Health Care Costs and Value

Health Care Costs and Value

There are two major reasons that can best explain why so many open-heart surgery programs were launched, regardless of the declining market. The first reason is that open-heart surgery is an expensive operation and was deemed to be a highly profitable service. Although the market was declining, as evidenced by the 653 to 300 fall in services provided, the hospitals found that the expensive open-heart surgeries could help compensate for other parts of the organization that were making losses or generating low minimum profits. Therefore, a number of major hospitals developed open-heart surgery programs to provide the services and benefit themselves instead of referring such high-income sources to other hospitals.

The other reason why so many open-heart surgery programs were launched despite the declining market was based on the relationship between a facility providing a higher number of complex surgeries and the perception of higher quality of care and better patient outcomes. According to Iacobone et al. (2019), performing surgeries in high-volume settings is associated with increased rates of curing, reduced morbidity risks, and improved surgery cost-effectiveness. Therefore, the health facilities launched open-heart surgery in addition to the complex surgeries they provided to achieve a competitive advantage and attract more customers to their facilities.

From a personal perspective, the new programs were not justified. All Pennsylvania hospitals were only launching the programs because of the high price tags of the open-heart surgeries. Ending the CON-based system and allowing a free market approach in the provision and pricing of healthcare services allowed the hospitals the capacity to provide open-heart surgery programs. This is an unfair advantage over other small-scale providers and community healthcare centres that provide limited services and may lack the capacity to launch such programs. This competitive advantage can harm other players within the healthcare market in Pennsylvania. It risks the small providers exiting the market and creating a form of monopoly where the dominant players collude to decide the prices of the services provided. Monopolies can destroy the healthcare systems by imposing higher prices, leading to unequal access to healthcare services for people from lower-income backgrounds (Hartmann, 2020).

If I was the governor of Pennsylvania, I would not rationalize the number of programs in an open and free market. One issue of government involvement in controlling free markets is the reduction of coemption, which can lead to increased care costs and low-quality products. I would also not return to the CON-based healthcare environment even though it is beneficial to all players in the market. I would only focus on pushing for laws that support the development of a properly functioning free market, including that push for the provision of value-based care to the people of Pennsylvania. All value-based care models within a free market can support the improvement of patient outcomes such as care quality and satisfaction, support access to quality health care, improve people’s health, and reduce care costs(Knickman et al., 2019).

The first topic I would address is the effects of open-heart surgery. Although not much addressed, an open heart can lead to negative, long-lasting mental and physical health outcomes. Research evidence shows that open-surgery patients experience an increased rate of emotional and behavioural problems, including anxiety and depressive symptoms, with long-term psychiatric problems, including early deterioration of cognitive functions after the operation (Younes et al., 2019). Open-heart surgery is also a risk for increased pain, especially on the collar bone, and other physical discomforts that can last long after the surgery.

 References

Hartmann, T. (2020). The Hidden History of Monopolies: How Big Business Destroyed the American Dream. Berrett-Koehler Publishers.

Iacobone, M., Scerrino, G., & Palazzo, F. F. (2019). Parathyroid surgery: an evidence-based volume—outcomes analysis: European Society of Endocrine Surgeons (ESES) positional statement. Langenbeck’s Archives of Surgery, 404(8), 919–927. https://doi.org/10.1007/S00423-019-01823-9/METRICS

Knickman, J. R., Elbel, B., & Jonas, S. (2019). Jonas & Kovner’s: Health Care Delivery in the United States: 12th Edition. Jonas and Kovner’s Health Care Delivery in the United States, 12th Edition, 1–436. https://doi.org/10.1891/9780826172730

Younes, O., Amer, R., Fawzy, H., & Shama, G. (2019). Psychiatric disturbances in patients undergoing open-heart surgery. Middle East Current Psychiatry, 26(1), 1–7. https://doi.org/10.1186/S43045-019-0004-9/TABLES/4

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Health Care Costs and Value ****PLEASE MAKE RESEARCH PERSONABLE*****

Review Chapter 11 Knickman and Elbel (2019).

Certificate of need (CON) legislation was designed to control costs by limiting the approval of new construction and new healthcare services based on demand for those services. By limiting supply, CON would allow efficient development of the health care infrastructure. The first CON legislation was enacted in New York state in 1964. Other states enacted various forms of CON legislation and, in 1974, the Nixon Administration supported federal legislation calling for all 50 states to enact CON laws. This mandate stood for 13 years until it was repealed in 1987. Today 36 states retain their CON laws.

Health Care Costs and Value

Without CON legislation, the healthcare environment becomes a free market with open competition and decision-making about expanding services that are not directly related to the demand for them. For example, Pennsylvania’s CON legislation sunset in 1996. With the market freed from CON supply and demand controls, the state saw significant changes in health care services. A case in point is open-heart surgery—a highly profitable service, which often supports many of a hospital’s money-losing services that are, nonetheless, part of its mission. With the lifting of CON controls, from 1996–1997 to 2007–2008, Pennsylvania experienced a 25% increase in the number of hospitals providing open-heart surgery, even though the number of procedures across the state declined 37% during that period. The result was that the average annual volume per hospital declined 49%, from 653 to 300. At the same time, it is well documented that facilities performing a higher volume of complex surgeries have better patient outcomes and that it can be dangerous to have such services in facilities that do too few of them.

