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Health Care Delivery System

MPAN 642

Elizabeth Nunez

Touro College PA program

NUMC class of 2021

12/06/2020
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UNIT 1
Please answer the questions below based on the reading you are to complete in the textbook,
Health Care Delivery Systems in the United States, 11th Edition Only.
Please read Chapter 1 [The Challenge of Health Care Delivery and Health Care Policy] and
answer the following Discussion Questions found at the end of the Chapter:
1. Question #2: Why do we spend so much money on health care.
The prices for a hospital or doctor’s visit in the United States are higher than any other
developed industrial nation. For instance, US hospital prices are 60% higher than those in
Europe. The US uses an unbundled cost system where all aspects of a patient visit are
itemized and checked off, maximizing the total tally of services to be billed. There is also a
code system which is used to link certain conditions or patient scenarios to different price
structures. For instance, a laceration on your arm would be a different cost than one on your
leg. All of these complex billing procedures are used to make the medical bill as high as
possible. The US also has switched from healthcare being a philanthropic venture, to a highly
profitable mega industry comprising publicly traded hospital systems, insurers, healthcare
suppliers and pharmaceutical companies. Healthcare has also now surpassed retail as the
largest employer in the US. Where a system has no cap on cost, and the very mechanics of
the industry are driven by increasing shareholder value, it’s no wonder there has been a major
deviation in prices compared to the rest of the developed world with little difference in
patient outcome.

2. Question #5: What are your priorities to improve the value of health care Americans get
for the money we spend? What is your rationale for these priorities?
One of the most important priorities I have as a future health care provider is to make sure I
do not over treat my patients. I will refrain from ordering unnecessary tests that lead to an
increase in healthcare costs for patients and do not increase health outcomes. Many clinicians
only do this in attempt to decrease the risk of a malpractice lawsuit. I would treat patients with
chronic conditions such as HTN, DM and cardiovascular disease with proven effective evidence-
based strategies to prevent the worsening of their conditions and focus more on preventative
care. Early detection and aggressive treatment of chronic conditions can spare patients suffering
and leads to less complex and expensive health care later. Also, I could offer same day
appointments and encourage my patients to call the office before presenting to the ER. Hospitals
are much more expensive than a visit to your PCP because hospital prices take into account all of
the indirect costs like departmental overhead, and amount to cover uncompensated care. Indirect
costs for hospitals include people who can't or don't pay their bills since the hospital cannot turn
anyone away based on their ability to pay. These costs are re-allocated into future pricing
creating inflated charges. There is also an amount that is not covered by insurance, Medicare or
Medicaid that is too passed on in the pricing.
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Please read Chapter 2, [Organization of Care] answer this one Discussion Question found at the
end of the Chapter:
3. Question #2: The baby boomer generation which represents a significant portion of the
U.S. population is reaching an age when its utilization of health services will most likely
increase. Discuss how this aging of such a large segment of the population will affect
specific health care delivery services and organizations?
The aging baby boomer population will affect health care delivery is by changing supply and
demand. The new demands placed on the health care system will not only include a need for
more health care workers but will also change the way services are provided. Services being
provided at patient’s homes, in group settings, in nursing homes and assisted living facilities, and
through telemedicine are something we may need to do to decrease the amount of crowded
outpatient offices, long wait times to see doctors and to simply deal with the increased amount of
patients in need of a high level of care. This will mean that nursing homes and other settings
such as home health and assisted living facilities that deliver care to an elderly population now
will need to increase their workforce as well. We may need to look to other countries to see how
they are preparing to deal with their increasing elderly populations. For example, in Sweden,
they have taken a different approach to health care delivery for the elderly with central care
coordination. This in an all-inclusive group of doctors, nurses OT, PTs and conducts all care
management in house. There are many different ways we can change health care delivery to fit
the needs for a growing elderly population and hopefully, with time, we can solve some of these
problems for a better future in health care for all Americans.

