The cost of healthcare is continually rising. In fact, U.S. healthcare spending is estimated to hit $6.2 trillion by 2028. Consumers are frightened and quick to place blame. Much of this blame is landing on physicians and insurance companies. While all facets of healthcare play a role in its cost, physicians and insurance companies aren’t the main culprits.
If Not Doctors, Then What?
The truth is that there is not one single factor making healthcare more expensive. Culprits include (but are not limited to) technology, administrative expenses, pharmaceutical costs, and lifestyle choices.
New technology is vastly improving healthcare equipment, but of course, it’s not free. Modern medicine has seen countless new successful diagnoses and treatments, much of which can be attributed to advancements in technology. Technology is vital for the progression of society, and there are millions of healthy people today that would not be healthy without it, but is it possible for tech to go too far? According to an article in Missouri Medicine, there are “few requirements that effectiveness be demonstrated before technologies are used broadly and concern that their application tends to go beyond those patients likely to benefit the most from them.” In other words, healthcare facilities are quick to adopt new, expensive technology that may be unnecessary.
Administrative costs make up an estimated 21% of excess U.S. spending on healthcare. A large portion of these administrative expenses is made up of product design and marketing. Healthcare facilities that advertise more and charge more per procedure are not necessarily higher quality than facilities that don’t receive a lot of media attention. Often, part of the reason you are paying top dollar for highly advertised facilities is to cover their marketing costs, not because you are receiving superior care. Think brand name products vs. generic equivalents.
Rising pharmaceutical costs are one of the most significant contributors to the overall rise of healthcare expenses. Pharmaceutical companies primarily make their money through patents.* If a pharmaceutical company is the only one that offers a drug, they can charge consumers as much as they want—and they do. For instance, a 2018 study estimated that one vial of insulin costs between $3-$4 to produce, and yet one vial of insulin can cost up to $250. However, once a drug patent ends (patents usually end after a certain number of years) the drug becomes open source, meaning anyone who is FDA-certified can create the same drug. Once drugs become open source, other drug manufacturers realize just how much the original, patented company is overcharging. They sell the exact same drug for a much lower price, driving up competition in the market. These lower-priced drugs are generic drugs (as opposed to patented, name-branded drugs) and they are just as effective as their expensive counterparts. Purchasing generic medications whenever possible will significantly reduce your healthcare costs. Call MotivHealth’s pharmacy team (385-247-1030) to see if you can receive your medication at a lower cost.
An increasingly unhealthy America is contributing to increasingly expensive healthcare nationwide. Poor lifestyle choices such as smoking (including e-cigarettes), lack of exercise, and unhealthy diets lead to more doctor visits. The obesity epidemic even forces healthcare facilities to purchase equipment that can accommodate more weight. This is a burdensome expense that reflects in every patient’s bill—even those who are treated with less expensive equipment. The more that people on a particular insurance plan visit the doctor, the higher the premiums rise each year.High-deductible insurance plans can provide some relief from this issue as they allow consumers to pay for actual care received and less for “what-if costs.” MotivHealth also offers a Steps Program that pays members $1 toward their HSA for every day they walk 8,000 steps or more, up to 20 days per month. (Hot tip: This incentive can be doubled through spousal participation, and MotivHealth also offers a $10 holiday incentive in December, meaning that your family can earn $500 per year just from steps!) There’s nothing more motivating than money, and you’ll be amazed at the health benefits that result simply from walking.
Is There Anything We Can Do to Stop Rising Costs?
New Healthcare Laws Took Effect in 2022
While MotivHealth has always been ahead in the price transparency initiative, the rest of the nation is finally being pushed to be more transparent as well. On January 1st, 2022 the No Surprise was set into action. As its name suggests, the No Surprise Act targets surprise bills. Under the No Surprise Act, patients that receive emergency services from out-of-network providers will only be required to pay the deductibles and copayments that they would have paid for service from in-network providers. Also under the No Surprise Act, patients that receive non-emergency services from out-of-network providers at in-network facilities will, in most cases, only be responsible to cover their in-network cost-sharing amounts.
The Affordable Care Act (ACA) passed in 2010 required that hospitals publish a list of standard charges for all given services. More recently, under the Trump administration, the Centers for Medicare and Medicaid Services (CMS) began issuing rules about what needed to be done to meet the ACA pricing transparency rules. If all goes to plan, then by January 1st, 2023, insurers will be required to make rates for common services available to consumers. In the meantime, by July, 2022, insurers will be required to publish:
- Negotiated rates for all covered items and services
- Negotiated rates and historical net prices for all covered prescription drugs
- Historical payments and billed charges from out-of-network providers
- Medical cost estimates.
MotivHealth Is Here to Help
We know that it can be difficult to navigate healthcare. There are so many complexities that lead to price variation and excess spending, and no one wants to think about that—especially if they are sick or injured. That’s why MotivHealth strives to simplify and change healthcare. We want to be there for you when it matters most. It’s easy for healthcare providers to take advantage of people who are preoccupied with healing, and we want to set you up with low-cost, high-quality providers and lift the weight of down-the-road bills off your shoulders.
We want you to call us! (844-234-4472) We look forward to your calls. We view our members as people, not numbers—our goal is to solve healthcare, not to raise premiums.
*To be clear, pharmaceutical companies are not the enemy. They spend billions of dollars researching medications that patents help them recoup their costs on. Even so, generic drug are more affordable and should be used whenever possible.