{"id":171,"date":"2021-08-17T13:35:13","date_gmt":"2021-08-17T13:35:13","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/chapter\/8-2-trends-related-to-increased-health-care-costs\/"},"modified":"2025-02-18T18:43:02","modified_gmt":"2025-02-18T18:43:02","slug":"8-2-trends-related-to-increased-health-care-costs","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/chapter\/8-2-trends-related-to-increased-health-care-costs\/","title":{"raw":"8.2 Trends Related to Increased Health Care Costs","rendered":"8.2 Trends Related to Increased Health Care Costs"},"content":{"raw":"The cost of health care in the United States is higher than any other country in the world and has a significant financial impact on our economy.<sup>[footnote]CMS.gov. (2020, December 16). <em>National health expenditure data - historical. <\/em>Centers for Medicare &amp; Medicaid Services<em>.<\/em> <a href=\"https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NationalHealthAccountsHistorical\" target=\"_blank\" rel=\"noopener\">https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NationalHealthAccountsHistorical<\/a>[\/footnote] <\/sup>U.S. health care spending grew 4.1 percent in 2022, reaching $ 4.5 trillion or $13,493 per person. Health care spending accounts for 17.3 percent of our Gross Domestic Product (GDP), the total value of goods produced and services provided annually.<sup>[footnote]CMS.gov. (2020, December 16). <em>National health expenditure data - historical<\/em>. Centers for Medicare &amp; Medicaid Services. <a href=\"https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NationalHealthAccountsHistorical\" target=\"_blank\" rel=\"noopener\">https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NationalHealthAccountsHistorical<\/a>[\/footnote] <\/sup>See Figure 8.1<sup>[footnote]\u201c<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Health_Care_Cost_as_Percentage_of_GDP.png\" target=\"_blank\" rel=\"noopener\">Health_Care_Cost_as_Percentage_of_GDP.png<\/a>\u201d by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Delphi234\" target=\"_blank\" rel=\"noopener\">Delphi234<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/deed.en\" target=\"_blank\" rel=\"noopener\">CC0 1.0<\/a>[\/footnote]<\/sup> for a graph of health care cost as a percentage of GDP in the United States compared to other countries around the world.\n\n[caption id=\"attachment_170\" align=\"aligncenter\" width=\"1024\"]<img class=\"wp-image-167 size-full\" title=\"\u201cHealth_Care_Cost_as_Percentage_of_GDP.png\u201d by Delphi234 is licensed under CC0 1.0\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2021\/08\/Health_Care_Cost_as_Percentage_of_GDP.png\" alt=\"Image of a line graph depicting Comparison of Health Care Costs from 1960 to 2010\" width=\"1024\" height=\"768\"> Figure 8.1 Comparison of Health Care Costs[\/caption]\n\nDespite spending more money on health care than other high-income countries, the United States has some of the poorest health outcomes, such as the lowest life expectancy, the highest infant mortality rate, and a higher prevalence of chronic diseases.<sup>[footnote]Bush, M. (2018). Addressing the root cause: Rising health care costs and social determinants of health. <em>North Carolina Medical Journal, 79<\/em>(1), 26-29. <a href=\"https:\/\/doi.org\/10.18043\/ncm.79.1.26\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.18043\/ncm.79.1.26<\/a> [\/footnote]<\/sup> The increasing costs of health care also have several negative impacts on society, employers, and individuals, including the following effects<sup>[footnote]Schreck, R. I. (2020, March). Overview of health care financing. <em>Merck Manual Consumer Version<\/em>. <a href=\"https:\/\/www.merckmanuals.com\/home\" target=\"_blank\" rel=\"noopener\">https:\/\/www.merckmanuals.com\/home\/fundamentals\/financial-issues-in-health-care\/overview-of-health-care-financing<\/a>[\/footnote]<\/sup>:\n<ul>\n \t<li style=\"font-weight: 400\">When the government spends more on health care, the national debt increases and funds available for other programs decrease.<\/li>\n \t<li style=\"font-weight: 400\">When people spend more on health care, they have less money to spend on other items.<\/li>\n \t<li style=\"font-weight: 400\">When health insurance is paid by employers, employees are paid less.<\/li>\n \t<li style=\"font-weight: 400\">When employers spend more on health care, the costs of their products and services increase. Jobs may be moved to countries with lower health care costs.<\/li>\n \t<li style=\"font-weight: 400\">An increasing number of people cannot afford health care insurance. When people without health care insurance receive health care, they often cannot pay for it. As a result of unpaid bills, this care is indirectly paid for by other people paying increased insurance premiums and taxes.<\/li>\n \t<li style=\"font-weight: 400\">People without health care insurance may not seek preventative care and develop a more costly, serious medical disorder that could have been prevented.<\/li>\n \t<li style=\"font-weight: 400\">Medical bills that are not covered by health insurance can cause bankruptcy.<\/li>\n<\/ul>\nThere are several national trends affecting the cost of health care and related impacts, including the aging population, increased costs of medical technology, increased prescription medication cost, the Affordable Care Act,\u00a0 social determinants of health, etc.\u00a0 These trends can be further classified as intrinsic or extrinsic factors. <strong>[pb_glossary id=\"537\"]Intrinsic factors[\/pb_glossary]<\/strong> related to increased health care costs are inherent to the characteristics and needs of the population. One significant intrinsic factor is the demographics of the population, such as age, gender, and overall health status. An aging population, for example, typically requires more medical care due to the prevalence of chronic conditions and the natural decline in health associated with aging. Another intrinsic factor is the demand for health care services. As people become more health-conscious, the demand for preventive care, regular check-ups, and advanced treatments rises, leading to increased overall health care spending. Additionally, the extent and nature of health insurance coverage play a crucial role. Comprehensive insurance plans often lead to higher utilization of health care services, as insured individuals are more likely to seek medical care, knowing that a significant portion of the costs will be covered by their insurance.\n\n<strong>[pb_glossary id=\"538\"]Extrinsic factors[\/pb_glossary]<\/strong> are external elements that impact health care costs. One of the most prominent extrinsic factors is the availability and adoption of medical technology. Advanced diagnostic tools, treatment methods, and surgical techniques can drive up costs due to their high development, implementation, and maintenance expenses. While these technologies can significantly improve client outcomes, they also contribute to rising health care expenditures. Another critical extrinsic factor is the cost of prescription drugs. Pharmaceutical pricing strategies, including research and development costs, marketing, and profit margins, often lead to high prices for medications, especially for new and specialized drugs. Workforce costs are also a significant extrinsic factor. The salaries and benefits of health care professionals, including doctors, nurses, and administrative staff, constitute a substantial portion of health care expenses. These costs are influenced by factors such as education and training requirements, labor market conditions, and regulatory policies. Addressing these extrinsic factors requires strategic planning and policy interventions to balance cost containment with the quality and accessibility of health care services.\n<h2>Aging Population<\/h2>\nAccording to the Agency for Healthcare Research and Quality (AHRQ), the United States has a growing number of older adults (age 65 years or older) who are living longer than previous generations. It is anticipated that older adults will make up more than 20 percent of the U.S. population by 2030.<sup>[footnote]Agency for Healthcare Research and Quality. (n.d.). <em>Elderly.<\/em> <a href=\"https:\/\/www.ahrq.gov\/topics\/elderly.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/topics\/elderly.html<\/a>[\/footnote] <\/sup>See Figure 8.2<sup>[footnote]\u201c<a href=\"https:\/\/www.census.gov\/library\/stories\/2018\/03\/graying-america.html\" target=\"_blank\" rel=\"noopener\">graying-america-aging-nation.jpg<\/a>\u201d by <a href=\"https:\/\/www.census.gov\/\" target=\"_blank\" rel=\"noopener\">U.S. Census Bureau<\/a> is in the <a href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" target=\"_blank\" rel=\"noopener\">Public Domain<\/a>[\/footnote]<\/sup> for an illustration of the aging population from the U.S. Census Bureau. This change in demographics will result in increased national health care costs because older adults typically experience more chronic conditions than younger populations, requiring expensive specialty and long-term care.