Business Insight Where are we heading? American health care system's costs have been steadily growing over the years. Yes, it is true, we have access to excellent resources, technology, diagnostics, and variety of specialty providers. Many of these resources are used freely and sometimes with no consideration of the cost vs. benefit ratio. Particular attention should be given to prescription drug. Not only their pricing is beyond any imaginable level, but seniors, take 10-12 medications, with no coordination of their influence on each other. We hear about one medication taken causing some side effects, and another two medications issued for helping those side effects, and some others, helping the side effects of these two. This causes a chain of drugs, which, when evaluated, often can be limited to lesser number. Some diagnostic testing is duplicated mostly due to multiple providers involved and not being able to access medical records. Why is this happening? Administration and operational costs of running our system is a huge burden. Studies from 2017, recently published by Healio Primary Care' on-line magazine, show that American Healthcare system spends 34% of its total cost on administration. This means that less than 2/3 of the total cost is related to the true clinical care. In contrast, Canada spends just 17% to fund their system. What does it mean for each and every American? Please, do not be shocked: $2497 is spent every year, per each American, to cover not medical resources but paperwork and administration. In Canada, that number is $812.00. Many of you probably do not spend that much for your total annual medical care. And this is just for the administration. The cost is related to operating hundreds of insurance plans, with tons of mymedicare.gov to track claims paid by variety of medical benefits description, covering or not covering some procedures, patients' responsibility. Clear and simple. using networks of doctors and referrals, pre-certifying some services, and denying others. Every year, in January, my billing bankruptey due to inability to pay their staff must re-assess what insurances we participate in and which insurances changed their rules. There is no rhyme or reason for some changes but they still have to be followed. Patients do not understand their benefits, mostly because they are complicated and require reading booklets of complicated language terms. Deductibles in-network and out-of networks, co-pays, patients, especially often, co-insurances, share costs, no coverage for some benefits, and separate prescription plans. I could go on and on. If my billing staff has to learn it every year anew and has trouble defining changes, how can our patients understand what is going on? Medicare part A and B, just regular Medicare handled by the government, is the only medical insurance that stays almost the same year to year. They change the level of deductible by some $20.00 but most of other services are just updated by the novel procedures that might have not been known previously. Medicare also openly publishes their fees so that the patients and providers know what to expect. And finally, Medical alone spends only 9% of their total cost on administration. 91% is used directly to cover the clinical care. Patients can go on a web site: www. Medicare to all their providers, showing Our country is the only developed country in the world where people file for medical bills. At the same time, we spend the highest dollar amount to cover the cost of administration of our dysfunctional system. All of us will get sick one day. No chance it will not happen. Shouldn't we think and learn from others how to make the healthcare more accessible and functional? Michael Bukhalo, MD Arlington Dermatology 5301 Keystone Court Rolling Meadows, IL 60008 Tel. 847 392 5440 | www.arlingtondermatology.net Business Insight Where are we heading? American health care system's costs have been steadily growing over the years. Yes, it is true, we have access to excellent resources, technology, diagnostics, and variety of specialty providers. Many of these resources are used freely and sometimes with no consideration of the cost vs. benefit ratio. Particular attention should be given to prescription drug. Not only their pricing is beyond any imaginable level, but seniors, take 10-12 medications, with no coordination of their influence on each other. We hear about one medication taken causing some side effects, and another two medications issued for helping those side effects, and some others, helping the side effects of these two. This causes a chain of drugs, which, when evaluated, often can be limited to lesser number. Some diagnostic testing is duplicated mostly due to multiple providers involved and not being able to access medical records. Why is this happening? Administration and operational costs of running our system is a huge burden. Studies from 2017, recently published by Healio Primary Care' on-line magazine, show that American Healthcare system spends 34% of its total cost on administration. This means that less than 2/3 of the total cost is related to the true clinical care. In contrast, Canada spends just 17% to fund their system. What does it mean for each and every American? Please, do not be shocked: $2497 is spent every year, per each American, to cover not medical resources but paperwork and administration. In Canada, that number is $812.00. Many of you probably do not spend that much for your total annual medical care. And this is just for the administration. The cost is related to operating hundreds of insurance plans, with tons of mymedicare.gov to track claims paid by variety of medical benefits description, covering or not covering some procedures, patients' responsibility. Clear and simple. using networks of doctors and referrals, pre-certifying some services, and denying others. Every year, in January, my billing bankruptey due to inability to pay their staff must re-assess what insurances we participate in and which insurances changed their rules. There is no rhyme or reason for some changes but they still have to be followed. Patients do not understand their benefits, mostly because they are complicated and require reading booklets of complicated language terms. Deductibles in-network and out-of networks, co-pays, patients, especially often, co-insurances, share costs, no coverage for some benefits, and separate prescription plans. I could go on and on. If my billing staff has to learn it every year anew and has trouble defining changes, how can our patients understand what is going on? Medicare part A and B, just regular Medicare handled by the government, is the only medical insurance that stays almost the same year to year. They change the level of deductible by some $20.00 but most of other services are just updated by the novel procedures that might have not been known previously. Medicare also openly publishes their fees so that the patients and providers know what to expect. And finally, Medical alone spends only 9% of their total cost on administration. 91% is used directly to cover the clinical care. Patients can go on a web site: www. Medicare to all their providers, showing Our country is the only developed country in the world where people file for medical bills. At the same time, we spend the highest dollar amount to cover the cost of administration of our dysfunctional system. All of us will get sick one day. No chance it will not happen. Shouldn't we think and learn from others how to make the healthcare more accessible and functional? Michael Bukhalo, MD Arlington Dermatology 5301 Keystone Court Rolling Meadows, IL 60008 Tel. 847 392 5440 | www.arlingtondermatology.net