The report, Health Imperative -. Reducing costs and improving outcomes , explores the problem deeply and explains the major issues quite well. IOM breaks unnecessary health care spending categories:
Category One: unnecessary services - $ 210 billion
This includes the completion of a medical examination or procedure which need not be done. With hind sight being 20/20 and all, we can not say that some medical services are useless after they have already occurred. For example, if a patient has severe recurrent headaches, the likelihood of them being caused by a brain tumor is extremely low. Some will say that the control of an expensive MRI to exclude is not a cost-effective course of treatment. However, if a tumor is indeed found, MRI is considered "necessary" and in some cases save the lives
Category Two :. excessive administrative costs - $ 10 billion
And you thought your Accounting Office was sloppy! unproductive and redundant costs in the administration of health insurance are to blame here. Imperfect humans are administrative errors all the time. Although this part of the total waste can not be eliminated completely, huge changes can be made to reduce this number significantly.
We already see electronic health records make a lot of momentum in the health care industry. This should reduce human error. In addition, the health reform calls for a medical loss ratio (MLA) which requires health insurance companies to designate 80 to 85 percent of premiums to pay for actual medical treatments. In other words, only 15 to 20 percent of health insurance premiums can be used to pay administrative costs
Category Three: Services. Inefficiently delivered - $ 130 billion
This category exists because of the following:
- medical errors
- uncoordinated care
- inefficient operations
Category Four: Outrageous prices - $ 105 Billion
the rate of cost inflation healthcare is far from being in line with other rates inflation. IOM notes that if the following household items were inflated at the same rate as the cost of health care since 1945:
- A gallon of milk cost $ 48
- A cardboard eggs would cost $ 55
- A dozen oranges would cost $ 134
Category Five: fraud - $ 75 billion
Medicare and Medicaid fraud is endemic in America. There are a few weeks, the Department of Justice announced that the Medicare Fraud Strike Force had charged 91 people for about faux billing $ 430 million
Category Six :. Missed opportunities for prevention - $ 55 billion
Why are we waiting so often until a medical problem is full-blown seek treatment? Well, there are a variety of reasons, but for many it was the fact that they have no insurance. In 2014, the Affordable Care Act takes full effect and about 26 million Americans will have access to free preventive care. It will be interesting to see if / how it helps to reduce waste.
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