<sup>[footnote]Agency for Healthcare Research and Quality. (n.d.).<em> Elderly<\/em>. <a href=\"https:\/\/www.ahrq.gov\/topics\/elderly.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/topics\/elderly.html<\/a>[\/footnote]<\/sup>\n\n[caption id=\"attachment_170\" align=\"aligncenter\" width=\"648\"]<img class=\"wp-image-168 \" title=\"\u201cgraying-america-aging-nation.jpg\u201d by U.S. Census Bureau is in the Public Domain\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/graying-america-aging-nation.jpg\" alt=\"Infographic illustrating the Aging Population in the United States \" width=\"648\" height=\"687\"> Figure 8.2 Aging Population in the United States[\/caption]\n<h2>Increased Costs of Medical Technology<\/h2>\nHighly visible medical technologies, such as organ transplantation, diagnostic imaging systems, and biotechnology products, attract both praise and blame. Evolving medical technologies may save lives and improve a client\u2019s health status, but they are also viewed as a dominant cause of continued escalation of medical costs. Research suggests that medical technology accounts for about 10 to 40 percent of the increase in health care expenditures over time.<sup>[footnote]Neumann, P. J., &amp; Weinstein, M. C. (1991). The diffusion of new technology: Costs and benefits to health care. In Institute of Medicine (US) Committee on Technological Innovation in Medicine, Gelijns, A. C., &amp; Halm, E. A. (Eds.). <em>The changing economics of medical technology.<\/em> National Academies Press. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK234309\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK234309\/<\/a>[\/footnote]<\/sup> These costs also lead to further ethical dilemmas as decisions regarding what scarce resources are provided to which clients are made. See Figure 8.3<sup>[footnote]\u201c<a href=\"https:\/\/www.flickr.com\/photos\/wonderlane\/49458105981\" target=\"_blank\" rel=\"noopener\">49458105981_fe87fd521c_o.jpg<\/a>\u201d by <a href=\"https:\/\/www.flickr.com\/photos\/wonderlane\/\" target=\"_blank\" rel=\"noopener\">Wonderlane<\/a> is licensed under <a href=\"https:\/\/www.creativecommons.org\/licenses\/by\/2.0\/\" target=\"_blank\" rel=\"noopener\">CC BY 2.0<\/a>[\/footnote]<\/sup> for an image of common technology used in health care.\n\n[caption id=\"attachment_170\" align=\"aligncenter\" width=\"713\"]<img class=\"wp-image-169 \" title=\"\u201c49458105981_fe87fd521c_o.jpg\u201d by Wonderlane is licensed under CC BY 2.0\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/49458105981_42705f8ab1_k-1024x576.jpg\" alt=\"Photo showing various health care equipment \" width=\"713\" height=\"401\"> Figure 8.3 Health Care Technology[\/caption]\n\nMedical technologies, especially new ones, must justify their costs in a climate of competing claims on limited resources. Resource allocation follows American society's objective of cost effectiveness: if a new technology improves health outcomes at a lower cost than existing technologies, it should be adopted; otherwise, it should not.<sup>[footnote]Neumann, P. J., &amp; Weinstein, M. C. (1991). The diffusion of new technology: Costs and benefits to health care. In Institute of Medicine (US) Committee on Technological Innovation in Medicine, Gelijns, A. C., &amp; Halm, E. A. (Eds.). <em>The changing economics of medical technology.<\/em> National Academies Press. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK234309\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK234309\/<\/a>[\/footnote]<\/sup>\n<h2>Increased Prescription Medication Costs<\/h2>\nRetail prices for commonly-used prescription medications continue to increase twice as much as inflation, contributing to increased health care costs and making these life-sustaining medicines potentially unaffordable to many Americans. According to a recent AARP <em>Rx Price Watch<\/em> report, in 2020 prices for 260 commonly used medications increased 2.9 percent while the general rate of inflation was 1.3 percent.<sup>[footnote]Bunis, D. (2021, June 7). <em>Prescription drug price increases continue to outpace inflation<\/em>. AARP. <a href=\"https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html<\/a>[\/footnote] <\/sup>For example, the cost of Symbicort, a medication used to treat asthma and COPD, increased 46 percent, from $2,940 to $4,282.<sup>[footnote]Bunis, D. (2021, June 7). <em>Prescription drug price increases continue to outpace inflation<\/em>. AARP. <a href=\"https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html<\/a>[\/footnote]<\/sup> See Figure 8.4<sup>[footnote]Peterson_KFF Health Systems Tracker. (n.d.). <em>Health expenditures 1960-2020. <\/em><a href=\"https:\/\/www.healthsystemtracker.org\/health-spending-explorer\/?outputType=%24pop-adjusted&amp;serviceType%5B0%5D=prescriptionDrug&amp;serviceType%5B1%5D=hospitals&amp;serviceType%5B2%5D=allTypes&amp;sourceOfFunds%5B0%5D=allSources&amp;tab=0&amp;yearCompare%5B0%5D=%2A&amp;yearCompare%5B1%5D=%2A&amp;yearRange%5B0%5D=%2A&amp;yearRange%5B1%5D=%2A&amp;yearSingle=%2A&amp;yearType=range\">https:\/\/www.healthsystemtracker.org\/health-spending-explorer\/?outputType=%24pop-adjusted&amp;serviceType%5B0%5D=prescriptionDrug&amp;serviceType%5B1%5D=hospitals&amp;serviceType%5B2%5D=allTypes&amp;sourceOfFunds%5B0%5D=allSources&amp;tab=0&amp;yearCompare%5B0%5D=%2A&amp;yearCompare%5B1%5D=%2A&amp;yearRange%5B0%5D=%2A&amp;yearRange%5B1%5D=%2A&amp;yearSingle=%2A&amp;yearType=range<\/a>[\/footnote]<\/sup> for an illustration related to prescription medication costs.\n\n[caption id=\"attachment_170\" align=\"aligncenter\" width=\"765\"]<img class=\"wp-image-170 size-full\" title=\"&quot;Health Expenditures 1960-2020&quot;, KFF, accessed March 12, 2022 https:\/\/www.healthsystemtracker.org\/health-spending-explorer\/?outputType=%24pop-adjusted&amp;serviceType%5B0%5D=prescriptionDrug&amp;serviceType%5B1%5D=hospitals&amp;serviceType%5B2%5D=allTypes&amp;sourceOfFunds%5B0%5D=allSources&amp;tab=0&amp;yearCompare%5B0%5D=%2A&amp;yearCompare%5B1%5D=%2A&amp;yearRange%5B0%5D=%2A&amp;yearRange%5B1%5D=%2A&amp;yearSingle=%2A&amp;yearType=range\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/Historical-Prescription-Drug-Costs.png\" alt=\"Line graph showing historical trends in prescription drug costs, 1960 to 2020\" width=\"765\" height=\"554\"> Figure 8.4 Prescription Medication Costs[\/caption]\n\nAlthough the majority of Americans have either public or private insurance that helps them pay for medications, increased medication prices result in higher health insurance premiums and higher taxpayer costs for the Medicare and Medicaid programs. Some insurance companies only cover approved formulary medications. As a result, national organizations like the American Association of Retired Persons (AARP) advocate for national policy changes, such as allowing Medicare to negotiate the prices of prescription medications with drug companies and allowing private insurance plans to have access to those lower prices.<sup>[footnote]Bunis, D. (2021, June 7). <em>Prescription drug price increases continue to outpace inflation<\/em>. AARP. <a href=\"https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html<\/a>[\/footnote] <\/sup>\n\nMany consumers find themselves tasked with the difficult decision of purchasing expensive medication or going without prescribed medication and paying for their families' housing and food. Nurses often become involved in case management activities when assisting clients to obtain medications they cannot afford. Nursing case management activities are discussed later in this chapter.\n<h2>Affordable Care Act<\/h2>\nThe Patient Protection and Affordable Care Act (PPACA), also known as the<strong> [pb_glossary id=\"390\"]Affordable Care Act (ACA)[\/pb_glossary] <\/strong>or Obamacare, was signed into law in 2010. The purpose of this legislation was to increase consumers' access to health care coverage and protect them from insurance practices that restricted care or significantly increased the cost of care. The ACA mandated health insurance coverage for employers and individuals. Employers were mandated to provide health care coverage based on the number of their employees, and individuals who were not covered through employer insurance plans were mandated to seek coverage through a newly created Marketplace. The Marketplace provides a central, website that offers three standard health insurance coverage levels to facilitate comparison by consumers. As a result of the ACA and associated Medicaid expansion, 32 million people had health care coverage in 2021.<sup>[footnote]HealthCare.gov. <em>Insurance marketplace.<\/em> <a href=\"https:\/\/www.healthcare.gov\/subscribe\/?gclid=Cj0KCQjwiqWHBhD2ARIsAPCDzamNRkS3URx_uUvJGdpX15DrZnVbBadXbPmOjBBlLyjtZBn7cLei6WEaAl8GEALw_wcB&amp;gclsrc=aw.ds\" target=\"_blank\" rel=\"noopener\">https:\/\/www.healthcare.gov\/subscribe\/? gclid=Cj0KCQjwiqWHBhD2ARIsAPCDzamNRkS3URx_uUvJGdpX15DrZnVbBadXbPmOjBBlLyjtZBn7cLei6WEaAl8GEALw_wcB&amp;gclsrc=aw.ds<\/a>[\/footnote]<\/sup>\n<div class=\"textbox shaded\"><span class=\"arrow\">Read about the Affordable Care Act at <a href=\"https:\/\/www.hhs.gov\/healthcare\/about-the-aca\/index.html\" target=\"_blank\" rel=\"noopener\">HHS.gov.