Ways to reduce health care costs.


What are some of the things that can be implemented to reduce healthcare costs in the USA? These idea's can be as simple as eating more healthy foods, getting more exercise, more vaccinations to having more or less health insurance coverages. What would you suggest?

Health Policy
Healthcare Management
Health Education
Healthcare Cost Reduction Strategies
Healthcare cost reduction research
Healthcare Cost Containment
David Barckhoff-Sag-Aftra/Producer, Director
35 months ago

21 answers


Very easy answer, but very hard to implement. BTW, these are the same four things I talked about in a paper I wrote 35 years ago, and nothing has changed.

  1. Get the patient engaged - healthier lifestyle, taking care of themselves proactively when they have a chronic condition, and listening to their health care professionals. I work with hospitals on analyzing patient behavior to understand how to best spend their limited outreach dollars. As a friend of mine once describer his diet - put the sandwich down and go for a walk.
  2. Help the patients understand the true cost of healthcare and provide incentives to choose wisely. A high deductible plan coupled with a MSA is a good start, as a previous responder said. Let the patients keep their MSA fund if they don't spend it all. But, is the average patient able to understand what requires medical attention and what does not, what setting they should seek out, the cost/outcomes profile of providers, etc.?
  3. Keep moving toward value-based care. Pay the providers for results.
  4. Design a healthcare model where providers don't have to practice defensive medicine. The combination of defensive medical protocols and the fee for service model really drive a lot of unnecessary care.

Now, how do we implement?

William Parkinson
35 months ago
Excellent suggestions! Point #4 is also pivotal, as unnecessary or inappropriate care may account for a third of all healthcare expenditures in the US. - Mark 35 months ago
Well said. Today it is HSAs, CM, direct pay, and private pay, etc. - Dr. David E. 25 months ago
Re: "helping patients understand the true cost of healthcare" -- I couldn't disagree more strongly. I have been writing about healthcare for nearly 30 years, have helped advocate for appropriate care across my extended family and have managed my own chronic illnesses and even *I* am not capable of discrminating between medical service providers, so pricing information is useless. - Anne 25 months ago
Kinda pompous - but healthcare is not free market. - Dr. David E. 25 months ago
I get paid for "your" compliance - nadda! - Dr. David E. 25 months ago
Expenditure required for health care. - Er. Jangyadutta 23 months ago
Yes - indeed - Dr. David E. 23 months ago
A vital expenditure - Dr. David E. 23 months ago

Finding innovative ways to engage non responsive, non engaged, noncompliant patients. We have to seek them out in non-traditional ways, use social services to remedy the reasons they’re non compliant (usually cost) and remain consistent in providing aid. Early intervention and ongoing management of this population are key. And let's help the docs. If capitation taught us anything, it's that upfront payment for a population of patients without actionable reporting and meaningful incentives will continue to lead to service to compliant patients only.

Jacqueline G
35 months ago
Capitaton 1.0 was a hated failure but several generations later led to VBC and ACOs - Dr. David E. 25 months ago
Now, are EoCs really that much different? - Dr. David E. 25 months ago
Value-based care is just capitation in a different dinner jacket. It proposes to adhere to more patient-friendly goals but still gives providers quite an incentive to avoid caring for sick patients. I for one can't wait to see it fail so we can get back to reality. - Anne 25 months ago
Agree-finally said-you are insightful - Dr. David E. 25 months ago
Population health is also fancy capitation. - Dr. David E. 25 months ago
Compliant patients - why serve any other type? - Dr. David E. 25 months ago
Social health care awareness can reduce medical expenses. - Er. Jangyadutta 23 months ago
NOPE = we all know drugs are bad = yet still opioid crisis! - Dr. David E. 23 months ago
Human behavior = reduce moral hazards - Dr. David E. 23 months ago

Cost containment and even cost reduction in healthcare can be achieved via transparent, cost accounting in hospitals and health systems coupled with published quality measures to ignite more elastic free market principles in healthcare. Let health consumers to make decisions on how to spend their healthcare savings dollars with the aid of ombudsmen and / or artificial intelligence. The government or catastrophic health insurance carriers could then set provider reimbursement rates according to supply and demand. Cost of provider liability insurance could also be curtailed based on free market principles as well via transparency of quality measures.