Write a professional paper to reflect upon and draw conclusions upon the following:

Why would so many open-heart surgery programs be launched, in the face of a declining market?
Were the new programs justified?
What would you do to rationalize the number of programs in an open and free market? If you were the governor of Pennsylvania, would you consider returning to a CON-based health care environment?
As you consider the various learning needs of your hospital and community, what would be the first topic that you would address in a CEU event on CON legislation/open-heart surgery?

Provide evidence to support your opinions. In your paper reflect upon the topic. Analyze research findings and draw conclusions in your paper. Review the grading rubric for grading criterion. You will need an introduction and conclusion. It is highly recommended that you use Level 1 APA headings to organize your thoughts/paper.
If you are still having trouble with your writing and/or APA style, make an appointment with the Center for Writing Excellence and have your paper reviewed prior to submission.
Submit your paper as an attachment in the Module 3 Assignment Dropbox. Your paper will be evaluated for plagiarism by Turnitin.
Refer to the grading rubric by clicking the Settings icon located in the top right corner of the assignment page and select the Show Rubric

NU502 Assignments (1)
NU502 Assignments (1)
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeContent relevance and Evidence
45 pts
Evidence used to support the central point is rich, detailed and well chosen. Evidence sections employ appropriate illustrations and/or quotations. The connection between argument and evidence is clearly and compellingly articulated in all cases. (Where applicable) Important opposing evidence (i.e. evidence that might seem to contradict your argument) is considered and convincingly refuted. Uses evidence appropriately and effectively, providing sufficient evidence and explanation to convince.
25 pts
Begins to offer reasons to support its points, perhaps using varied kinds of evidence. Begins to interpret the evidence and explain connections between evidence and main ideas. Its examples bear some relevance.
12 pts
Often uses generalizations to support its points. May use examples, but they may be obvious or not relevant. Often depends on unsupported opinion or personal experience, or assumes that evidence speaks for itself and needs no application to the point being discussed. Often has lapses in logic.
4 pts
Depends on cliches or overgeneralizations for support, or offers little evidence of any kind. May be personal narrative rather than essay, or summary rather than analysis.
0 pts
Uses irrelevant details or lacks supporting evidence entirely. May be unduly brief.
45 pts
This criterion is linked to a Learning OutcomeCritical thought/reasoning
45 pts
Paper goes beyond the assignment to explore the implications of arguments or evidence in new contexts or in particularly thoughtful, insightful, and/or original ways. Paper shows a nuanced grasp of health policy and social issues principles and the ability to apply these principles to clinical practice.
25 pts
Paper fully meets the parameters of the assignment but does not exceed them. (and/or…) Paper demonstrates a good grasp of course/text health policy and social issues principles but some awkwardness applying them.
16 pts
Paper does not address some aspects of the assignment. (and/or…) Paper demonstrates a somewhat shaky grasp of assignment principles.
0 pts
No Marks
45 pts
This criterion is linked to a Learning OutcomeIdeas well organized
35 pts
Uses a logical structure appropriate to paper’s subject, purpose, audience, thesis, and disciplinary field. Sophisticated transitional sentences often develop one idea from the previous one or identify their logical relations. It guides the reader through the chain of reasoning or progression of ideas. Exemplary introduction and conclusion
25 pts
Shows a logical progression of ideas and uses fairly sophisticated transitional devices; e.g., may move from least to more important idea. Some logical links may be faulty, but each paragraph clearly relates to paper’s central idea. Introduction and conclusion present but not organized.
12 pts
May list ideas or arrange them randomly rather than using any evident logical structure. May use transitions, but they are likely to be sequential (first, second, third) rather than logic-based. While each paragraph may relate to central idea, logic is not always clear. Paragraphs have topic sentences but may be overly general, and arrangement of sentences within paragraphs may lack coherence. Missing an introduction or conclusion.
0 pts
No appreciable organization; lacks transitions and coherence. No Introduction or conclusion
35 pts
This criterion is linked to a Learning OutcomeMechanics:APA/Grammar/Spelling
20 pts
Paper is clean and appropriately formatted. There are no incomplete or run-on sentences. Quotes are all properly attributed and cited. There are virtually no spelling or grammatical errors.
16 pts
There are a few minor spelling or grammatical errors. Quotes are all properly attributed and cited.
8 pts
There are a number of spelling and grammatical errors. (and/or) In a few places, quotes are not attributed and cited.
0 pts
Paper is unacceptably written. (and/or…) Quotes are frequently not attributed or improperly cited.
20 pts
This criterion is linked to a Learning OutcomeClarity and Depth
25 pts
Throughout the paper, wording is precise and unambiguous. Sentence structure is consistently clear and lucid. Quotations are all framed effectively in the text (i.e. integrated properly in terms of both grammar and meaning) and explicated where necessary.Clearly and eloquently identifies a demonstrable and nuanced central argument. Provides the reader with a clear sense of the nature of evidence that will follow. Reveals the organizational structure of the paper. Guides the reader smoothly and logically into the body of the paperElegantly synthesizes and reframes key points from the paper. Suggests new perspectives or questions relevant to the central argument, and brings closure..
12 pts
Paper is for the most part precisely worded and unambiguous. Sentence structure is mostly clear. Quotations are framed effectively in the text. Synthesizes and brings closure but does not examine new perspectives or questions. Gives the reader a reasonably good sense of the nature of evidence that will follow.
9 pts
Wording is imprecise or ambiguous fairly often. (and/or…) Sentence structure is often confusing. (and/or…) Quotations are not framed effectively in the text.
0 pts
Throughout the paper, wording is imprecise or ambiguous. (and/or…) Sentence structure is consistently confusing.
25 pts