overall cost of healthcare in
America.

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References
Callahan, Daniel. 2011. "Rationing: Theory, Politics, and Passions." Hastings Center Report 41,
no. 2: 23-27. CINAHL Plus with Full Text, EBSCOhost (accessed October 25, 2013).
K. Davis, C. Schoen, and K. Stremikis. (2010, June 23). Mirror, Mirror on the Wall: How the
Performance of the U.S. Health Care System Compares Internationally, 2010 Update.
Retrieved January 12, 2014, from http://www.commonwealthfund.org/Publications/Fund-
Reports/2010/Jun/Mirror-Mirror-Update.aspx?page=all.
Medicaid and CHIP Payment Access and Commission. (2011, March). Retrieved October 16,
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http://cnsnews.com/sites/default/files/documents/MACPAC_March2011_web_0.pdf.
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