Please read Chapter 3 [The Politics of Health Care in the United States)] and answer the
following Discussion Questions at the end of the Chapter:
4. Question #1: How is the US health care system financed?
Private health insurance plans are paid by the members of an insurance pool, these
contributions are called premiums. Each member usually has a minimum yearly deductible and
has to pay a fee for visits to a medical office or hospital. Medicare public health insurance run by
the federal government. Funding for Medicare comes primarily from general revenues, payroll
tax revenues. This covers 80% of the cost for seniors 65 and older, the remaining 20% cost is
paid either out-of-pocket or with supplemental private insurance via premiums or deductibles.
Medicaid is a public health insurance run by each individual state which is only afforded to
individuals below the poverty line or who meet special circumstances. Each state has its own
system, budget and networks who take Medicaid. (Not all doctors or providers take Medicaid as
a form of payment).
b. Question #3: What is the role of politics in Medicare and Medicaid?
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Medicare and Medicaid are the United States version of socialized Medicine. Unlike the
most of the industrialized world, the US does not have universal coverage. In the United States,
Medicare and Medicaid have had an interesting journey in the US political process. 
The US created Medicare and Medicaid under the Social Security Amendments of 1965,
Medicare was created to help seniors who lived on a fixed income and Medicare to help those
most vulnerable and unable to pay for their own medical expenses individually or through
private insurance. Expansion of either program individually or the reorganization of both
programs under a single payer system has proved difficult. 
In the case of Medicaid, The Social Democrats who wrote the legislation had to build in
compromises to get the bill passed. The primary of which was that of the program, or rather
programs, were to be primarily funded and managed at the state level. This means that there are
50 individual Medicaid programs in the US and until the ACA slightly expanded coverage, was
primarily regulated entirely on a state level. 
In the case of Medicare, There was the 80/20 compromise which has been untouched
since 1965, where only 80% of costs are covered by the federal program. The authors of the
legislation hoped to have this 20% gap addressed at some point by amending the legislation, but
the political will and means never came.
Any expansion or reorganization of either program is associated with socialism and it’s
stigma. This was the case in 1965, and still is. Like the creators of the ACA, the authors of the
Social Security Amendments of 1965 sought to use the legislation as a stepping stone to
something else, but that something else has proven too difficult to achieve. 
Lobbying groups representing stakeholders (Insurers, private hospitals, pharmaceutical
companies, Medical equipment manufacturers and resellers) put constant pressure on legislators
to protect their industries, leading to a stagnation in expansion. There is also the concept of path
entrenchment. Decisions and compromises of the past prevent certain outcomes in the future.
Examples of this include the push for 1940s employer-provided insurance which was used to
incentivize workers during a wage freeze amidst WWII. The fact that seniors, the main group
whom universal coverage would benefit, already receive socialized healthcare, and would not be
willing to put pressure on legislators to expand coverage to younger people as they have no stake
in the benefits. One thing is for certain, The cold war conversations of socialism vs capitalism
still frame our political discourse in the 20th century and the objectivism argument of individual
self-liberty versus social welfare continues in the American conversation.

Please read Chapter 5, [Population Health]. Please write at least one paragraph describing what
we mean when we use the term “population health.” Write the paragraph in such a way that you
could explain the concept—simply and easily—to someone working outside of the health care
industry. Imagine you are trying to explain the concept to your grandmother, or a college friend
who works in finance or real estate.
The term ‘population health’ refers to the health (health status and outcomes) of a group
of people in a specific population instead of an individual patient. This helps public health
clinicians look at the health of population defined by their location. Certain aspects of population
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health and its determinates are things such as poverty, education and housing. For example, one
way that population health can be improved is by renovating a public housing building that is
contaminated with black mold. This would decrease the rates of asthma in that specific
population. Population health is focused on improving the health of a population based on its
geographic location. This differs from public health that focuses on what we do as a society to
assure good health such as changes in government policies.

