Week 5 Discussion 1: Cost and Quality
Health care cost is consistently a concern for Americans. From insurance premiums to medication prices, to surprise medical bills, and much more, it is becoming a barrier to care. Even though the Affordable Care Act has decreased the amount of those who were uninsured, it has not made overall care affordable.
One of the contributions to the high cost of care is colonoscopies. Colonoscopies are the most expensive screening test and are the first-line routine screening for colon cancer (Rosenthal, E. 2013). It is not the cost of the colonoscopy procedure that makes it expensive, it is the cost of anesthesia and the anesthesiologist that brings up the price. Only moderate sedation is required for the procedure, however, the United States standard practice is to use general anesthesia. This is not only more costly for the medication, but the patient must pay for the anesthesiologist’s time. Certain lobbying actions of the American Society of Anesthesiologists have prevented doctors’ offices and hospitals from switching to moderate sedation methods (Rosenthal, E. 2013). A pilot for a proposed policy took place in 2018, that mailed out fecal immunochemical tests for people to complete at home (S. Gupta et al., 2020). This test can screen for colon cancer just like a colonoscopy and is much more cost-effective for the consumer. The reason it has not been utilized more is due to a lack of knowledge of such tests. This program turned out to be successful but there need to be policies put into place to sustain such a system and follow up on data. I would propose that a task force be put together within the American Gastroenterology Association to sustain and advocate for this program.
Another aspect of health care that causes high expenses is prescription medication prices. The reason for this is because, in the United States, pharmaceutical manufacturers are allowed to set their own prices. Since America is a capitalist country, we can expect that prices will begin at a ridiculous amount. When a new drug is first released, the manufacturer is given the opportunity to have exclusivity of sales for a 5-7 year period, however, these manufacturers have found strategies to extend this exclusivity period to 12.5
years on average (L. N. McEwen et al., 2017). This is not fair to consumers to have only one option for a medication that could be potentially life-saving, but detrimental to their savings. This scenario is what leads to families having to choose between health and providing food and shelter for their children and dependent loved ones. The article states that when there are five manufacturers for the same medication, the cost drops down to 33% of the original price (L. N. McEwen et al., 2017). To keep the cost of medication so high when it could easily be lowered for the greater good for a greater number of people is just criminal. Policymakers should think about reducing the years of exclusivity to a 3-5 year period. I feel like that amount of time is a good compromise to thank the pharmaceutical companies for their hard work on the job, but also it is not too long to put consumers in debt or delay them from starting treatments. One policy that Europe has that the United States should evaluate is generic prescribing. There are 13 countries that make generic drugs the mainstream of prescribing medications whereas the United States allows physicians to choose if they want to prescribe generic drugs or brand name (WOUTERS et al., 2017b). It has been my experience that most people think that brand-name drugs are more effective than the generic counterparts. There should be awareness brought to this idea and end the stigma of generic drugs if we can call it that.
References:
Gupta, A., LaFaver, K., Duque, K. R., Lingaiah, A., Meriwether, K. V., Gaskins, J., Gomes, J., Espay, A. J., & Mahajan, A. (2021). Pelvic Floor Health in Women with Parkinson’s Disease. Journal of Parkinson’s Disease, 11(2), 857–864. https://doi.org/10.3233/jpd-202491
McEwen, L. N., Casagrande, S. S., Kuo, S., & Herman, W. H. (2017). Why Are Diabetes Medications So Expensive and What Can Be Done to Control Their Cost? Current Diabetes Reports, 17(9).
https://doi.org/10.1007/s11892-017-0893-0
Rosenthal, E. (2013). The $2.7 trillion medical bill: Colonoscopies explain why U.S. leads the world in health expenditures. Retrieved from http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html.
WOUTERS, O. J., KANAVOS, P. G., & McKEE, M. (2017b). Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending. The Milbank Quarterly, 95(3), 554–601. https://doi.org/10.1111/1468-0009.12279
Value: 100 points
Due: In an effort to facilitate scholarly discourse, create your initial post by Day 4, and reply to at least two of your classmates, on two separate days, by Day 7.
Note: In this type of discussion, you will not see the responses of your classmates until after you have posted your own response to the question below.
Important information for writing discussion questions and participation
Welcome to class
Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to
I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.
Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.
If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.
Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.
Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Hi Class,
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- The is a great resource
Initial Post
Select one topic below to write about in your initial post. Please make it clearly which topic you chose to write about in your initial post. Write 500 to 750 words related to:
- Topic 1: Discuss two major reasons why health care costs are so high in the United States and recommend at least two public policies to control health care costs. Make clear in your entry if they are policies already adopted, proposed by others, and/or ones that you would propose.
- Topic 2: Discuss at least two major reasons why health outcomes are poor in the United States compared to other first-world countries and recommend at least two public policies to improve health care quality. Make clear in your entry if they are policies already adopted, proposed by others, and/or ones that you would propose.
Cite additional sources beyond the Learning Materials for this week.
