Kelly Vana's Nursing Leadership and Management

According to Boddenheimer (2005a), the cost of administration of U.S. health care in 1999 was 24% of the nation's health care expenditures. In an attempt to reduce these costs, providers such as practitioners' offices, clinics, hospitals, and so on, have invested in Information Technology (IT). IT has played a role in improving quality through availability of the electronic medical record, aiding with HIPAA compliance, and streamlining insurance coding and billing services. Because of the increased demand for such systems, the administrative cost of implementation has also gone up.

It may seem to Americans that U.S.‐style free enterprise (i.e., private‐sector, for‐profit health insurance) is naturally the most cost‐effective way to pay for health care. But, in fact, many other countries' payment systems are more efficient than ours. U.S. health insurance companies have the highest administrative costs in the world. The CMS (2019) estimates project that $496 billion will be spent on administrative costs in the U.S. alone. Himmelstein (2014) reports that administrative costs account for about one‐fourth of the US hospital spending and this is more than spent in Canada (12%), England (16%), and the Netherlands (20%). Interestingly, Himmelstein found that there is no apparent link between higher administrative costs and better quality care (2014).

U.S. hospital administrative costs rose from 23.5% of total hospital costs ($97.8 billion) in 2000 to 25.3% ($215.4 billion) in 2011. During that period, the hospital administration share of national GDP rose from 0.98% to 1.43%. Canada spends 0.41% of their GDP on health care administrative costs. The rising spending on administrative costs need to be addressed at every level and corporate greed addressed.

Several years ago, I went to the hospital with excruciating pain. They admitted me to the hospital, and I had tests and X‐rays for 9 days before they found the cause. I had cancer in my left kidney, and I needed immediate surgery. I had the surgery and was discharged on my 18th hospital day. Thank heaven, I was now cancer free.

The hospital bill for this stay was $18,689.20. The radiologist and surgeon submitted additional bills. I was glad that I had Medicare and Blue Cross insurance, which paid it all. The only charge I had to pay was $25.00 per day for a private room. When I looked at the hospital bill, there were many charges for medications and treatments I never received. There were even charges for the day after I was discharged. I wonder how the hospital makes out the bill. I also wonder how people with no insurance pay these kinds of hospital bills.

Leona McGuan

Patient

Schererville, Indiana

Americans could narrow the life‐expectancy gap between the United States and other countries by adopting a healthier lifestyle. It is estimated that sticking to five low‐risk lifestyle‐related factors could prolong life expectancy at age 50 years by 14.0 and 12.2 years for female and male US adults, respectively, compared with individuals who adopted zero low‐risk lifestyle factor (Li et al., 2018). The five lifestyle related factors include diet, smoking, physical activity, alcohol consumption, and body mass index(BMI). Unhealthy lifestyles counterbalance the gain in life expectancy, particularly the increasing obesity epidemic and decreasing physical activity levels. Three‐quarters of premature CVD deaths and half of premature cancer deaths in the U.S. could be attributed to lack of adherence to a low‐risk lifestyle (Li et al., 2018). Prevention should be a top priority for national health policy, and preventive care should be an integral part of the US health care system. A healthy diet pattern, moderate alcohol consumption, nonsmoking, a normal weight, and regular physical activity are each associated with a low risk of premature mortality. Smoking is a strong independent risk factor of cancer, diabetes mellitus, CVDs, and mortality (Li et al., 2018). Physical activity and weight control significantly reduce risks of diabetes mellitus, cardiac disease, and breast cancer. Changing lifestyles is the most cost‐effective way to prevent illness and increase quality of life, yet it seems to be the most difficult for Americans. Note other factors that can both increase and decrease utilization, as listed in Table 2.6.

Table 2.6 Forces that Affect Overall Health Care Utilization

Source: Adapted from Bernstein, A. B., Hing, E., Moss, A. J., Allen, K. F., Siller, A. B., Tiggle, R. B. (2003). Health care in America: Trends in utilization . Hyattsville, MD: National Center for Health Statistics; and Shortell, S. M., & Kaluzny, A. D. (2006). Health care management (5th ed.). Clifton Park, NY: Delmar Cengage Learning. And CDC. (2018). National Center for Health Statistics. Health, United States, 2017: With special feature on mortality .. National Center for Health Statistics. Health, United States, 2017: With special feature on mortality . Retrieved from www.cdc.gov/nchs/data/hus/hus17.pdf