Continuing on with Chapter 5 [Population Health] what do you, as a health care provider, feel
are some of the advantages in using the population health model? In contrast, what might be
some of the disadvantages when using the population health model?
As a health care provider, I feel the population health model is important. The widespread
use of population health models could help us as clinicians understand causes of health
disparities within population subgroups. This is important to initiate health care policies and to
change current policies within certain populations. Population health models emphasize
preventative care with the goal of lowering costs and improving quality of healthcare. For
example, patient education in an integral part of population health. You cannot just prescribe a
medication to lower cholesterol without educating you patient about what factors contributed to
their high cholesterol levels and what lifestyle modifications they can do to prevent it.
Population health models facilitate agencies and organizations to work together in the common
goal of optimizing health.
One of the disadvantages of the population health model is that it may be too broad in it’s
scope. While the medical model primarily focuses on the eradication of illness through diagnosis
and effective treatment in an individual, the population health model emphasis changes within in
a community or society as a whole and a change in health behaviors to benefit the health of a
population. I believe that the medical model and the population model both have advantages and
I think incorporating some of the individualism of the medical model into the population health
model would fully encompass what is needed to make a population healthier overall.

6. Please read one of my favorite Chapters, Chapter 7 [Health and Behavior], please answer the
following discussion questions found at the end of the chapter:
Question #1: Briefly describe the effects of personal health behavior (e.g., tobacco use, risky
drinking, diet, and physical activity) on individual and population health status and health care
costs in the United States.
According to the CDC “Smoking-related illness in the United States costs more than
$300 billion each year, about $170 billion for direct medical care for adults and $156 billion in
lost productivity, including $5.6 billion in lost productivity due to secondhand smoke exposure.”
In a 2016 study published in PLOS medicine, the authors quantify the extent to which lower
rates of smoking in the US might translate into lower health care costs. This study found that a
10% reduction in smoking equated to about $6.3 billion reduction in health care expenditure
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(Lightwood & Glantz, 2016). The study also noted that the states with smoking and tobacco
policies had a lower smoking rate overall. Multiple studies have shown that once smoking rates
are reduced, rates of cardiovascular disease (heart attacks, strokes, respiratory disease) are
reduced as well. Despite the positive health correlations being obvious, the studies reveal a
profound savings and increased productivity that is possible when personal health behavior
policies are implemented. Similar studies have also shown that populations with increased
alcohol use, unhealthy diets or lack of physical activity are associated with increased health
expenditure costs.  Improvements in unhealthy behaviors translate into reduced health care costs
and the economic impacts of better health behaviors are profound. Reductions in health care
costs can include costs associated with medical care (e.g., hospitalizations, medications),
transportation to medical visits, lost wages and many more. For these reasons, it is important to
implement health policies such as tobacco-free advertising, as well other public health
campaigns.

Question #2: How have health behavior change programs and interventions evolved over
the past 40 years?
Public health education campaigns started in the mid 1960’s and were based on educating
the public on the harms of certain unhealthy behaviors. The success of such campaigns made
physicians at the time begin to realize that health education and prevention were important
discussions to have with their patients. In the 2000’s more research was done on this subject and
this helped broaden health interventions to implement new ways to not only to advise patients of
health risks but to teach them how they can implement change and behavioral modifications to
their everyday lives. These treatments began as individual or group therapies where patients were
able to set realistic goals for themselves. These treatments were changed from an individualized
level to widespread demographics such as free telephone quit lines for smokers. The invention of
the stages of change model by Prochaska and DiClemente in the late 1970s determined that
people quit smoking if they were ready to do so. This model has now become one of the most
commonly used clinical frameworks and is applied to not only smoking but alcohol / substance
abuse, weight management, exercise habits, sunscreen use, and even preventative measures such
as mammograms and colonoscopies. In more recent years, health campaigns are looking towards
social marketing strategies, taking a marketing approach for health promotion. These campaigns
have been successful and are now even tailored to medically underserved populations.

Question #3: In order to achieve effective behavioral interventions, most physicians use
clinical practice guidelines that are based on the 5 A’s model. Briefly describe this model, using
tobacco cessation counseling as an example.