<\/a><\/span><\/div>\n<h3>Key Provisions of the ACA<\/h3>\nThe ACA includes the following key provisions<sup>[footnote]HHS.gov. <em>About the Affordable Care Act.<\/em> U.S. Department of Health &amp; Human Services. <a href=\"https:\/\/www.hhs.gov\/healthcare\/about-the-aca\/index.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.hhs.gov\/healthcare\/about-the-aca\/index.html<\/a>[\/footnote]<\/sup>:\n<ul>\n \t<li>Insurers can no longer deny coverage or care for preexisting conditions like diabetes, asthma, and cancer.<\/li>\n \t<li style=\"font-weight: 400\">Young adults may remain on their parents\u2019 insurance plans until they are 26 (even if they are married, financially independent, or not living with their parents).<\/li>\n \t<li style=\"font-weight: 400\">Health insurance plans cannot place annual or lifetime limits on coverage, except for nonessential exceptions, such as cosmetic procedures.<\/li>\n \t<li style=\"font-weight: 400\">Many preventive services must be provided, such as:\n<ul>\n \t<li style=\"font-weight: 400\">Well-child visits, flu shots, and other common vaccines<\/li>\n \t<li style=\"font-weight: 400\">Screening tests for blood pressure and diabetes<\/li>\n \t<li style=\"font-weight: 400\">Diagnostic screening tests, such mammograms and colonoscopies<\/li>\n \t<li style=\"font-weight: 400\">Counseling services related to mental health and substance use<\/li>\n<\/ul>\n<\/li>\n<\/ul>\nThe ACA also provides an avenue for consumers to appeal insurance companies\u2019 denials for care or payment of services and restricts situations in which an insurance carrier may cancel a policy.\n<h3>Challenges to the ACA<\/h3>\nAlthough the ACA has significantly increased the number of Americans with health insurance coverage, it continues to be debated. Debates focus on increased taxes, increased insurance premiums, and some people\u2019s belief that mandated coverage is governmental intrusion on an individual\u2019s rights. The Affordable Care Act has been challenged three times without success. In 2012 the U. S. Supreme Court upheld mandated coverage as a constitutional exercise of Congress\u2019 taxing powers because it could be interpreted as an individual\u2019s choice to maintain health insurance or pay a tax. However, in 2017 Congress set the penalty for failing to comply with the mandate at zero dollars after multiple attempts to repeal and replace the ACA. In June 2021 the U.S. Supreme Court rejected a third major challenge regarding the constitutionality of the ACA. In a 7-to-2 decision, the U.S. Supreme Court upheld the ACA based on the judgment that the states who brought forth the case did not prove damage to citizens because the fines for not having health coverage had been eliminated since the original legislation was passed.<sup>[footnote]K&amp;L Gates LLP, Carnevale, A., Hamscho, V., Lawless, T., &amp; Sha Page, K. (2021, June 21).<em> The Affordable Care Act survives Supreme Court challenge: What happens next?<\/em> JD Supra. <a href=\"https:\/\/www.jdsupra.com\/legalnews\/the-affordable-care-act-survives-3115372\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.jdsupra.com\/legalnews\/the-affordable-care-act-survives-3115372<\/a>\/[\/footnote]<\/sup>\n<h3>What to Expect Next<\/h3>\nGiven the Supreme Court\u2019s recent decision regarding the ACA, it is expected the current administration will continue to advocate for the ACA and work towards making ACA tax credits permanent. Congress is also actively debating other legislative proposals to reduce health care costs, such as medication pricing reform and expanding Medicare eligibility age and benefits.<sup>[footnote]K&amp;L Gates LLP, Carnevale, A., Hamscho, V., Lawless, T., &amp; Sha Page, K. (2021, June 21).<em> The Affordable Care Act survives Supreme Court challenge: What happens next?<\/em> JD Supra. <a href=\"https:\/\/www.jdsupra.com\/legalnews\/the-affordable-care-act-survives-3115372\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.jdsupra.com\/legalnews\/the-affordable-care-act-survives-3115372<\/a>\/[\/footnote]<\/sup>\n<h2>Social Determinants of Health<\/h2>\n<strong>[pb_glossary id=\"408\"]Social Determinants of Health (SDOH)[\/pb_glossary]<\/strong> are the conditions in the environments where people live, learn, work, and play that affect a wide range of outcomes. SDOH include health care access and quality, neighborhood and environment, social and community context, economic stability, and education access and quality. These conditions have a major impact on people\u2019s health and well-being, ultimately affecting national health care costs.<sup>[footnote]Healthy People 2030. (n.d.).<em> Social determinants of health<\/em>. U.S. Department of Health and Human Services. <a href=\"https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health\" target=\"_blank\" rel=\"noopener\">https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health<\/a>[\/footnote]\u00a0<\/sup>\n\nSDOH directly impact individuals' health behaviors, their access to routine health care, and development of chronic disease. Yet, the United States spends a significantly lower percentage of its gross domestic product (GDP) on social services as compared to similar countries with better health outcomes.<sup>[footnote]Bush, M. (2018). Addressing the root cause: Rising health care costs and social determinants of health. <em>North Carolina Medical Journal. 79<\/em>(1), 26-29. <a href=\"https:\/\/ncmedicaljournal.com\/article\/55056\">https:\/\/www.ncmedicaljournal.com\/content\/79\/1\/26<\/a>[\/footnote]<\/sup>\n\nHealthy People 2030, established by the U.S. Department of Health and Human Services, identifies public health priorities to help individuals, organizations, and communities across the United States improve health and well-being over the next decade by addressing SDOH. One of Healthy People 2030\u2019s goals states, \u201cCreate social, physical, and economic environments that promote attaining the full potential for health and well-being for all.\u201d<sup>[footnote]Healthy People 2030. (n.d.). <em>Social determinants of health.<\/em> U.S. Department of Health and Human Services. <a href=\"https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health\" target=\"_blank\" rel=\"noopener\">https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health<\/a>[\/footnote]<\/sup> Nurses act in many ways to address these priorities as they advocate for individuals, families, and communities.\n<div class=\"textbox shaded\"><span class=\"arrow\"> Read more about efforts addressing SDOH for improved economic stability and health care access in <a href=\"https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health\" target=\"_blank\" rel=\"noopener\">Healthy People 2020<\/a>.<\/span><\/div>\n<div><strong>SDOH Case Study<\/strong><\/div>\n<div class=\"textbox shaded \">\n\n<strong>Maria's Journey Through the Health Care System <\/strong><em>(Answers are located in the answer key at the back of the book)<\/em>\n\n<em>Maria, a 45-year-old woman, lives in a low-income neighborhood in a large urban area. She works two part-time jobs to support her family of four and has limited access to health care due to financial constraints and transportation issues. Maria has been diagnosed with type 2 diabetes, and her health care outcomes are significantly influenced by various Social Determinants of Health (SDOH).<\/em>\n\n<em>Maria's low income and unstable employment contribute to her inability to afford healthy food, medications, and regular medical check-ups. This economic instability exacerbates her diabetes, as she often skips doses of her medication to save money and cannot afford nutritious meals that would help manage her condition. The constant stress of making ends meet and providing for her family leads to increased cortisol levels, which can negatively impact her blood sugar control.<\/em>\n\n1. How can Maria's financial stress impact her ability to manage her diabetes effectively?\n\n2. What programs or policies could be implemented to assist individuals like Maria in managing their health care costs?\n\n<em>Maria has limited knowledge about diabetes management due to a lack of education and access to health information. This impacts her ability to understand and implement lifestyle changes or adhere to treatment plans. With limited education, Maria struggles to find better-paying jobs that could provide health insurance and more financial stability.<\/em>\n\n3. In what ways can improved health literacy impact Maria's diabetes management?\n\n4. What community resources could be made available to enhance health education for individuals in Maria's situation?