Common Healthcare Methods and Tools

A cost-benefit analysis

A cost-benefit analysis is a systematic process for estimating the flaws and strengths of alternatives. These options are for decisions about transaction activity, project investments, and business processes. A healthcare practitioner can generate lasting and credible choices for cost savings using this strategy.

Medical services and the mechanisms for cost-benefit analysis

Medical services and other related services are provided by countries such as the United States to aid in the provision of quality healthcare. The government has established two mechanisms to aid in cost-benefit analysis: the CEA and the CBA. These two systems assist healthcare institutions in making better costing judgments. Most healthcare organizations in the United States have incorporated these strategies. The reason for this is that the systems not only help in the decision making but also in the establishment of the most quality and valid options. This provides for the extensive work processes within a health institution. The processes of incorporating cost-benefit techniques have been seen to help in arriving at decisions that are socially acceptable, fair, and most importantly cost effective (Josselin & Le Maux, 2017).

Choosing between variable or fixed costs

These techniques also help in choosing between variable or fixed costs for a given scenario. In order to establish this, CEA begins by first setting an objective that maximizes the health subject to a budget constraint. After that, it varies the options in terms of the objective and its cost. Then after, a decision on whether to choose a fixed cost or variable cost will be made. A cost-benefit scenario or in this case the set objective will dictate the type of cost. There is, therefore, no pre-decision regarding the choice between fixed and varied cost. The decision will be made after the above assessment has been done.

Common Healthcare Methods and Tools

In order to combat the high cost and by extension the general healthcare’s financial and economic challenges, companies in conjunction with health centers have developed various health care methods and tools. Examples of these are the Managed Care Plans and Consumer Driven Healthcare Plans. A Managed Care Plan is a medical plan put in place to reduce the cost of treatment. In the United States, the managed care plan was put in place to provide health benefits, improve medical care, and most importantly reduce the cost of medical treatment. There are also Consumer Driven Healthcare Plans. These covers provide insurance plans that allow people to use different kinds of payments for health services through the use of Health Reimbursement Accounts, Health Savings Accounts or any similar payment products. The main aim of the consumer-driven healthcare is to protect health seekers from the high costs of medical services by using pre-funded accounts to make payment deductions. The main dissimilarity is that with the consumer-driven healthcare plan is that the patients have control over their health budget unlike with the Managed Care Plan.

Billing and reimbursement process

According to Berkowitz (2016), the main issues that affect the billing and reimbursement process of the two healthcare plans are the restrictions made by insurance companies. For instance, an individual under a Managed Care Plan may not be satisfied by the services or treatment the provider offered. Managed care plans have strict SOPs and the, therefore, this individual will have no other option but to adhere to the insurance terms and provisions. There are also complaints about the length of time it takes for managed care plans to respond. Another major drawback is the lack of privacy given that the managed care companies require that they receive medical information of the treatments made of the covered individuals regardless of their nature.

Changes in Health Care Services

Treatment of Diabetes

The treatment and management of diabetes have changed over the last 30 years. The changes have been characterized by the improvement of medicine and methods of treatment. For instance, in the past, the methods of glucose measurement, insulin administration, and types of insulin were different. The challenges, however, remain the cost and access to the treatments. Moreover, the prevalence of the disease has risen through time. This has been mainly attributed to the lifestyle changes that have been witnessed all over the world. Given the nature of the treatment of diabetes, nurses and doctors are supposed to be extra cautious. For instance, glycemia tests need to be tested and the appropriate medical medicine and equipment used. Failure of this may jeopardize the medical practitioner’s ethical conduct.

The growing prevalence has seen improved preventive measures. Given that the disease has been characterized as a lifestyle disease, health practitioners have established easy and achievable preventive measures. The preventive measures include healthy eating habits and regular exercising. Specialists such as nutritionists have also stepped up to provide for the population. People are now more assertive and are aware of the implications of unhealthy lifestyles. In addition to the prevention, the improved treatments have also seen reduced numbers of fatalities and amputations attributed to diabetes. Blood glucose is now easy to test with the improved technology and now patients can receive appropriate insulin formulations (Cyganek et al., 2016).

Drivers and Barriers for Health Care Reforms

The main drivers of heath reforms are the changing world economies. These changes have caused a change in the type and quality of health care products and systems. Governments of the world’s nations are similarly setting up appropriate policies to match these changes. These same drivers also act as barriers of the reforms. A major barrier of reforms is the lack of initiative. Various entities are striving to develop and set up health reforms but the lack of support in form of funds and supportive legislations are making the reforms unachievable.

Insurance covers play major roles in reducing the cost of healthcare. However, the most prevalent problem facing insurance coverage is their universality. As mentioned above, there are various types of insurance covers. The issues arise when there are no insurance covers that favor everyone regardless of their social class, wealth or income. Governments are trying to place legislations and initiative to ensure that healthcare covers are made affordable in order to achieve its universality. Private companies are also participating in this move while some work in conjunction with health institutions and governments to the development of covers that are all inclusive (Adler et al., 2016).

References

Adler, N. E., Cutler, D. M., Jonathan, J. E., Galea, S., Glymour, M., Koh, H. K., & Satcher, D. (2016). Addressing Social Determinants of Health and Health Disparities. Discussion Paper, Vital Directions for Health and Health Care Series. National Academy of Medicine, Washington, DC. https://nam. Edu/wp-content/uploads/2016/09/addressing-social-determinantsof-health-and-health-disparities. pdf.

Berkowitz, E. N. (2016). Essentials of health care marketing. Jones & Bartlett Publishers.

Cyganek, K., Skupien, J., Hebda-Szydlo, A., Katra, B., Janas, I., Trznadel-Morawska, I., ... & Malecki, M. T. (2016, June). Changes in Preconception Treatment and Glycemic Control in Women with Type 1 Diabetes Mellitus: 15 Years, One Centre Observation. In Diabetes (Vol. 65, Pp. A591-A591). 1701 N Beauregard St, Alexandria, Va 22311-1717 USA: Amer Diabetes Assoc.

Josselin, J. M., & Le Maux, B. (2017). Cost Benefit Analysis. In Statistical Tools for Program Evaluation (pp. 291-324). Springer International Publishing.