The advancement of technology in the area of medicine has brought many benefits to humanity — from new exams to increasingly specific therapeutic methods, healthcare has become increasingly better. These new resources, however, can have an adverse effect on both the patient and healthcare providers, representing an increasingly higher cost.

For health plan managers, healthcare costs represent an important part of administration. It is necessary to measure certain factors, such as scientific evidence of treatments, prevalence of diseases and regional availability of resources. They all impact — directly or indirectly — the company’s financial health. But, after all, which parameters are most linked to this value?

In this article, we will discuss some of the factors that can result in an increase in healthcare costs for healthcare providers. We will address both modifiable factors, such as medical errors, and non-modifiable factors; after all, as a manager, you must be aware of all of them and try to minimize as many as possible within the service. Ready to learn more and improve your company's financial health? Stay with us!

What are the main factors that contribute to the increase in healthcare costs for healthcare providers?

Ageing population

While medical error is a modifiable parameter in the cost of a health plan, population aging is inevitable. Increasing life expectancy, both in Brazil and abroad, raises relevant concerns regarding health. This is because age is a risk factor for several diseases, such as cancer, diabetes and heart failure.

This has an impact not only on the healthcare provider's expenses, but also on strategic management of plan resources. Elderly patients tend to have more chronic illnesses and have a lower prevalence of infectious diseases or accidents. Therefore, outpatient care and hospital support for these conditions tend to be more expensive. Hence the need to thorough investigation of this data for the allocation of resources within the service.

More focus on treatment…

Currently, therapeutic approaches are becoming increasingly complex. Today we already have personalized medicines — such as monoclonal antibodies — that act in very specific areas of the human body. This brings greater personalization and, of course, more effective and patient-friendly treatment. But it can also increase costs.

Health spending already exceeds the growth rate of the global economy itself, occupying about 10% of the planet's GDP. The positive side is that we are diagnosing more and curing more diseases. The negative part is that we often inappropriately spend financial resources on healthcare. And this can be avoided.

…and less on prevention

An effective way to balance new, more effective and more costly treatments with the financial sector is through prevention. The public health sectors have known this for some time: the greatest examples of successful financial allocation of health in prevention are England and Canada. They realized years ago that “prevention is better than cure”. And this also applies to financial management.

Currently, it is known that approximately 80% of health demands can be resolved in Primary Care. This level of health care is less complex and cheaper. In the SUS, it is used as a gateway, which, when necessary, refers patients to higher levels of complexity. In this way, it is possible to create a rational flow within the healthcare system.

In addition, Primary Care is also responsible for carrying out prevention and health promotion measures. Vaccination campaigns, combating smoking and encouraging physical activities are part of this task. The bottom line is simple: by preventing more, the incidence of diseases decreases and, with it, the need for more complex treatments. It is important that we remember that the more complicated the disease becomes, the more expensive and invasive its treatment is.

Which assistance requests increase the cost?

The indication of procedures, exams and consultations can also be a factor that increases the cost of healthcare providers. Some types of these services correspond to around 80% of health plan expenses; for this reason, a audit detailed and judicious analysis is essential for the financial health of operators. Check out some sectors that require more resources below.

Emergency department

The emergency sector, anywhere, demands immediate resources. This is a place where you cannot miss, for example, surgical or respiratory assistance materials. Furthermore, it must work 7 days a week, 24 hours a day. This is a factor that causes emergency sectors to consume more resources and constantly demand new investments from health plans.

Specialized services

Some specialties are more expensive than others. This is the case of transplant or neurology outpatient clinics, for example, which require highly qualified professionals. Consultations with these doctors are often more expensive; Furthermore, the number of professionals is smaller and resources are scarcer. All of this causes the price of assistance to increase and interfere with the financial health of the plan.

Intensive Care Units

Intensive care units, as well as urgency and emergency sectors, require constant investment. These are where patients need more specialized assistance, requiring more costly support. Monitors, defibrillators and specialized professional assistance are some examples of expenses in these sectors.

How to adapt expenses to demand?

Given the number of factors that can influence the expenses of healthcare providers, it is essential that there is a well-done audit of these resources. Therefore, this sector must be well structured and have clear rules for a good relationship between health plans and service providers.

In this context, the use of technology can help. Currently, there are systems specialized in auditing accounts for health plans, which facilitate the entire billing and data transfer process. In addition, they also allow a longitudinal view of the company's expenses and facilitate long-term planning and budgeting. A artificial intelligence has been increasingly used to improve effectiveness and productivity in this field.

In this article, you understood a little better about which factors influence spending on a healthcare provider. There are modifiable and non-modifiable parameters: the aging of the population is an example of a non-modifiable factor, while medical errors can be avoided and bring better results to the plan.

Furthermore, effective supervision is essential for reducing costs in a healthcare provider. Unnecessary expenses or those that drain a lot of resources, in specific areas of assistance, can be reduced and bring better financial health to the plan. Finally, the use of technology in this sense can reduce friction in communication with suppliers and bring benefits to the operator.

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