\n\n<em>The availability of health care services in Maria\u2019s neighborhood is limited, with long wait times and fewer specialists. This results in delayed diagnoses and treatments for her diabetes-related complications. Maria lacks comprehensive health insurance, making it difficult for her to access primary and specialist care. High out-of-pocket costs deter her from seeking regular medical attention.<\/em>\n\n5. How does the lack of accessible health care services affect Maria's long-term health outcomes?\n\n6. What are some potential solutions to improve health care access in underserved areas?\n\n<em>Maria lives in a food desert with limited access to fresh fruits and vegetables. She often relies on inexpensive, processed foods that worsen her diabetes. Public transportation in Maria\u2019s area is unreliable, making it challenging for her to attend medical appointments. This lack of transportation contributes to missed check-ups and unmanaged diabetes.<\/em>\n\n7. How does living in a food desert affect Maria's ability to manage her diabetes?\n\n8. What transportation initiatives could help individuals like Maria access healthcare services more easily?\n\n<em>Maria has a limited social network and lacks support from friends and family, which is crucial for managing a chronic condition like diabetes. This isolation can lead to depression and further neglect of her health. Living in a high-crime area, Maria feels unsafe walking outside for exercise, which is essential for diabetes management. This sedentary lifestyle negatively affects her health outcomes.<\/em>\n\n9. How does a lack of social support contribute to Maria's health challenges?\n\n10. What community programs or interventions could be implemented to enhance social support and safety in high-crime areas?\n\n<\/div>","rendered":"<p>The cost of health care in the United States is higher than any other country in the world and has a significant financial impact on our economy.<sup><a class=\"footnote\" title=\"CMS.gov. (2020, December 16). National health expenditure data - historical. Centers for Medicare &amp; Medicaid Services. https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NationalHealthAccountsHistorical\" id=\"return-footnote-171-1\" href=\"#footnote-171-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a> <\/sup>U.S. health care spending grew 4.1 percent in 2022, reaching $ 4.5 trillion or $13,493 per person. Health care spending accounts for 17.3 percent of our Gross Domestic Product (GDP), the total value of goods produced and services provided annually.<sup><a class=\"footnote\" title=\"CMS.gov. (2020, December 16). National health expenditure data - historical. Centers for Medicare &amp; Medicaid Services. https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NationalHealthAccountsHistorical\" id=\"return-footnote-171-2\" href=\"#footnote-171-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a> <\/sup>See Figure 8.1<sup><a class=\"footnote\" title=\"\u201cHealth_Care_Cost_as_Percentage_of_GDP.png\u201d by Delphi234 is licensed under CC0 1.0\" id=\"return-footnote-171-3\" href=\"#footnote-171-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/sup> for a graph of health care cost as a percentage of GDP in the United States compared to other countries around the world.<\/p>\n<figure id=\"attachment_170\" aria-describedby=\"caption-attachment-170\" style=\"width: 1024px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-167 size-full\" title=\"\u201cHealth_Care_Cost_as_Percentage_of_GDP.png\u201d by Delphi234 is licensed under CC0 1.0\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2021\/08\/Health_Care_Cost_as_Percentage_of_GDP.png\" alt=\"Image of a line graph depicting Comparison of Health Care Costs from 1960 to 2010\" width=\"1024\" height=\"768\" srcset=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/08\/Health_Care_Cost_as_Percentage_of_GDP.png 1024w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/08\/Health_Care_Cost_as_Percentage_of_GDP-300x225.png 300w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/08\/Health_Care_Cost_as_Percentage_of_GDP-768x576.png 768w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/08\/Health_Care_Cost_as_Percentage_of_GDP-65x49.png 65w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/08\/Health_Care_Cost_as_Percentage_of_GDP-225x169.png 225w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/08\/Health_Care_Cost_as_Percentage_of_GDP-350x263.png 350w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption id=\"caption-attachment-170\" class=\"wp-caption-text\">Figure 8.1 Comparison of Health Care Costs<\/figcaption><\/figure>\n<p>Despite spending more money on health care than other high-income countries, the United States has some of the poorest health outcomes, such as the lowest life expectancy, the highest infant mortality rate, and a higher prevalence of chronic diseases.<sup><a class=\"footnote\" title=\"Bush, M. (2018). Addressing the root cause: Rising health care costs and social determinants of health. North Carolina Medical Journal, 79(1), 26-29. https:\/\/doi.org\/10.18043\/ncm.79.1.26\" id=\"return-footnote-171-4\" href=\"#footnote-171-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/sup> The increasing costs of health care also have several negative impacts on society, employers, and individuals, including the following effects<sup><a class=\"footnote\" title=\"Schreck, R. I. (2020, March). Overview of health care financing. Merck Manual Consumer Version. https:\/\/www.merckmanuals.com\/home\/fundamentals\/financial-issues-in-health-care\/overview-of-health-care-financing\" id=\"return-footnote-171-5\" href=\"#footnote-171-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li style=\"font-weight: 400\">When the government spends more on health care, the national debt increases and funds available for other programs decrease.<\/li>\n<li style=\"font-weight: 400\">When people spend more on health care, they have less money to spend on other items.<\/li>\n<li style=\"font-weight: 400\">When health insurance is paid by employers, employees are paid less.<\/li>\n<li style=\"font-weight: 400\">When employers spend more on health care, the costs of their products and services increase. Jobs may be moved to countries with lower health care costs.<\/li>\n<li style=\"font-weight: 400\">An increasing number of people cannot afford health care insurance. When people without health care insurance receive health care, they often cannot pay for it. As a result of unpaid bills, this care is indirectly paid for by other people paying increased insurance premiums and taxes.<\/li>\n<li style=\"font-weight: 400\">People without health care insurance may not seek preventative care and develop a more costly, serious medical disorder that could have been prevented.<\/li>\n<li style=\"font-weight: 400\">Medical bills that are not covered by health insurance can cause bankruptcy.<\/li>\n<\/ul>\n<p>There are several national trends affecting the cost of health care and related impacts, including the aging population, increased costs of medical technology, increased prescription medication cost, the Affordable Care Act,\u00a0 social determinants of health, etc.\u00a0 These trends can be further classified as intrinsic or extrinsic factors. <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_171_537\">Intrinsic factors<\/a><\/strong> related to increased health care costs are inherent to the characteristics and needs of the population. One significant intrinsic factor is the demographics of the population, such as age, gender, and overall health status. An aging population, for example, typically requires more medical care due to the prevalence of chronic conditions and the natural decline in health associated with aging. Another intrinsic factor is the demand for health care services. As people become more health-conscious, the demand for preventive care, regular check-ups, and advanced treatments rises, leading to increased overall health care spending. Additionally, the extent and nature of health insurance coverage play a crucial role. Comprehensive insurance plans often lead to higher utilization of health care services, as insured individuals are more likely to seek medical care, knowing that a significant portion of the costs will be covered by their insurance.<\/p>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_171_538\">Extrinsic factors<\/a><\/strong> are external elements that impact health care costs. One of the most prominent extrinsic factors is the availability and adoption of medical technology. Advanced diagnostic tools, treatment methods, and surgical techniques can drive up costs due to their high development, implementation, and maintenance expenses. While these technologies can significantly improve client outcomes, they also contribute to rising health care expenditures. Another critical extrinsic factor is the cost of prescription drugs. Pharmaceutical pricing strategies, including research and development costs, marketing, and profit margins, often lead to high prices for medications, especially for new and specialized drugs. Workforce costs are also a significant extrinsic factor. The salaries and benefits of health care professionals, including doctors, nurses, and administrative staff, constitute a substantial portion of health care expenses. These costs are influenced by factors such as education and training requirements, labor market conditions, and regulatory policies. Addressing these extrinsic factors requires strategic planning and policy interventions to balance cost containment with the quality and accessibility of health care services.