U.S. Healthcare Spending & How Kaiser Permanente Deals With Reducing Cost
Dear Friends & Neighbors,
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There were many reasons why my mother moved to California years ago to stay with my brother. Besides more relatives (in addition to her favorite son, my brother, being there), opportunities for Chinese-American social interactions, and greater number of Chinese restaurants, the health insurance and services she was/is able to obtain from Kaiser Permanente under the Kaiser Senior Advantage are far more cost effective and with more physicians and nurses who speak Chinese/Mandarin. Kaiser Senior Advantage plan generally replaces one’s Medicare coverage, once some one agreed to let Kaiser manage his/her Medicare benefits. It is an HMO (health maintenance organization) with a closed network of providers.
Videos below help to explain how Medicare Part A, B, C, D work and how Kaiser Permanente works:
Below, excerpt from UCnet, explains how this plan (Kaiser Senior Advantage) works:
How the plan works
- You choose a primary care physician (PCP) from Kaiser’s network.
- The PCP coordinates your care and refers you to specialists.
- The plan covers the cost of services only when your primary care physician authorizes it.
- Kaiser provides coverage for services outside of the Kaiser network only in cases of emergency.
- Kaiser provides behavioral health services.
- The Centers for Medicare and Medicaid Services must approve the service area for each Medicare plan. If your home zip code is outside of the Kaiser Senior Advantage service areaPDF, you will not be eligible to enroll. Eligible zip codes can change throughout the year. Please contact the Retirement Administration Service Center, Kaiser or Medicare.gov if you have a question about the eligibility of a particular zip code.
Best fit for you if:
- You want lower out-of-pocket costs
- You like having one doctor manage your care
- You are comfortable with out-of-network coverage only in emergencies
Typical out-of-pocket costs
- Office visit/urgent care visit: $20 (preventive care has no charge)
- Emergency room: $65
- Hospital stay: $250
- Prescription drugs: $5, generic; $25, brand name
New members should receive ID cards from Kaiser. You may also order a copy of your ID card on the Kaiser website or call 800-464-4000 to request your ID number.
In the California Healthcare Quality Report Card 2013 Edition, Kaiser Permanente’s Northern California and Southern California regions, Kaiser received four out of four possible stars in Meeting National Standards of Care. Kaiser North and South also received three out of four stars in Members Rate Their HMO. KP’s performance has been attributed to three practices: First, KP places a strong emphasis on preventive care, reducing costs later on. Second, its doctors are salaried rather than paid per service, which removes the main incentive for doctors to perform unnecessary procedures. Thirdly, KP attempts to minimize the time patients spend in high-cost hospitals by carefully planning their stay and by shifting care to outpatient clinics. This practice results in lower costs per member, cost savings for KP and greater doctor attention to patients. A comparison to the UK’s National Health Service found that patients spend 2–5 times as much time in NHS hospitals as compared to KP hospitals.
Early in the 21st century the NHS and UK Department of Health became impressed with some aspects of the Kaiser operation, and initiated a series of studies involving several healthcare organizations in England. Visits occurred and suggestions of adopting some KP policies are currently active. The management of hospital bed-occupancy by KP, by means of integrated management in and out of hospital and monitoring progress against care pathways has given rise to trials of similar techniques in eight areas of the UK.
In 2002, a controversial study by California-based academics published in the British Medical Journal compared Kaiser to the British National Health Service, finding Kaiser to be superior in several respects. Subsequently, a group of health policy academics who were experts on the NHS published a competing analysis claiming that Kaiser’s costs were actually substantially higher than the NHS and for a younger and healthier population.
If we look at the seven spending comparison charts above, U.S. has been spending far more than other comparable (developed nations) countries. But the three practices of Kaiser Permanente has been able to bring down much of the overall costs and emphasis in preventive care has been very comforting for seniors. I’ve personally had opportunities to observe how KP operate whenever I had to visit/bring my mom to Kaiser. I was impressed both by the short amount of waiting time and level of care.
I have lived in the state of Florida for over eleven years and love its warmth, humidity level, lush greenery, and friendly and relaxed people. I do hope our healthcare system would also observe the three practices above, as KP does, so that I would continue my stay here in Florida by the time I will be a senior.
Gathered, written, and posted by Windermere Sun-Susan Sun Nunamaker
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