Replies
Reply to at least two of your classmates. In your reply posts, each reply should be on a topic different from the one you chose to write about. Each reply should be 200 to 400 words. You should cite at least one to two sources that add new information in response to your classmate’s post.
Please refer to the for details on how this activity will be graded.
Posting to the Discussion Forum
- Select the appropriate Thread.
- Select Reply.
- Create your post.
- Select Post to Forum.
An example of cost control in other places around the world is the use of global budgets. They are utilized on a national level and distribute resources within budgetary constraints (Shi & Singh, 2019). One bill I would propose in hopes to reduce the cost of Medicare and Medicaid as we got older, would be called the Non-Usage Act. This Act would target the many young healthy adults or even older healthy adults that have minimally utilized health care. For those who are relatively healthy and only see a MD for physicals would be a prime candidate. By not utilizing their health care would in turn produce savings for future (personal) usage. The savings would not go back to the insurance company but rather reinvested back into the patient. This would be most useful for life events such as, job loss, accidents, disability, or early retirement. A yearly fixed stipend would go into a personal health care account and saved for you when you really need it the most down the road.
The introduction to Biosimilars were suggested to increase pharmaceutical competition and have the potential to “reduce health care spending by $54 billion over the next decade” (Taylor, 2015). One past proposed health reform bill was from Hillary Clinton in 1994 called The Health Security Act. This bill proposed that pharmaceutical costs be offset by rebates, price caps, and the formation of a formal advisory council that would collaborate on setting realistic drug prices, recommendations of cost, and “was intended to reduce drug prices by influencing Medicare, Medicaid, and private insurance formularies” (Daemmrich, 2011). But after millions of dollars were spent on advertisements on behalf of the drug companies the bill didn’t even reach the house or the senate. Austin Smith, head of the pharmaceutical industry trade association and a physician and former editor of the Journal of the American Medical Association opposingly stated, “that high prices compared to the costs of manufacturing were necessary to recoup the expense of failed research” (Daemmrich, 2011).References
Daemmrich, A. (2011, September 14). U.S. Healthcare Reform and the Pharmaceutical Industry. U.S. Healthcare Reform and the Pharmaceutical Industry . .
Harvey, A. (2020, May 13). Six Reasons HealthCare is so Expensive in the U.S. The Entrepreneur. The Entrepreneur Fund. s/#:~:text=6%20Reasons%20Healthcare%20Is%20So%20Expensive%20in%20the,are%20
Shi, L., & Singh, D. A. (2019). Delivering health care in America: A systems approach (7th ed.). Jones & Barlett Learning. free%20to%20charge%20what%20the%20market%20.
Taylor, E. Rand Health Care. Small Ideas for Saving Big Health Care Dollars. Retrieved from .
Graduate Program in Health Administration Discussion Question Rubric
Note: The value of each of the criterion on this rubric represents a point range (example: 25–20 points, 20–15 points, 15–10 points, 10–0 points).
Criteria | Exceeds Expectations | Meets Expectations | Needs Improvement | Inadequate | Total Points |
---|---|---|---|---|---|
Quality of Initial Post | Initial post is on time and of the correct length (500–750 words).
All components of the initial post requirements are addressed. Course content synthesis is applied. References are included according to the Discussion instructions. 25 points |
Initial post is on time and of the correct length (500–750 words).
Most components of the initial post requirements are addressed. Course content synthesis is applied but limited. References are included according to the Discussion instructions. 20 points |
Initial post is one day late.
Does not meet the correct length (500–750 words). Some components of the initial post requirements are addressed. Course content synthesis is weak or missing. References are included but not according to the Discussion instructions. 15 points |
Initial post is more than one day late.
Initial post much fewer than (500–750 words). Few components of the initial post requirements are addressed. Course content synthesis is missing. References are not included. 10 points |
25 |
Peer Replies | On time.
There was substantial evidence and synthesis of course content utilizing course topics and the introduction of questions and new information. Replies are 200–400 words. References are included according to the Discussion instructions. 25 points |
On time. There was some evidence and synthesis of course content utilizing course topics and the introduction of questions or new information.
Replies are 200–400 words. References are included according to the Discussion instructions. 20 points |
There was either some synthesis of course content or the introduction of questions or new information.
Replies are less than 200 words. References are included but not according to the Discussion instructions. 15 points |
There was little or no evidence of course content utilizing course topics or the introduction of questions or new information.
Replies are less than 200 words References are not included. 10 points |
25 |
Frequency of Contribution | Initial post with two peer replies posted on two separate days.
25 points |
Initial post with two peer replies posted on the same day.
20 points |
Initial post with one peer reply.
15 points |
Only initial post submitted or only replied to peers.
10 points |
25 |
Organization, Writing Mechanics, and APA Format | Clearly organized, no or limited writing mechanics and/or APA errors.
25 points |
Clearly organized, few to some writing mechanics and/or APA errors.
20 points |
Poorly organized, several to moderate writing mechanics and/or APA errors.
15 points |
Poorly organized, many writing mechanics and/or APA errors.
10 points |
25 |
Total points | 100 |