<\/p>\n<h2>Aging Population<\/h2>\n<p>According to the Agency for Healthcare Research and Quality (AHRQ), the United States has a growing number of older adults (age 65 years or older) who are living longer than previous generations. It is anticipated that older adults will make up more than 20 percent of the U.S. population by 2030.<sup><a class=\"footnote\" title=\"Agency for Healthcare Research and Quality. (n.d.). Elderly. https:\/\/www.ahrq.gov\/topics\/elderly.html\" id=\"return-footnote-171-6\" href=\"#footnote-171-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a> <\/sup>See Figure 8.2<sup><a class=\"footnote\" title=\"\u201cgraying-america-aging-nation.jpg\u201d by U.S. Census Bureau is in the Public Domain\" id=\"return-footnote-171-7\" href=\"#footnote-171-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/sup> for an illustration of the aging population from the U.S. Census Bureau. This change in demographics will result in increased national health care costs because older adults typically experience more chronic conditions than younger populations, requiring expensive specialty and long-term care.<sup><a class=\"footnote\" title=\"Agency for Healthcare Research and Quality. (n.d.). Elderly. https:\/\/www.ahrq.gov\/topics\/elderly.html\" id=\"return-footnote-171-8\" href=\"#footnote-171-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a><\/sup><\/p>\n<figure id=\"attachment_170\" aria-describedby=\"caption-attachment-170\" style=\"width: 648px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-168\" title=\"\u201cgraying-america-aging-nation.jpg\u201d by U.S. Census Bureau is in the Public Domain\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/graying-america-aging-nation.jpg\" alt=\"Infographic illustrating the Aging Population in the United States\" width=\"648\" height=\"687\" srcset=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/graying-america-aging-nation.jpg 800w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/graying-america-aging-nation-283x300.jpg 283w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/graying-america-aging-nation-768x813.jpg 768w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/graying-america-aging-nation-65x69.jpg 65w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/graying-america-aging-nation-225x238.jpg 225w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/graying-america-aging-nation-350x371.jpg 350w\" sizes=\"auto, (max-width: 648px) 100vw, 648px\" \/><figcaption id=\"caption-attachment-170\" class=\"wp-caption-text\">Figure 8.2 Aging Population in the United States<\/figcaption><\/figure>\n<h2>Increased Costs of Medical Technology<\/h2>\n<p>Highly visible medical technologies, such as organ transplantation, diagnostic imaging systems, and biotechnology products, attract both praise and blame. Evolving medical technologies may save lives and improve a client\u2019s health status, but they are also viewed as a dominant cause of continued escalation of medical costs. Research suggests that medical technology accounts for about 10 to 40 percent of the increase in health care expenditures over time.<sup><a class=\"footnote\" title=\"Neumann, P. J., &amp; Weinstein, M. C. (1991). The diffusion of new technology: Costs and benefits to health care. In Institute of Medicine (US) Committee on Technological Innovation in Medicine, Gelijns, A. C., &amp; Halm, E. A. (Eds.). The changing economics of medical technology. National Academies Press. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK234309\/\" id=\"return-footnote-171-9\" href=\"#footnote-171-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a><\/sup> These costs also lead to further ethical dilemmas as decisions regarding what scarce resources are provided to which clients are made. See Figure 8.3<sup><a class=\"footnote\" title=\"\u201c49458105981_fe87fd521c_o.jpg\u201d by Wonderlane is licensed under CC BY 2.0\" id=\"return-footnote-171-10\" href=\"#footnote-171-10\" aria-label=\"Footnote 10\"><sup class=\"footnote\">[10]<\/sup><\/a><\/sup> for an image of common technology used in health care.<\/p>\n<figure id=\"attachment_170\" aria-describedby=\"caption-attachment-170\" style=\"width: 713px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-169\" title=\"\u201c49458105981_fe87fd521c_o.jpg\u201d by Wonderlane is licensed under CC BY 2.0\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/49458105981_42705f8ab1_k-1024x576.jpg\" alt=\"Photo showing various health care equipment\" width=\"713\" height=\"401\" srcset=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/49458105981_42705f8ab1_k-1024x576.jpg 1024w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/49458105981_42705f8ab1_k-300x169.jpg 300w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/49458105981_42705f8ab1_k-768x432.jpg 768w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/49458105981_42705f8ab1_k-1536x864.jpg 1536w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/49458105981_42705f8ab1_k-65x37.jpg 65w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/49458105981_42705f8ab1_k-225x127.jpg 225w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/49458105981_42705f8ab1_k-350x197.jpg 350w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/49458105981_42705f8ab1_k.jpg 2048w\" sizes=\"auto, (max-width: 713px) 100vw, 713px\" \/><figcaption id=\"caption-attachment-170\" class=\"wp-caption-text\">Figure 8.3 Health Care Technology<\/figcaption><\/figure>\n<p>Medical technologies, especially new ones, must justify their costs in a climate of competing claims on limited resources. Resource allocation follows American society&#8217;s objective of cost effectiveness: if a new technology improves health outcomes at a lower cost than existing technologies, it should be adopted; otherwise, it should not.<sup><a class=\"footnote\" title=\"Neumann, P. J., &amp; Weinstein, M. C. (1991). The diffusion of new technology: Costs and benefits to health care. In Institute of Medicine (US) Committee on Technological Innovation in Medicine, Gelijns, A. C., &amp; Halm, E. A. (Eds.). The changing economics of medical technology. National Academies Press. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK234309\/\" id=\"return-footnote-171-11\" href=\"#footnote-171-11\" aria-label=\"Footnote 11\"><sup class=\"footnote\">[11]<\/sup><\/a><\/sup><\/p>\n<h2>Increased Prescription Medication Costs<\/h2>\n<p>Retail prices for commonly-used prescription medications continue to increase twice as much as inflation, contributing to increased health care costs and making these life-sustaining medicines potentially unaffordable to many Americans. According to a recent AARP <em>Rx Price Watch<\/em> report, in 2020 prices for 260 commonly used medications increased 2.9 percent while the general rate of inflation was 1.3 percent.<sup><a class=\"footnote\" title=\"Bunis, D. (2021, June 7). Prescription drug price increases continue to outpace inflation. AARP. https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html\" id=\"return-footnote-171-12\" href=\"#footnote-171-12\" aria-label=\"Footnote 12\"><sup class=\"footnote\">[12]<\/sup><\/a> <\/sup>For example, the cost of Symbicort, a medication used to treat asthma and COPD, increased 46 percent, from $2,940 to $4,282.<sup><a class=\"footnote\" title=\"Bunis, D. (2021, June 7). Prescription drug price increases continue to outpace inflation. AARP. https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html\" id=\"return-footnote-171-13\" href=\"#footnote-171-13\" aria-label=\"Footnote 13\"><sup class=\"footnote\">[13]<\/sup><\/a><\/sup> See Figure 8.4<sup><a class=\"footnote\" title=\"Peterson_KFF Health Systems Tracker. (n.d.). Health expenditures 1960-2020. https:\/\/www.healthsystemtracker.org\/health-spending-explorer\/?outputType=%24pop-adjusted&amp;serviceType%5B0%5D=prescriptionDrug&amp;serviceType%5B1%5D=hospitals&amp;serviceType%5B2%5D=allTypes&amp;sourceOfFunds%5B0%5D=allSources&amp;tab=0&amp;yearCompare%5B0%5D=%2A&amp;yearCompare%5B1%5D=%2A&amp;yearRange%5B0%5D=%2A&amp;yearRange%5B1%5D=%2A&amp;yearSingle=%2A&amp;yearType=range\" id=\"return-footnote-171-14\" href=\"#footnote-171-14\" aria-label=\"Footnote 14\"><sup class=\"footnote\">[14]<\/sup><\/a><\/sup> for an illustration related to prescription medication costs.