The 5 A’s model is a brief intervention approach implemented by multiple health

organizations for behavior modification. The five steps are ask, advise, assess, assist and arrange.
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An example of the 5 A’s model for smoking cessation is to ask the patient about their tobacco
use, how much they are smoking, etc., advise them to quit, assess their willingness to quit, assist
them in quitting, and arrange follow up. If the patient is not willing to quit at this time you can
offer resources for them for when they are ready to quit in the future. You can assist them in
quitting by offer counselling or medications such as Chantix or Wellbutrin that help with
smoking cessation. You can then arrange follow up usually within the first week of their quit
date as early follow up has been shown to increase prolonged smoking cessation in patients.
Question #5: With reference to McKinlay’s population-based intervention model, outline
possible coordinated downstream, midstream, and upstream strategies that can be used to achieve
one of the following: (a) curb binge drinking on a college campus, (b) increase smoking
cessation, especially among pregnant smokers enrolled in a Medicaid managed care plan, or (c)
increase physical activity and healthy eating among middle school students in an urban center.
Be sure to mention the different sectors that would need to be involved (e.g., public health, law
enforcement, local business, school officials, policymakers, community planning, transportation,
health plan leaders/providers, and so on).

Downstream- Medicaid covered individual counselling services tailored towards smoking

cessation in pregnant women. Smoking cessation medications being covered fully by
Medicaid for pregnant women, if medication is found to be safe and effective. Resources for
self help groups and group therapies. Information provided about the risks of tobacco use in
pregnancy.
Midstream- state based initiatives such as Medicaid covered quit lines, primary care
screening and intervention for smoking cessation through an OBGYN Medicaid health
provider.
Upstream- increasing tobacco prices nationwide, implementing tobacco control policies.
Health intervention campaigns on how smoking affects a fetus.

7. Please read Chapter 8, [Vulnerable Populations: Meeting the Health Needs of Populations
Facing Health Inequities]. Please answer Question 2: A wide array of medical and social services
exists to help meet the complex needs of vulnerable populations; however, the United States has
been unable to curb health care costs or improve health outcomes for this segment of the
population. What are some of the underlying problems with the current approach to services for
vulnerable populations?
One of the major factors contributing to these issues is budget cuts for programs that
serve vulnerable populations. Fighting misconceptions and biases of policy and decision makers
who can greenlight budgets for programs that serve vulnerable populations is another challenge
in itself. President Ronald Reagan once coined the phrase “welfare queen” by providing an
anecdotal example of an individual exploiting welfare programs.
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Since the 1970’s the perception remains amongst some legislators that those who use
assistive programs do so in an exploitative manner and that those who legitimately use these
programs could receive the same assistance from private charities. Although this is mostly a
partisan issue in the US, there are several historical examples of large bipartisan support to cut
funds for welfare programs out of the US federal budget. The availability of resources is the
main driving force in decisions about services for the most vulnerable and, unfortunately,
funding for these types of programs are always on the chopping block.
Another issue with the current approach to services for vulnerable populations is that they
do not search to solve the socioeconomic issues that put these populations at risk in the first
place. These programs do not solve the problems with economic immobility and underlying
issues within vulnerable communities. Better investment in public education, federal jobs
programs, investment in infrastructure and promotion of healthier behaviors would be a start to
solve the underlying issues. Another problem is the metric driven incentives for the delivery of
health care to vulnerable populations. Strategies such as these tend to miss the underlying
behavioral and social problems that a more qualitative approach would be able to address.

8. Please read Chapter 10, [Health Care Financing] Please answer Discussion Question 1 and 2:
Question 1: What complications does our current financing system cause for providers of
care?
Our current financing system causes many complications for providers especially for
reimbursement. Payment rates for Medicare and Medicaid are set by law unlike private insurance
that negotiates prices with hospitals. The rates for reimbursement through Medicaid and
Medicare are set below the actual costs of providing that care which results in underpayment for
physicians and other healthcare providers. To offset the issues that lead to underpayment for
providers, private insurers and self-pay patients make up what is lost to hospitals from the low
rates set by public coverage. There is also reimbursement problems for providers who accept
Medicaid as there are state laws that state if a bill is not covered by Medicaid, it is now illegal for
the healthcare provider to bill the Medicaid recipient for payment. Medicaid can turn down
payment requests for multiple different reasons as well, whether it be the wrong ICD-10 codes or
CPT codes or maybe it was not billed in time.
Question 2: What complications does our insurance system cause for individual
consumers?
The most obvious complication out insurance system causes for individual’s is the high
cost of it. According to the NCSL in two years ago the average annual premium for employer-
based family coverage cost $19,616 and those premiums are rising (Cauchi, 2020). Even with
insurance you must pay out of pocket expenses in the form of deductibles and co-pays which
many people cannot afford. The denied claim and referral process can significantly delay needed
treatment for people and many claims are outright denied. There are in-network restrictions
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which limit choice of provider and the opportunity to seek better providers or specialists.
Employed based insurance which provides the bulk of private insurance in the US intrenches
individuals to their jobs and prevents them from either seeking alternative employment or even
starting their own businesses.