scott whitmore
35 months ago
"The government or catastrophic health insurance carriers could then set provider reimbursement rates according to supply and demand."? This is not free-market S-D. - Dr. David E. 25 months ago
Health care scheme adopted by different organisations and institutions. - Er. Jangyadutta 23 months ago
OK - Dr. David E. 23 months ago

Other forms of "healthcare in the future" that is being implemented today is the use of "TeleMedicine". The use of cell phone, Skype and video conferencing with one or more doctors to help diagnose and treat a patient. The use of robots in surgery and for delivering in hospital pharmacy medications to nurses stations. Another source of localised healthcare can be accomplished via the use of Community Care Paramedics, Nurses and Emergency Medicine doctors. These professionals can visit a patient after a hospital discharge to make sure the patient is healing properly or taking their medication on time. This would reduce the chance of the patient being readmitted to the hospital. Think of this as "more of a doctor's house call" that occured in the 1800's and early 1900's in the USA. This can also be used by doctors to reduce hospital admissions by treating more people "at home" for minor injuries or minor illnesses that in a hospital Emergency room.

David Barckhoff-Sag-Aftra/Producer, Director
35 months ago
NOPE: The “doctor's house call” concept is fifty years old. It is not good for either the patient or doctor. WHY? The doctor is still held to the same standard of care as if h/she were actually in the hospital, clinic. So, this model is only good for malpractice attorneys. - Dr. David E. 25 months ago
SORRY: Patients do not pay for, and far too many third parties do not pay, or pay next to nothing, for TM. Yet, the doc may have the very same liability.- - Dr. David E. 25 months ago
Valuable time of doctor will be waste in road travel rather he can serve for mor patients at clinic or micro hospital. - Er. Jangyadutta 23 months ago
Good points = travel has a cost - Dr. David E. 23 months ago

The USA's healthcare is based on a reactive approach to medical treatment instead of on a preventative approach. Most to all medical doctors diagnose and treat patients after an illness or injury occurs. They rather provide a "pill" to cover up or mask a patient's symptoms rather than trying to find a cause and to treat or cure the cause of the patients symptoms. This "reactive based medicine" approach needs to be changed in the early stages of a medical students training. More training and emphasis needs to be placed into education of "prevention and preventing" illnesses and injuries. This can be accomplished through more effective patient education, focusing on vaccinations, healthy eating, more exercise, more use of "CAM =common alternative medicine", such as Chiropractors, massage therapy, exercises like tai chi. yoga, acupuncture, physical therapy, maintaining a healthy weight, reduce or eliminate all tobacco products.

David Barckhoff-Sag-Aftra/Producer, Director
35 months ago
NOPE-Walk more, eat less, and avod moral hazards. KISS. - Dr. David E. 25 months ago
Right suggestions. Thanks. - Er. Jangyadutta 23 months ago
U R welcomed - David 15 months ago

Some great thoughts and ideas that need to applied in a way that can meet the patient where they are at in the course of a medical condition. Tools like "PAM" that has been used in Medicaid has been adapted to commercial self-funded use, but both suffer from inadequate utilization due to 3rd party interference of sustainable use or application.

Inappropriate care continues as does the very few driving the highest & increasing cost trend in medical care, including drugs and diagnostics. Marketing speak and messages have resulted in widening gaps in real results. We need less talk with more action focused around clinical efficiencies that provide high performance results in commercial plans for sponsors and patients.

More efficiency in care delivery as a system will go along way to improving economic and clinical outcomes. Relying on HDHPs or cost shifting to patients has not improved plan performance by many measures. A lack of understanding options and an inability to move status-quo market players to address needed innovation needs to be addressed by the plan sponsors. With the technological advances now available, doing nothing is no longer an option for providers or purchasers of care.