<\/p>\n<figure id=\"attachment_170\" aria-describedby=\"caption-attachment-170\" style=\"width: 765px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-170 size-full\" title=\"&quot;Health Expenditures 1960-2020&quot;, KFF, accessed March 12, 2022 https:\/\/www.healthsystemtracker.org\/health-spending-explorer\/?outputType=%24pop-adjusted&amp;serviceType%5B0%5D=prescriptionDrug&amp;serviceType%5B1%5D=hospitals&amp;serviceType%5B2%5D=allTypes&amp;sourceOfFunds%5B0%5D=allSources&amp;tab=0&amp;yearCompare%5B0%5D=%2A&amp;yearCompare%5B1%5D=%2A&amp;yearRange%5B0%5D=%2A&amp;yearRange%5B1%5D=%2A&amp;yearSingle=%2A&amp;yearType=range\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/Historical-Prescription-Drug-Costs.png\" alt=\"Line graph showing historical trends in prescription drug costs, 1960 to 2020\" width=\"765\" height=\"554\" srcset=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/Historical-Prescription-Drug-Costs.png 765w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/Historical-Prescription-Drug-Costs-300x217.png 300w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/Historical-Prescription-Drug-Costs-65x47.png 65w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/Historical-Prescription-Drug-Costs-225x163.png 225w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/Historical-Prescription-Drug-Costs-350x253.png 350w\" sizes=\"auto, (max-width: 765px) 100vw, 765px\" \/><figcaption id=\"caption-attachment-170\" class=\"wp-caption-text\">Figure 8.4 Prescription Medication Costs<\/figcaption><\/figure>\n<p>Although the majority of Americans have either public or private insurance that helps them pay for medications, increased medication prices result in higher health insurance premiums and higher taxpayer costs for the Medicare and Medicaid programs. Some insurance companies only cover approved formulary medications. As a result, national organizations like the American Association of Retired Persons (AARP) advocate for national policy changes, such as allowing Medicare to negotiate the prices of prescription medications with drug companies and allowing private insurance plans to have access to those lower prices.<sup><a class=\"footnote\" title=\"Bunis, D. (2021, June 7). Prescription drug price increases continue to outpace inflation. AARP. https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html\" id=\"return-footnote-171-15\" href=\"#footnote-171-15\" aria-label=\"Footnote 15\"><sup class=\"footnote\">[15]<\/sup><\/a> <\/sup><\/p>\n<p>Many consumers find themselves tasked with the difficult decision of purchasing expensive medication or going without prescribed medication and paying for their families&#8217; housing and food. Nurses often become involved in case management activities when assisting clients to obtain medications they cannot afford. Nursing case management activities are discussed later in this chapter.<\/p>\n<h2>Affordable Care Act<\/h2>\n<p>The Patient Protection and Affordable Care Act (PPACA), also known as the<strong> <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_171_390\">Affordable Care Act (ACA)<\/a> <\/strong>or Obamacare, was signed into law in 2010. The purpose of this legislation was to increase consumers&#8217; access to health care coverage and protect them from insurance practices that restricted care or significantly increased the cost of care. The ACA mandated health insurance coverage for employers and individuals. Employers were mandated to provide health care coverage based on the number of their employees, and individuals who were not covered through employer insurance plans were mandated to seek coverage through a newly created Marketplace. The Marketplace provides a central, website that offers three standard health insurance coverage levels to facilitate comparison by consumers. As a result of the ACA and associated Medicaid expansion, 32 million people had health care coverage in 2021.<sup><a class=\"footnote\" title=\"HealthCare.gov. Insurance marketplace. https:\/\/www.healthcare.gov\/subscribe\/? gclid=Cj0KCQjwiqWHBhD2ARIsAPCDzamNRkS3URx_uUvJGdpX15DrZnVbBadXbPmOjBBlLyjtZBn7cLei6WEaAl8GEALw_wcB&amp;gclsrc=aw.ds\" id=\"return-footnote-171-16\" href=\"#footnote-171-16\" aria-label=\"Footnote 16\"><sup class=\"footnote\">[16]<\/sup><\/a><\/sup><\/p>\n<div class=\"textbox shaded\"><span class=\"arrow\">Read about the Affordable Care Act at <a href=\"https:\/\/www.hhs.gov\/healthcare\/about-the-aca\/index.html\" target=\"_blank\" rel=\"noopener\">HHS.gov.<\/a><\/span><\/div>\n<h3>Key Provisions of the ACA<\/h3>\n<p>The ACA includes the following key provisions<sup><a class=\"footnote\" title=\"HHS.gov. About the Affordable Care Act. U.S. Department of Health &amp; Human Services. https:\/\/www.hhs.gov\/healthcare\/about-the-aca\/index.html\" id=\"return-footnote-171-17\" href=\"#footnote-171-17\" aria-label=\"Footnote 17\"><sup class=\"footnote\">[17]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li>Insurers can no longer deny coverage or care for preexisting conditions like diabetes, asthma, and cancer.<\/li>\n<li style=\"font-weight: 400\">Young adults may remain on their parents\u2019 insurance plans until they are 26 (even if they are married, financially independent, or not living with their parents).<\/li>\n<li style=\"font-weight: 400\">Health insurance plans cannot place annual or lifetime limits on coverage, except for nonessential exceptions, such as cosmetic procedures.<\/li>\n<li style=\"font-weight: 400\">Many preventive services must be provided, such as:\n<ul>\n<li style=\"font-weight: 400\">Well-child visits, flu shots, and other common vaccines<\/li>\n<li style=\"font-weight: 400\">Screening tests for blood pressure and diabetes<\/li>\n<li style=\"font-weight: 400\">Diagnostic screening tests, such mammograms and colonoscopies<\/li>\n<li style=\"font-weight: 400\">Counseling services related to mental health and substance use<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>The ACA also provides an avenue for consumers to appeal insurance companies\u2019 denials for care or payment of services and restricts situations in which an insurance carrier may cancel a policy.<\/p>\n<h3>Challenges to the ACA<\/h3>\n<p>Although the ACA has significantly increased the number of Americans with health insurance coverage, it continues to be debated. Debates focus on increased taxes, increased insurance premiums, and some people\u2019s belief that mandated coverage is governmental intrusion on an individual\u2019s rights. The Affordable Care Act has been challenged three times without success. In 2012 the U. S. Supreme Court upheld mandated coverage as a constitutional exercise of Congress\u2019 taxing powers because it could be interpreted as an individual\u2019s choice to maintain health insurance or pay a tax. However, in 2017 Congress set the penalty for failing to comply with the mandate at zero dollars after multiple attempts to repeal and replace the ACA. In June 2021 the U.S. Supreme Court rejected a third major challenge regarding the constitutionality of the ACA. In a 7-to-2 decision, the U.S. Supreme Court upheld the ACA based on the judgment that the states who brought forth the case did not prove damage to citizens because the fines for not having health coverage had been eliminated since the original legislation was passed.<sup><a class=\"footnote\" title=\"K&amp;L Gates LLP, Carnevale, A., Hamscho, V., Lawless, T., &amp; Sha Page, K. (2021, June 21). The Affordable Care Act survives Supreme Court challenge: What happens next? JD Supra. https:\/\/www.jdsupra.com\/legalnews\/the-affordable-care-act-survives-3115372\/\" id=\"return-footnote-171-18\" href=\"#footnote-171-18\" aria-label=\"Footnote 18\"><sup class=\"footnote\">[18]<\/sup><\/a><\/sup><\/p>\n<h3>What to Expect Next<\/h3>\n<p>Given the Supreme Court\u2019s recent decision regarding the ACA, it is expected the current administration will continue to advocate for the ACA and work towards making ACA tax credits permanent. Congress is also actively debating other legislative proposals to reduce health care costs, such as medication pricing reform and expanding Medicare eligibility age and benefits.<sup><a class=\"footnote\" title=\"K&amp;L Gates LLP, Carnevale, A., Hamscho, V., Lawless, T., &amp; Sha Page, K. (2021, June 21). The Affordable Care Act survives Supreme Court challenge: What happens next? JD Supra. https:\/\/www.jdsupra.com\/legalnews\/the-affordable-care-act-survives-3115372\/\" id=\"return-footnote-171-19\" href=\"#footnote-171-19\" aria-label=\"Footnote 19\"><sup class=\"footnote\">[19]<\/sup><\/a><\/sup><\/p>\n<h2>Social Determinants of Health<\/h2>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_171_408\">Social Determinants of Health (SDOH)<\/a><\/strong> are the conditions in the environments where people live, learn, work, and play that affect a wide range of outcomes. SDOH include health care access and quality, neighborhood and environment, social and community context, economic stability, and education access and quality. These conditions have a major impact on people\u2019s health and well-being, ultimately affecting national health care costs.