The Blueprint for a Healthier Florida 2013, produced by the Florida Blue Center for Health Policy, makes two key points about health care costs. The first is that they consistently outpace inflation and this is unsustainable. The second is that we can both bend this health care cost spiral and improve the quality of care.
Health care cost is the second of five pillars the Blueprint details in its high-level plan to deliver better quality care and value to patients and improve the health status of Florida residents. You can read the more about the blueprint and its goals in Florida Blue’s Plan for Transforming Health Care, in addition to the first pillar on transforming health care quality
The Blueprint lists the key contributors that make American health care spending per capita more than twice that of the most developed nations, including France, Sweden and the United Kingdom.
Although Florida personal health care expenditure trends for hospital and physician care from 1991 to 2009 mirror those of the U.S., the state’s average growth rates for prescription drug spending outpaced the national average by nearly two percent during this period. And Florida’s overall average Medicare reimbursements per enrollee are more than 15-percent higher than the national average for fiscal year 2011-2012.
Other factors driving up American health care costs include fraudulent billings, “defensive medicine” that prompts physicians to perform procedures that are not medically necessary due to fear of litigation, and unhealthy lifestyle behaviors. One study asserts that 87.5 percent of health care claims are due to an individual’s lifestyle.
Considering these forces, the Blueprint for a Healthier Florida proposes four solutions:
1. Provide education, tools and resources to consumers to drive quality improvement and healthier behaviors. Tools and education along with the guidance of providers motivated to provide quality care are essential in helping consumers make informed health care decisions. There should also be incentives and penalties to stress personal responsibility in leading a healthy lifestyle.
2. Maximize efforts to drive fraud, waste and abuse out of the system through aggressive law enforcement, tort reform and engaged consumers. The FBI estimates that fraud is responsible for three to 10 percent of health spending. National estimates for expenditures on defensive medicine range from $56 billion to $210 billion.
3. Incentivize investment in wellness programs through grants and tax credits. Research clearly shows that worksite wellness programs improve employee health, lower medical costs, and increase worker productivity. Public policy should motivate employers, especially small employers, to implement these types of programs.
4. Maintain competiveness in the delivery system. It is important to maintain an environment that invites healthy competition within a market so that consumers have choice, receive quality at a fair price, and are privy to value-added innovation. This is especially important as the health care system experiments with alternate care and reimbursement models.
We’ll be covering each of the remaining four pillars in future articles.
This information is for illustrative purposes only and is being provided to help increase understanding of the impacts of some of the provisions of the Affordable Care Act (ACA). It does not attempt to cover all of the law’s provisions and is not intended as tax or legal advice.