Randy Vogenberg, PhD
35 months ago
Thank you for your comments Randy. - David 35 months ago
Ditto! - Dr. David E. 25 months ago
Technology promotions reduces treatment time cost with better service. - Er. Jangyadutta 23 months ago
Not yet - perhaps in future - Dr. David E. 23 months ago

With my limited knowledge on the situation in USA, the pro and against debates on Obama Care reforms and the overall general situation in USA and elsewhere, I've phrased the following steps to reduce the cost:

  • Focus on volume rather than value
  • Cost elements of internal operational mechanisms (such as bringing efficiencies, automation, process re-engineering, change management; all of it making an effective ecosystem for the lower cost healthcare)
  • Covering high priced elements of R&D with one time return to the individual/entity and enable others to use this R&D to develop competition
  • Bring synergy into distribution network and supply chain
  • Identification of corruption and fraudulent ways as weak links severely impacting the concept of optimization
  • Enable more small and medium enterprises to participate in the value chain of healthcare sector
  • The burden on health/medical insurance needs to be adjusted to other non-conventional mechanisms such as community based cooperative schemes
Suleman Hasan
35 months ago
Cost Transparency Requirements: The requirement has been criticized by hospitals and consumer advocates because standard charges are typically not what patients will pay. Medicare, Medicaid and private insurers individually negotiate prices with hospitals, but chargemasters don't reflect those deals. - Dr. David E. 25 months ago
Health care management is advisable. - Er. Jangyadutta 23 months ago
YES - Dr. David E. 23 months ago

Eliminate inappropriate or unnecessary care.

Mark Hiatt
35 months ago
Can you provide some examples of this? - David 35 months ago
Right advice. - Er. Jangyadutta 23 months ago
Agreed - Dr. David E. 23 months ago

CT for chronic headache.
MR for acute low-back pain.
Antibiotics for the flu.

Mark Hiatt
35 months ago
From my experience working in an ER, an MRI provides the best resolution for diagnosing low back pain, shoulder tendon tear, arm & shoulder tendonitis. These were used for my injuries. CT scan is best used for head injuries or confirming or ruling out blunt force trauma, hematoma, brain aneurysm. Antivirals are for flu ex. Tamiflu, antibiotics for sinusitis, other bacterial infections. - David 35 months ago
Chronic headache could have any number of causes: meningitis, strained neck muscles, brain aneurysm, cervical injury or misalignment, high blood pressure, excessive coughing, brain tumor. - David 35 months ago
The 3 examples I gave were of inappropriate or unnecessary care, which overall may account for a third of healthcare expenditures in this country: MRI does provide superior soft-tissue resolution, but is overused in evaluating low-back pain in the acute setting; CT is not the best for evaluating chronic headache; and antibiotics are inappropriately prescribed for (viral) influenza. - Mark 35 months ago
It may be useful to refer to these and other examples highlighted in the Choosing Wisely Campaign. - Mark 35 months ago
“The one who works with his hands is a craftsman. The one who works with his mind is a scientist. The one who works with his heart is an artist. But the one who works with his hands, mind, and heart is a doctor.” - Dr. David E. 25 months ago
Good information about doctors. - Er. Jangyadutta 23 months ago
I am aware - thanks - Dr. David E. 23 months ago
  1. Education about healthy behaviors from an early age, especially nutrition and exercise
  2. Transparency from healthcare providers about costs and alternatives
  3. Transparency regarding quality metrics AND increased quality metrics regarding care
  4. Remove prophylactic antibiotics from our food chain (the use of which increases antibiotic resistance in the general population far more than the occasional use of antibiotics for viruses, which is ineffective)
  5. Seek ways to reduce indoor and outdoor environmental pollutants on a national scale
Carolyn C. Tinsley, MHA CLSS GB
35 months ago
Walk more, eat less, and avod moral hazards - adjust #3 - others are meaningless - Dr. David E. 25 months ago
Social awareness and entertainment awareness, education development required. - Er. Jangyadutta 23 months ago
NOPE = Walk more, eat less, and avod moral hazards - Dr. David E. 23 months ago