<sup><a class=\"footnote\" title=\"Healthy People 2030. (n.d.). Social determinants of health. U.S. Department of Health and Human Services. https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health\" id=\"return-footnote-171-20\" href=\"#footnote-171-20\" aria-label=\"Footnote 20\"><sup class=\"footnote\">[20]<\/sup><\/a>\u00a0<\/sup><\/p>\n<p>SDOH directly impact individuals&#8217; health behaviors, their access to routine health care, and development of chronic disease. Yet, the United States spends a significantly lower percentage of its gross domestic product (GDP) on social services as compared to similar countries with better health outcomes.<sup><a class=\"footnote\" title=\"Bush, M. (2018). Addressing the root cause: Rising health care costs and social determinants of health. North Carolina Medical Journal. 79(1), 26-29. https:\/\/www.ncmedicaljournal.com\/content\/79\/1\/26\" id=\"return-footnote-171-21\" href=\"#footnote-171-21\" aria-label=\"Footnote 21\"><sup class=\"footnote\">[21]<\/sup><\/a><\/sup><\/p>\n<p>Healthy People 2030, established by the U.S. Department of Health and Human Services, identifies public health priorities to help individuals, organizations, and communities across the United States improve health and well-being over the next decade by addressing SDOH. One of Healthy People 2030\u2019s goals states, \u201cCreate social, physical, and economic environments that promote attaining the full potential for health and well-being for all.\u201d<sup><a class=\"footnote\" title=\"Healthy People 2030. (n.d.). Social determinants of health. U.S. Department of Health and Human Services. https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health\" id=\"return-footnote-171-22\" href=\"#footnote-171-22\" aria-label=\"Footnote 22\"><sup class=\"footnote\">[22]<\/sup><\/a><\/sup> Nurses act in many ways to address these priorities as they advocate for individuals, families, and communities.<\/p>\n<div class=\"textbox shaded\"><span class=\"arrow\"> Read more about efforts addressing SDOH for improved economic stability and health care access in <a href=\"https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health\" target=\"_blank\" rel=\"noopener\">Healthy People 2020<\/a>.<\/span><\/div>\n<div><strong>SDOH Case Study<\/strong><\/div>\n<div class=\"textbox shaded\">\n<p><strong>Maria&#8217;s Journey Through the Health Care System <\/strong><em>(Answers are located in the answer key at the back of the book)<\/em><\/p>\n<p><em>Maria, a 45-year-old woman, lives in a low-income neighborhood in a large urban area. She works two part-time jobs to support her family of four and has limited access to health care due to financial constraints and transportation issues. Maria has been diagnosed with type 2 diabetes, and her health care outcomes are significantly influenced by various Social Determinants of Health (SDOH).<\/em><\/p>\n<p><em>Maria&#8217;s low income and unstable employment contribute to her inability to afford healthy food, medications, and regular medical check-ups. This economic instability exacerbates her diabetes, as she often skips doses of her medication to save money and cannot afford nutritious meals that would help manage her condition. The constant stress of making ends meet and providing for her family leads to increased cortisol levels, which can negatively impact her blood sugar control.<\/em><\/p>\n<p>1. How can Maria&#8217;s financial stress impact her ability to manage her diabetes effectively?<\/p>\n<p>2. What programs or policies could be implemented to assist individuals like Maria in managing their health care costs?<\/p>\n<p><em>Maria has limited knowledge about diabetes management due to a lack of education and access to health information. This impacts her ability to understand and implement lifestyle changes or adhere to treatment plans. With limited education, Maria struggles to find better-paying jobs that could provide health insurance and more financial stability.<\/em><\/p>\n<p>3. In what ways can improved health literacy impact Maria&#8217;s diabetes management?<\/p>\n<p>4. What community resources could be made available to enhance health education for individuals in Maria&#8217;s situation?<\/p>\n<p><em>The availability of health care services in Maria\u2019s neighborhood is limited, with long wait times and fewer specialists. This results in delayed diagnoses and treatments for her diabetes-related complications. Maria lacks comprehensive health insurance, making it difficult for her to access primary and specialist care. High out-of-pocket costs deter her from seeking regular medical attention.<\/em><\/p>\n<p>5. How does the lack of accessible health care services affect Maria&#8217;s long-term health outcomes?<\/p>\n<p>6. What are some potential solutions to improve health care access in underserved areas?<\/p>\n<p><em>Maria lives in a food desert with limited access to fresh fruits and vegetables. She often relies on inexpensive, processed foods that worsen her diabetes. Public transportation in Maria\u2019s area is unreliable, making it challenging for her to attend medical appointments. This lack of transportation contributes to missed check-ups and unmanaged diabetes.<\/em><\/p>\n<p>7. How does living in a food desert affect Maria&#8217;s ability to manage her diabetes?<\/p>\n<p>8. What transportation initiatives could help individuals like Maria access healthcare services more easily?<\/p>\n<p><em>Maria has a limited social network and lacks support from friends and family, which is crucial for managing a chronic condition like diabetes. This isolation can lead to depression and further neglect of her health. Living in a high-crime area, Maria feels unsafe walking outside for exercise, which is essential for diabetes management. This sedentary lifestyle negatively affects her health outcomes.<\/em><\/p>\n<p>9. How does a lack of social support contribute to Maria&#8217;s health challenges?<\/p>\n<p>10. What community programs or interventions could be implemented to enhance social support and safety in high-crime areas?<\/p>\n<\/div>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-171-1\">CMS.gov. (2020, December 16). <em>National health expenditure data - historical. <\/em>Centers for Medicare &amp; Medicaid Services<em>.<\/em> <a href=\"https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NationalHealthAccountsHistorical\" target=\"_blank\" rel=\"noopener\">https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NationalHealthAccountsHistorical<\/a> <a href=\"#return-footnote-171-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-171-2\">CMS.gov. (2020, December 16). <em>National health expenditure data - historical<\/em>. Centers for Medicare &amp; Medicaid Services. <a href=\"https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NationalHealthAccountsHistorical\" target=\"_blank\" rel=\"noopener\">https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NationalHealthAccountsHistorical<\/a> <a href=\"#return-footnote-171-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-171-3\">\u201c<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Health_Care_Cost_as_Percentage_of_GDP.png\" target=\"_blank\" rel=\"noopener\">Health_Care_Cost_as_Percentage_of_GDP.png<\/a>\u201d by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Delphi234\" target=\"_blank\" rel=\"noopener\">Delphi234<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/deed.en\" target=\"_blank\" rel=\"noopener\">CC0 1.0<\/a> <a href=\"#return-footnote-171-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-171-4\">Bush, M. (2018). Addressing the root cause: Rising health care costs and social determinants of health. <em>North Carolina Medical Journal, 79<\/em>(1), 26-29. <a href=\"https:\/\/doi.org\/10.18043\/ncm.79.1.26\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.18043\/ncm.79.1.26<\/a>  <a href=\"#return-footnote-171-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-171-5\">Schreck, R. I. (2020, March). Overview of health care financing. <em>Merck Manual Consumer Version<\/em>. <a href=\"https:\/\/www.merckmanuals.com\/home\" target=\"_blank\" rel=\"noopener\">https:\/\/www.merckmanuals.com\/home\/fundamentals\/financial-issues-in-health-care\/overview-of-health-care-financing<\/a> <a href=\"#return-footnote-171-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-171-6\">Agency for Healthcare Research and Quality. (n.d.). <em>Elderly.<\/em> <a href=\"https:\/\/www.ahrq.gov\/topics\/elderly.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/topics\/elderly.html<\/a> <a href=\"#return-footnote-171-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-171-7\">\u201c<a href=\"https:\/\/www.census.gov\/library\/stories\/2018\/03\/graying-america.html\" target=\"_blank\" rel=\"noopener\">graying-america-aging-nation.jpg<\/a>\u201d by <a href=\"https:\/\/www.census.gov\/\" target=\"_blank\" rel=\"noopener\">U.S. Census Bureau<\/a> is in the <a href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" target=\"_blank\" rel=\"noopener\">Public Domain<\/a> <a href=\"#return-footnote-171-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-171-8\">Agency for Healthcare Research and Quality. (n.d.).