Professor’s Question: Have you or a family member ever had a problem with their health
insurance or a medical bill? Have you interfaced (or witnessed) any questions about payment of
medical bills and coverage during any of your rotations?
I think everyone in the US has experienced the slough of paperwork that comes after a
single visit to a healthcare provider. For several months after the visit you receive several
versions of a bill as the provider and the insurer barter for the final agreed invoice. For instance,
my cousin had a cholecystectomy and he received 6 difference versions of a bill where he owed
different amounts on each version, some and some less. Most patients I have encountered on my
rotations are in some way worried about coverage with their insurance. Be it a lab draw for
bloodwork not being covered and them being billed thousands of dollars thereafter or patients
having to switch from a better medicine to one that is covered although it doesn’t work as well.
There are numerous examples I can recall where a patient has put off something that was
medically necessary because they cannot afford to pay the out of pocket expenses.

9. Chapter 12, [High Quality Health Care] Please answer Discussion Questions 2 and 3 as
follows:
Question 2: What is the range of factors beyond the patient–physician (or other clinician) dyad
that can affect quality of care for the patient?
There are many factors beyond the care provided immediately by a physician that can
contribute to a higher quality of care. For instance, quality and accuracy of information acquired
by other members of clinical staff as well as barriers of language can lead to improper
information and improper assessments being made. Things like patient centered medical homes
can improve quality for patients who need primary care planning. Quality care can be delivered
through nutritionists, social workers, emergency housing providers and many more organizations
that are not medical providers but still contribute greatly to the health of a patient.

Question 3: What are the most promising new developments likely to improve health care
quality?
I believe one of the most promising new developments likely to improve health care
quality is the fact we are moving away from fee-for-service payment structures. We are now
moving towards a health care system that rewards value and prevention. The ACA helped with
the needed changes in how health care in how it is paid for and delivered. One of these key
delivery system reforms is the encouragement of Accountable Care Organizations (ACOs) which
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take responsibility for the quality and costs of care for a population of patients. Another
initiative, value- based purchasing (VBP). When this is followed within healthcare organizations,
providers will still be paid on a paid fee-for-service basis, but payments are adjusted up or down
depending on quality care and value metrics. There are many new ways we can look towards a
value-based health care system and the initiatives set forth by the ACA have helped and multiple
studies showed that many of these programs are proving to efficacious.

UNIT 2
UNIT 2: Review TED TALKS/Suggested Articles and craft a short personal essay that
reflects your viewpoint on the health care topics discussed. Please answer all 4 (four) essays.
You will be graded based on your having viewed or read the suggested material and your
hopefully interesting observations. Is your own experience the same as what is being discussed at
the national level or different? NOTE: NO PENALTY FOR GOING OVER THE WORD
LIMIT. ADDITIONALLY, 250 WORDS IS AN ACCEPTABLE LENGTH. I AM LOOKING
FOR YOUR VIEWPOINT. ☺

ESSAY #1: (250-350 words) Please write a personal essay on any topic of your choosing.
It could be an experience in PA school, a commentary on something you read during this course,
an especially poignant moment that you experienced with a patient, a cherished hope or dream
you want to accomplish in the next 10 years as it relates to healthcare. Please make your essay
authentic, original and in your “voice.” You do not need to worry about citations, or any other
scholarly formalities. I am interested in your observations.