As we age it is harder to get to a gym or workout, there is less time to eat healthy. More people are allergic to foods now than in the 1970's or 1980's. This could be caused by GMO's to make growing food faster and more abundant. Today there are more organic foods, more fitness centers, more food allergies, more diseases, more medicines, more vaccines, more technology, more pollution. All could be a potential cause of obesity. Yet many people are becoming obese while less are becoming healthy. More healthy living needs to be promoted by Doctors, other healthcare providers, the food industry, and by the company's who employee workers. Some people become obese due to having several physical injuries that cause them to be bedridden for months on end. For some of these people that can fully recover or mostly recover can lose the excess weight and be healthy again. For some who end up with chronic pain and physical disabilities this obesity struggle could last a lifetime even with exercise (physical therapy, nutrition counselling, a support system of family and medical professionals).

David Barckhoff-Sag-Aftra/Producer, Director
35 months ago
"As we age it is harder to get to a gym or workout, there is less time to eat healthy" REALLY - Don't we have MORE TIME. - Dr. David E. 25 months ago
Actually difficult for aged - Er. Jangyadutta 23 months ago
Just at the end? - Dr. David E. 23 months ago

Fire depts and Emergency Management Analysts/Planners train and prepare for a wide variety of emergencies in their jurisdictions. This is called "All Hazards approach". With this said and repeated many times over, hospitals, emergency workers, the CDC, US military all need to continually train for not only the most commonly seen diseases but train for the lesser seen diseases including biological, chemical, radiation, etc. The military has used Agent Orange and other chemicals during the Vietnam War. These soldiers are getting more health problems the older they get due to their war time and non war time military service. Same for the Gulf War veterans with the "Gulf War Illnesses/syndrome". Many research studies have been done by the VA =Veterans Administration, Universities and other institutions to figure out what agents were used during their military war service and what is causing an increase in their health problems. These health problems often times occur many long years after the service member left the military. Civilian healthcare workers need to have additional training to be able to better diagnose, treat and hopefully cure these aging veterans. There conditions could/can also be affecting their family members (kids) when they try to reproduce. So many of the health conditions could/can have a multi-generational effect.  

David Barckhoff-Sag-Aftra/Producer, Director
35 months ago
Hospitals have disaster plans and conduct disaster drills on a regular basis to address catastrophic disasters and accidents including chemical, radiation, natural causes (i.e. earthquake), accidents (i.e. explosions, multi-vehicular accidents) and others. Generally, a disaster plan is activated anytime a hospital's Emergency Department reaches/nearly reaches capacity. - Carolyn C. 35 months ago
"Everyone has a Plan - Unit they get punched in the Face" - Iron Mike Tyson - Dr. David E. 25 months ago
  • Keep yourself fit
  • Exercise regularly
  • Yoga and Meditation
  • Prefer Natural Products
  • Avoid junk foods
  • Keep yourself happy
  • Appreciate others for good work
  • Do not stress your life
  • Have a positive attitude
  • Prefer healthy diet
Abhishek Raj
35 months ago
YEP - Walk more, eat less, and avoid moral hazards. - Dr. David E. 25 months ago
I agree. - Er. Jangyadutta 23 months ago
Thanks - Dr. David E. 23 months ago

Healthy lifestyle campaigns are never in the priority for governments like Polio, or H1B. Maybe they don't think this necessary. However, educating about a healthy lifestyle that includes eating well, gyming and emotional positivity should be taught in schools. This has a direct impact on the environment and the global climate as well. 

Basic Medical Training
Most of the time, the things go worst when we don't cure in the beginning. I think basic medical training for small things like - how to react in fever, flu or cold should be provided. Again - in schools, workplaces, and offices. 

Strong Food Inspection Policy
What we eat is what we see in our health. In North America - fast food, packed food, and preservative food is a big source of diet. We all agree that sometimes they are not very good. A transparent system has to be applied where you can see - the reputation of the brand, past complaints against the product, ingredients in terms of health etc. I know this exists today in some form but it looks more compliance then behavior. 

