What most people do not understand is that the US Health care system is a comple

Question

What most people do not understand is that the US Health care system is a complex thing. Health care has connections with the Centers for Medicare and Medicaid, Department of Health and Human Services, State Medicaid Agencies, Private Insurance organizations, along with the professional licensure entities. This can be very convoluted; and then throw in the Office of Inspector General, Department of Justice, State Bureaus of Investigation. All of these services must attempt to work together at times. Of course staffing can also be an ongoing issue, especially with the growing fraud activity.

What do you attribute to the growth of fraud

Explanation / Answer

Factors Attributing to the Growth of Fraud

Health Care Organisations and Stake Holders Engaging in Unethical Lobbying

In a democratic political system, interest groups like health care organisations can influence the making and the implementation of public policy by communication their problems with the current policy along with its magnitude and degree of impact with clarity. Once interest groups have communicated their issues with the current policy, its very important to offer and alternative policy that could b proposed to be implemented instead. By defining the problem with the existing policy and by providing validated options and opinions or alternative to the existing policy. interest groups are able to provide policy makers a rough frame work or an outline to work with. They can influence this through the means of mass media, debates, through an existing representative in the senate or the congress who supports a policy change or identifies with the issue.

Health Care Organisations can interact with the legislative process through their regulatory bodies that carry out or implement their regulations. Health care organisations interact with the legislative process through the Representatives of these bodies which carry feedback from health care organisations along with their own external audits and research and supply them to the congress for the legislative process.

For Eg : Joint Commission standards is an objective evaluation or an auditing process that allow health care organisations to benchmark themselves both qualitatively and quantitatively to improve their performance in providing safe and high quality health care services. Health care organisations are also regulated by the US Health & Human Services, FDA or the Food and Drug Administration , Joint Commission Standards and MHRA or the Medicines and Healthcare ProductsRegulatory Agency.

The issue of Over Charging : Rising Cost of Health Care is Driven By A Rise in Government Mandated Insurance

Economies run in a simple principle o Demand and Supply. Greater the demand and lower the supply higher the price and lower and demand and greater the supply lower the the price. This is economics 101. The health care industry is a socio economic system because of government intervention in health care. The government steps in and decides to offer health care coverage through Federal and or State Health Care programmes or make employers contribute to an employee's health care programme.

When this happens, we have a free or subsidised health care, this means that when patients are not paying for the majority of their health care costs, they tend to consume more health care services despite of the rising costs of health care. Now come into play the economics of demand or supply. If the demand remains constant when the supply is limited and the price is rising, this only happens in monopolistic products or services or situations where the consumer is not the payer. This is like the chicken and egg problem but its clear that health care costs only rose after government health care programmes not reduce

Monopolisation : Patents awarded to life saving drugs result in monopolies and restrict access to important drugs  

Should a drug manufacturer that holds a patent on a drug that is very effective for many AIDS or Zika patients be able to sell that drug well above its cost of production during the period of patent protection?

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