Many of us in healthcare say that we chose this career “to help people”, but that is not
always the truth. It was not until recently that I realized what it really means to help people, not
just saying it because it sounds good or because that is what the admission board members want
to hear.
I was first introduced to the specialty of Addiction Medicine in my early 20’s as a
medical assistant. Working in an internal medicine office, there were many times a patient would
come in admitting they struggle with addiction and the provider could not do much but to refer
them out to an addiction specialist. I would wonder how a medical professional could help a
patient like this and imagined how rewarding a career like that must be. Several years later
during a volunteer opportunity at a homeless shelter, I met a veteran who struggled with
substance abuse and alcohol dependence for over 30 years. We spoke about how much his
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addiction took away from his life and how hopeless he was. He felt he would never be able to
regain a sense of normalcy without drugs or alcohol in his life. From that moment on I have felt
an overwhelming sense of urgency to do something meaningful to help this population.
Now during clinical year in PA school, I finally had the chance to work with the patients
I feel so connected to. For my 8th rotation I was placed the detox unit and drug and alcohol rehab
in St. Charles Hospital. I was responsible for evaluating and admitting patients who were in dire
need of help. We would see over 50 patients a day and many of them were new admissions. With
the heroin epidemic on the rise, and the relapse rate increasing due to the COVID pandemic,
there was never a dull moment in the detox unit. Patients who were admitted were kept for a 5-
day taper to medically stabilize them before going to a 30-day rehab or outpatient drug program.
During their time with us the counsellors and social workers did an amazing job to help them get
the resources they needed such as emergency housing, Medicaid, referring them to AA and NA
meetings, sober houses, and even schedule appointments with general practitioners and
psychiatrists. I came home after a 50-hour work week joyous, knowing that every minute I was
there I was really helping someone. The countless patient interactions where I was thanked
simply for doing my job was something extremely refreshing and knowing that their gratitude
was genuine meant even more.
I absolutely loved the work I did at the detox unit and drug rehab. As with any job, there
are stressful moments and times where you feel exhausted, but I never felt that doing this type of
work could possibly lead to burnout. I feel that I have now accomplished my personal goal of
clinical year, knowing that there is a medical specialty that I connect with and would be honored
to work in. I am so grateful for the patients who taught me so many life lessons during my time
there. I am looking forward towards graduation and becoming a certified PA as that means I will
be one step closer to a rewarding career in Addiction Medicine.

ESSAY #2 (250-350 words) Please read the TED MED article “How Perfectionism
became a hidden epidemic among young people” by Thomas Curran and Andrew P. Hill found
at this link: https://blog.tedmed.com/how-perfectionism-became-ahidden-epidemic-among-
young-people/ Please also view the TED MED talk by Thomas Curran, PhD, entitled “Our
Dangerous Obsession with Perfectionism is Getting Worse” found at
https://www.tedmed.com/talks/show?id=731050. In the article authors Curran and Hill write: In
this new market-based society, young people are evaluated in a host of new ways. Social media,
school and university testing and job performance assessments mean young people can be sifted,
sorted and ranked by peers, teachers and employers. If young people rank poorly, the logic of our
market-based society dictates that they are less deserving – that their inferiority reflects some
personal weakness or flaw. Of course, people being “sifted and sorted and ranked” is not
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confined to young people. Mid-career physicians battle negative patient satisfaction scores which
sometimes negatively impact their success (financial and otherwise) within the increasingly
corporate medical system. So the increasing metrics impacts everyone in society although the
impact on young people should be a societal focus. Please write a personal essay commenting on
your perspective of the article and the TED MED talk—either from your own life, someone close
to you, or perhaps a patient you encountered on rotation.