Hitesh Mathpal
25 months ago
Professional victim-hood is never attrative. - Dr. David E. 25 months ago
Walk more - eat less- reduce moral hazards = personal responsibility: KISS - Dr. David E. 25 months ago
Stop blaming "others" - coulda, woulda, shoulda never works.. - Dr. David E. 25 months ago
Regular physical exercise required. - Er. Jangyadutta 23 months ago

I come from very poor background. I do what I can (what I must), but it's a hard road.

  1. better lifestyles are expensive. Eating in my neighborhood was based on what you could afford - very little.. Gyming is playing basketball at your own risk - after school programs had been and continue to be eliminated. (thank God for the few remaining community centers and dedicated volunteers). Emotional positivity???????? Unfortunately the saddest most driven people I know are not poor. And the pressure on their kids - wow! I guess it depends on the definition of Emotional Positivity. So much misunderstanding about why we've all come to this place.
  2. Best to train on when to go to the EMR. And let's force better or lower transportation benefits to healthcare policies and make sure that the poor actually have ambulances that will come to their areas - and I don't mean the ones that request the money up-front.
  3. Let's face it fast food is not going away. It's inexpensive and an actual treat for poor kids - was for me!. Let's better regulate the food industry. Have you read what's in that food.
Jacqueline G
25 months ago
NOPE: Fast food is very EXPENSIVE. and unhealthy! - Dr. David E. 25 months ago
NOPE: Better lifestyles are less costly and safer. Walk more - eat less - avoid moral hazards, - Dr. David E. 25 months ago
PS: You are talkng about lifestyle [poor] choices; not healthcare costs. - Dr. David E. 25 months ago
Walk more is important. - Er. Jangyadutta 23 months ago

Rising Healthcare Costs

Rising healthcare costs are exploding with the cost of healthcare currently outpacing inflation with federal health spending expecting to increase from 25 percent to 40 percent by 2037 equivalent to 25 percent of the American economy.

With the country now out of recession, and all the changes in healthcare reform has brought, the issue as one of the hot topics after the last  presidential election.

Key Drivers of Rising Healthcare Costs

Hospital care and physician/clinical services combined account for half (51%) of the nation’s health expenditures sparking debates on how healthcare spending can be controlled. Some of the key drivers of rising healthcare costs are:

  • Prescription Drugs/Technology – Pharma is usually the biggest culprit associated with rising healthcare costs; however, medical technology has also been cited as a driver to an increase in overall healthcare spending. Cutting edge technology and drugs can fuel healthcare costs due to development costs and services.

  • Rise in Chronic Diseases – Baby boomers getting older, longer life spans, and the epidemic rates of obesity create an expensive dilemma for the healthcare system. Efforts have increased with the adoption of accountable care and healthcare technology to provide tools for chronic disease management while lowering costs.

  • Administrative Costs – 7% of health care expenditures are estimated to go toward for the administrative costs of government health care programs and the net cost of private insurance (e.g. administrative costs, reserves, taxes, profits/losses).

Any thoughts?

Dr. David E. M
25 months ago
Cost Transparency Requirements: The requirement has been criticized by hospitals and consumer advocates because standard charges are typically not what patients will pay. Medicare, Medicaid and private insurers individually negotiate prices with hospitals, but chargemasters don't reflect those deals. - Dr. David E. 25 months ago
Cost transparency will be appreciated. - Er. Jangyadutta 23 months ago


According to my colleague Bib Nelson, MD:

In 2011, James Robinson of the University of California reviewed hospital prices charged to commercial insurers for six common procedures: angioplasty, pacemaker insertion, knee replacement, hip replacement, lumbar fusion, and cervical fusion.

He found that, on average, procedures cost 44 percent more in hospital markets with an above-average degree of consolidation.

Any thoughts?

Dr. David E. M
24 months ago
Expensive due to producer costs. - Er. Jangyadutta 23 months ago

I will suggest you yoga and a good and healthy diet. Yoga has a power through this you can achieve any goal in fitness.

  • Having good and healthy food is important.
  • Supplements and artificial protein powders are injurious to heart don't take that.
  • Always have breakfast like a king ,lunch like normal man,dinner like a poor.

Thanks for reading
Any suggestions please comment down below.

