Module 8 - the gap

Chronic disease

Long-lasting conditions, such as diabetes or heart disease, that often require continuous treatment and medication

Rise in chronic disease

 More chronic illness means more long-term healthcare use and higher spending

Uninsured and underinsured people

People may delay care until illness becomes severe, which can lead to more costly emergency or hospital care

Emergency-department misuse

Using the emergency department for non-emergency care raises costs because emergency care is expensive.

Fee-for-service

A payment system where providers are paid for each test, visit, or procedure they perform

Fee-for-service incentive:

It can reward doing more services instead of rewarding prevention, efficiency, or better outcomes

Inappropriate care

Care that is unnecessary, ineffective, or not appropriate for the patient’s needs.

Defensive medicine

Ordering extra tests or procedures mainly because of fear of malpractice lawsuits

High-cost technology

Expensive medical machines, procedures, and specialized treatments increase healthcare spending

Prescription-drug costs

The United States spends heavily on medications, and prices are often higher than in other countries

Research and development

Developing new drugs and technologies is expensive and can contribute to higher prices.

Price variation

The same healthcare service can cost very different amounts depending on the hospital, provider, insurer, or location

Lack of price transparency

Patients often do not know the cost of care before receiving it.

Administrative costs

Costs from billing, insurance paperwork, marketing, claims processing, and complex payment rules.

Middlemen

Organizations between patients, providers, drug companies, and insurers that can add cost and complexity

Provider wages:

U.S. healthcare professionals are generally paid more than those in many other countries.

Limited competition:

Fewer competing hospitals, insurers, or drug companies can allow prices to stay high.

Profit:

 For-profit healthcare organizations may prioritize financial returns, which can increase prices.