The obsession with perfectionism is a problem which affects young people across
society. As the article stated, the author’s theory suggests this trend is a by-product of a
generation growing up in the wake of neoliberalism. I think that there are two main camps when
it comes to perfectionism. One which is driven by data centric analytics where job performance
is measured on a spreadsheet and professionals are held to mere number-based evaluations of
performance. The other is based on the influence of social media, and the continual evaluation of
one’s self, based on the suggested ideal station of life and happiness they see in other people’s
posts.
My perspective based off experiences in health care are mostly aligned with the author’s
point of view. It is clear that we have seen a financialization of health care and a consolidation
of hospitals and private health clinics. Most of these large corporations are publicly traded and
are beholden to their shareholders. Thus, quarterly earnings and performance metrics are
important. This, combined with the underrepresentation of labor in the, marketplace puts a
tremendous amount of pressure on HC professionals to meet certain metrics and quotas. These
young professionals spend a tremendous amount of time in school and competing with their
peers to earn a job in the marketplace. that they are obsessive in meeting and maintaining their
ideal job performance even to the detriment of their own mental health and wellbeing.
Based on the experiences on rotations I have seen a common theme among healthcare
workers. Many of us have pushed ourselves through because “it will all be worth it in the end”.
Many people in my class were used to being the top 1% in undergraduate studies and now they
are with 20 other straight A students in PA school. This made it harder for certain students
because they feel like they must work much harder than ever before just to keep up.
Perfectionism is a huge problem in PA school and in many other areas of medicine. This
increased stress and burnout leads to depression and metal health issues that unfortunately never
get dealt with because we simply do not have the time while we are in such an intense program. I
believe these issues need to be discussed more often and mental health to become a priority. In
conclusion, based on the article my observations and own life experiences, Thomas curran is
100% correct in his observation of perfectionism being a hidden epidemic.

ESSAY #3: (250-350 words) Please view the TED TALK by journalist Jeanne Pinder,
“What if all US health care costs were transparent?” found at
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https://www.ted.com/talks/jeanne_pinder_what_if_all_us_health_care_costs_were_transparent?
language=en noting that in the US the very same blood test can cost $19 at one clinic and $522 at
another clinic just blocks away—and nobody knows the difference until they get a bill weeks
later. Journalist Jeanne Pinder says it doesn’t have to be this way. She’s built a platform that
crowdsources the true costs of medical procedures and makes the data public, revealing the
secrets of health care pricing. Learn how knowing what stuff costs in advance could make us
healthier, save us money—and help fix a broken system. Then, write a brief essay
(approximately 250-350) describing your thoughts on the issue of price transparency in
healthcare? Have you seen, during your practice or with your clinical rotations, examples of
patients overly concerned about price, simply because they honestly had no idea how what they
were facing medically would impact them financially?

In October of last year, The Centers for Medicare and Medicaid Services (CMS) issued a
final rule which will require hospitals to release pricing information before providing services.
Now almost a year later hospitals are preparing to comply with this mandate that takes effect On
January 1st, 2021. This bill called the Health Care PRICE Transparency Act will require US
hospitals to create and maintain a public list of their charges, including private payer-negotiated
rates, for services. Hospital groups are seeking to shut down this bill stating it will become a
major burden to comply with, especially while facilities are fighting the COVID-19
pandemic. The hope with this new bill is for patients to be able to make informed decisions,
reduce the riding costs of health care and even improve the quality of care. The problem with this
is that what is charged in healthcare is not what is actually paid. Transparency in healthcare will
not matter for the costliest of services, for example, emergencies in which the most important
thing is getting to the closest hospital, so someone doesn’t die. I doubt that in a real emergency
that patients are going to go online to compare prices of the treatment they will need to stay
alive. You cannot compare healthcare’s economy to any other sector of the economy in the US.
What is paid for the same service will differ tremendously from one payer to the next. This is
because coverage for a specific service will vary depending on what insurance you have whether
it is Medicare, Medicaid, Veterans insurance, commercial insurance of self-pay. Hospitals that
charge a higher cost for services are larger, have large market shares, provide specialized
services, have more technology, and receive revenues from hospital funds. Although hospitals
like these charge substantially more money for the same services as their lower priced hospital
counterparts and research studies have shown their costs are not justified and do not indicate
higher quality of care. Although the Health Care PRICE Transparency Act will is a great first
step, some are saying it will lead to an increase in hospital prices. Furthermore, it will not
address the underlying issues with the rising cost of healthcare namely, overtreatment, cost of
prescription drugs, administrative costs and the lack of preventative care.
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ESSAY #4: (250-350 words) Please read the highlights found in the report by the US
Congress/Ways and Means Committee Staff entitled, “A Painful Pill to Swallow: US versus
International Prescription Drug Prices” found at
https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/U.S.
%20vs.%20Intern ational%20Prescription%20Drug%20Prices_0.pdf What are some of the
reasons U.S. drug prices are so high? Is there a difference between drug prices experienced by
holders of private U.S. insurance (usually provided through their employers) and drug prices
paid experienced by U.S. Citizens who are part of the Medicare program (through Part D the
Prescription Drug Benefit.) How might these high prices impact you as a provider? As a holder
of private insurance? As someone who is the son or daughter (or grandson or granddaughter) of a
family member who uses Medicare as their primary health insurance plan? NOTE: NO
PENALTY FOR GOING OVER THE WORD LIMIT. ADDITIONALLY, 250 WORDS IS AN
ACCEPTABLE LENGTH. I AM LOOKING FOR YOUR VIEWPOINT. ☺ -END OF
HEALTH CARE DELIVERY SYSTEMS ASSIGNMENTS-