Er. B
23 months ago
You are talking LIFE STYLE - not HEALTH CARE - Dr. David E. 23 months ago
Lifestyle is preventive measures by yoga diet exercise to reduce medical expenses. - Er. Jangyadutta 23 months ago
Dr. David E. Marcinko MBA it will definitely improve your health if you are maintaining a good and healthy diet - Er. 23 months ago
Er. Jangyadutta Das,CEO,Consultant,Researcher, well said...thanks.. - Er. 23 months ago
yoga is working as a common remedy for any kind of health issues. - Er. 23 months ago
Maybe lifestyle = not really medical care - Dr. David E. 23 months ago
If you will go for medical care then it will require money which improve your expenses. - Er. 23 months ago
Yoga is a preference - Er. Jangyadutta 23 months ago
YOGA is NOT medical care - sorry - it is lifestyle - Dr. David E. 23 months ago

Regular medical check up, taking medicine by advice of doctor,diet and regular exercise make good health to reduce medical expenses.

Er. Jangyadutta D
23 months ago
Taking a healthy lifestyle always a bit difficult to maintain, Once you are acquainted to this it will be more easier. - Er. 23 months ago
Must maintain - Dr. David E. 23 months ago

We all know what the standard guidelines are, but real life gets in the way. People are too busy to prepare healthy meals, so they eat out, either at a drive-thru or restaurant, or order in - perhaps a pizza. Restaurants have highly addictive components in their food to get you to come back, and it works. The portion sizes are larger, more fat is included, more frying in general, and taste rules. Fast, fresh, healthy food is harder to come by and more expensive, so the poor are hit harder. Go into any poor neighborhood and you're more like to see Popeye's than Panera. There is less education overall about nutrition, and a higher incidence of (preventable) early death and chronic diseases. There is less money and time for doctor visits for people working multiple jobs and/or taking care of small children.

Until there is a great effort to solve the root cause(s), the problem won't go away. It's not because people have become lazy couch potatoes. Perhaps the lack of nutrients makes them feel lousy, and Doritos make them feel good. They stay indoors and eat, while watching commercials that advertise food that's bad for them. Since they're indoors, they don't get enough Vitamin D, and they get depressed, so it's a vicious cycle.

We need a combination of many things, including incentives to reduce bad behaviors and poor quality food, incentives to increase education, awareness and ease of access to healthy foods, and penalties that change behavior.

  • Provide incentives to bring fresh, healthy fruits and vegetables, plus high-quality protein into poorer neighborhoods.
  • Leverage social media to spread the work about nutrition, disease, and simple steps to help people make better choices.
  • Find a way to educate all kids about proper nutrition at an early age, teach them to grow their own food, and train their taste buds. early so they don't consume so much sugar.
  • Provide incentives for healthy foods in schools.
  • Provide government food coupons that can only be used for approved, healthy foods.
  • Incentivize food manufacturers to limit processed ingredients and provide warning labels about addictive elements in food (sugar, artificial sweeteners, flavor enhancers, "mouth-feel" enhancers, MSG, etc.).
  • Incentivize restaurants to do the same.
  • Make it easy to create community vegetable gardens. Teach people how to grow more food, not just how to make their grass greener. Suburbia uses too much RoundUp, too, but that's another problem.
  • Disincentivize pharmaceutical companies from lobbying and prioritizing profits over health. Don't allow advertising of meds direct to consumers.
  • Disincentivize campaigns from advertising "Milk: It does a body good." when that's not always true.

We need a combination of many things, including incentives to reduce bad behaviors and poor quality food, incentives to increase education, awareness and ease of access to healthy foods, and penalties that change behavior.

Imagine if we had nicotine and opioids in the food supply. We would make a concerted effort to get those substances out, whatever it took. It's a complex issue, and we have to start somewhere. Why look at designing a better Band-Aid before trying to reduce the number of sharp objects?

Karen Bluestein
20 months ago

from an European point of view, more health insurance coverages (by the government) in order to prevent more and treat less hard damages

Isabel Moreno Indias
20 months ago

Have some input?