Americans spend more on prescription drugs than anyone else is the entire world. In the
UK for example, the NHS pays for a certain drug, buying it directly from the pharmaceutical
company in bulk at a discount. This eventually means patients have the ability to buy that drug
for a cheaper price. In the US, on the other hand, drug companies sell directly to consumer the
same exact way all other consumer goods are sold in the US. Drug companies can sell their
product at whatever price they set, there is no negotiating the price with government
representatives. Unfortunately, big pharma is looking towards American consumers to subsidize
their financial losses in other countries this means that drugs will continue to become more
expensive for Americans. Drugs are more expensive in America because they are so much
cheaper in every other country. The high cost of prescription drugs in the US impacts not only
the patients who have to decide between eating for the month or buying medication but impacts
health care providers as well.
To make this even worse, individuals with employer-based health care plans or private
insurance actually pay less for prescription drugs than Medicare part D recipients. According to
Kaiser Family Foundation (KFF) for the year 2016, Medicare part D recipients paid on average
$476 more for the same drug than those with a large employer insurance plan. Also, the cost of
prescription drugs for Medicaid part D recipients can vary largely depending on what drug it is,
whether it is on the list of covered drugs, what the “tier” the drug is in, which benefit phase you
are in and which pharmacy you use. This all makes it incredibly challenging and confusing for
the elderly people who need drug coverage the most.
As a future healthcare provider, I understand that the cost of medication is one of the
main reasons for patient non-compliance. This is something I must always take into
consideration. Prescribing drugs that are generic, comparing prices for a patient before
prescribing a more expensive option, pricing out difference pharmacies, using coupons like those
provided on GoodRx, and giving out samples are some of the many ways that I could help save
my patients money. As a holder of private insurance myself, I am subject to the same price as
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the rest of the marketplace and as seen with the EpiPen, American consumers are not protected
from outrageous price hikes when there is no cap to what pharmaceutical companies can change
to individual American consumers. In the case of patients who are on Medicare such as my
diabetic grandmother, they’re also subject to paying incredibly high prices. In my grandmother’s
case, she has to make the choice between insulin or atorvastatin. Elderly individuals on fixed
incomes are particularly vulnerable to fluctuations in market prices for drugs. Unfortunately,
Americans are subject to higher drug prices on average than the rest of the world, and within the
American system certain consumers pay more than others for the same drugs.
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References

Dick Cauchi, A. (2020). Health Insurance: Premiums and Increases.

https://www.ncsl.org/research/health/health-insurance-premiums.aspx

Kaiser Family Foundation (2020, October 14). An Overview of the Medicare Part D

Prescription Drug Benefit. https://www.kff.org/medicare/fact-sheet/an-overview-of-the-

medicare-part-d-prescription-drug-benefit/

Lightwood, J., & Glantz, S. A. (2016). Smoking Behavior and Healthcare Expenditure in the

United States, 1992-2009: Panel Data Estimates. PLoS medicine, 13(5), e1002020.

https://doi.org/10.1371/journal.pmed.1002020