<em> Elderly<\/em>. <a href=\"https:\/\/www.ahrq.gov\/topics\/elderly.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/topics\/elderly.html<\/a> <a href=\"#return-footnote-171-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-171-9\">Neumann, P. J., &amp; Weinstein, M. C. (1991). The diffusion of new technology: Costs and benefits to health care. In Institute of Medicine (US) Committee on Technological Innovation in Medicine, Gelijns, A. C., &amp; Halm, E. A. (Eds.). <em>The changing economics of medical technology.<\/em> National Academies Press. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK234309\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK234309\/<\/a> <a href=\"#return-footnote-171-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><li id=\"footnote-171-10\">\u201c<a href=\"https:\/\/www.flickr.com\/photos\/wonderlane\/49458105981\" target=\"_blank\" rel=\"noopener\">49458105981_fe87fd521c_o.jpg<\/a>\u201d by <a href=\"https:\/\/www.flickr.com\/photos\/wonderlane\/\" target=\"_blank\" rel=\"noopener\">Wonderlane<\/a> is licensed under <a href=\"https:\/\/www.creativecommons.org\/licenses\/by\/2.0\/\" target=\"_blank\" rel=\"noopener\">CC BY 2.0<\/a> <a href=\"#return-footnote-171-10\" class=\"return-footnote\" aria-label=\"Return to footnote 10\">&crarr;<\/a><\/li><li id=\"footnote-171-11\">Neumann, P. J., &amp; Weinstein, M. C. (1991). The diffusion of new technology: Costs and benefits to health care. In Institute of Medicine (US) Committee on Technological Innovation in Medicine, Gelijns, A. C., &amp; Halm, E. A. (Eds.). <em>The changing economics of medical technology.<\/em> National Academies Press. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK234309\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK234309\/<\/a> <a href=\"#return-footnote-171-11\" class=\"return-footnote\" aria-label=\"Return to footnote 11\">&crarr;<\/a><\/li><li id=\"footnote-171-12\">Bunis, D. (2021, June 7). <em>Prescription drug price increases continue to outpace inflation<\/em>. AARP. <a href=\"https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html<\/a> <a href=\"#return-footnote-171-12\" class=\"return-footnote\" aria-label=\"Return to footnote 12\">&crarr;<\/a><\/li><li id=\"footnote-171-13\">Bunis, D. (2021, June 7). <em>Prescription drug price increases continue to outpace inflation<\/em>. AARP. <a href=\"https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html<\/a> <a href=\"#return-footnote-171-13\" class=\"return-footnote\" aria-label=\"Return to footnote 13\">&crarr;<\/a><\/li><li id=\"footnote-171-14\">Peterson_KFF Health Systems Tracker. (n.d.). <em>Health expenditures 1960-2020. <\/em><a href=\"https:\/\/www.healthsystemtracker.org\/health-spending-explorer\/?outputType=%24pop-adjusted&amp;serviceType%5B0%5D=prescriptionDrug&amp;serviceType%5B1%5D=hospitals&amp;serviceType%5B2%5D=allTypes&amp;sourceOfFunds%5B0%5D=allSources&amp;tab=0&amp;yearCompare%5B0%5D=%2A&amp;yearCompare%5B1%5D=%2A&amp;yearRange%5B0%5D=%2A&amp;yearRange%5B1%5D=%2A&amp;yearSingle=%2A&amp;yearType=range\">https:\/\/www.healthsystemtracker.org\/health-spending-explorer\/?outputType=%24pop-adjusted&amp;serviceType%5B0%5D=prescriptionDrug&amp;serviceType%5B1%5D=hospitals&amp;serviceType%5B2%5D=allTypes&amp;sourceOfFunds%5B0%5D=allSources&amp;tab=0&amp;yearCompare%5B0%5D=%2A&amp;yearCompare%5B1%5D=%2A&amp;yearRange%5B0%5D=%2A&amp;yearRange%5B1%5D=%2A&amp;yearSingle=%2A&amp;yearType=range<\/a> <a href=\"#return-footnote-171-14\" class=\"return-footnote\" aria-label=\"Return to footnote 14\">&crarr;<\/a><\/li><li id=\"footnote-171-15\">Bunis, D. (2021, June 7). <em>Prescription drug price increases continue to outpace inflation<\/em>. AARP. <a href=\"https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.aarp.org\/politics-society\/advocacy\/info-2021\/prescription-price-increase-report.html<\/a> <a href=\"#return-footnote-171-15\" class=\"return-footnote\" aria-label=\"Return to footnote 15\">&crarr;<\/a><\/li><li id=\"footnote-171-16\">HealthCare.gov. <em>Insurance marketplace.<\/em> <a href=\"https:\/\/www.healthcare.gov\/subscribe\/?gclid=Cj0KCQjwiqWHBhD2ARIsAPCDzamNRkS3URx_uUvJGdpX15DrZnVbBadXbPmOjBBlLyjtZBn7cLei6WEaAl8GEALw_wcB&amp;gclsrc=aw.ds\" target=\"_blank\" rel=\"noopener\">https:\/\/www.healthcare.gov\/subscribe\/? gclid=Cj0KCQjwiqWHBhD2ARIsAPCDzamNRkS3URx_uUvJGdpX15DrZnVbBadXbPmOjBBlLyjtZBn7cLei6WEaAl8GEALw_wcB&amp;gclsrc=aw.ds<\/a> <a href=\"#return-footnote-171-16\" class=\"return-footnote\" aria-label=\"Return to footnote 16\">&crarr;<\/a><\/li><li id=\"footnote-171-17\">HHS.gov. <em>About the Affordable Care Act.<\/em> U.S. Department of Health &amp; Human Services. <a href=\"https:\/\/www.hhs.gov\/healthcare\/about-the-aca\/index.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.hhs.gov\/healthcare\/about-the-aca\/index.html<\/a> <a href=\"#return-footnote-171-17\" class=\"return-footnote\" aria-label=\"Return to footnote 17\">&crarr;<\/a><\/li><li id=\"footnote-171-18\">K&amp;L Gates LLP, Carnevale, A., Hamscho, V., Lawless, T., &amp; Sha Page, K. (2021, June 21).<em> The Affordable Care Act survives Supreme Court challenge: What happens next?<\/em> JD Supra. <a href=\"https:\/\/www.jdsupra.com\/legalnews\/the-affordable-care-act-survives-3115372\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.jdsupra.com\/legalnews\/the-affordable-care-act-survives-3115372<\/a>\/ <a href=\"#return-footnote-171-18\" class=\"return-footnote\" aria-label=\"Return to footnote 18\">&crarr;<\/a><\/li><li id=\"footnote-171-19\">K&amp;L Gates LLP, Carnevale, A., Hamscho, V., Lawless, T., &amp; Sha Page, K. (2021, June 21).<em> The Affordable Care Act survives Supreme Court challenge: What happens next?<\/em> JD Supra. <a href=\"https:\/\/www.jdsupra.com\/legalnews\/the-affordable-care-act-survives-3115372\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.jdsupra.com\/legalnews\/the-affordable-care-act-survives-3115372<\/a>\/ <a href=\"#return-footnote-171-19\" class=\"return-footnote\" aria-label=\"Return to footnote 19\">&crarr;<\/a><\/li><li id=\"footnote-171-20\">Healthy People 2030. (n.d.).<em> Social determinants of health<\/em>. U.S. Department of Health and Human Services. <a href=\"https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health\" target=\"_blank\" rel=\"noopener\">https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health<\/a> <a href=\"#return-footnote-171-20\" class=\"return-footnote\" aria-label=\"Return to footnote 20\">&crarr;<\/a><\/li><li id=\"footnote-171-21\">Bush, M. (2018). Addressing the root cause: Rising health care costs and social determinants of health. <em>North Carolina Medical Journal. 79<\/em>(1), 26-29. <a href=\"https:\/\/ncmedicaljournal.com\/article\/55056\">https:\/\/www.ncmedicaljournal.com\/content\/79\/1\/26<\/a> <a href=\"#return-footnote-171-21\" class=\"return-footnote\" aria-label=\"Return to footnote 21\">&crarr;<\/a><\/li><li id=\"footnote-171-22\">Healthy People 2030. (n.d.). <em>Social determinants of health.<\/em> U.S. Department of Health and Human Services. <a href=\"https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health\" target=\"_blank\" rel=\"noopener\">https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health<\/a> <a href=\"#return-footnote-171-22\" class=\"return-footnote\" aria-label=\"Return to footnote 22\">&crarr;<\/a><\/li><\/ol><\/div><div class=\"glossary\"><span class=\"screen-reader-text\" id=\"definition\">definition<\/span><template id=\"term_171_537\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_171_537\"><div tabindex=\"-1\"><p>Factors that are inherent to the characteristics and needs of the population.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_171_538\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_171_538\"><div tabindex=\"-1\"><p>External elements that impact healthcare costs.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_171_390\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_171_390\"><div tabindex=\"-1\"><p>Legislation enacted in 2010 to increase consumers' access to health care coverage and protect them from insurance practices that restricted care or significantly increased the cost of care.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_171_408\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_171_408\"><div tabindex=\"-1\"><p>Conditions in the places where people live, learn, work, and play, such as unstable housing, low income areas, unsafe neighborhoods, or substandard education that affect a wide range of health risks and outcomes.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><\/div>","protected":false},"author":32,"menu_order":2,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[48],"contributor":[],"license":[],"class_list":["post-171","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":164,"_links":{"self":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapters\/171","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/wp\/v2\/users\/32"}],"version-history":[{"count":2,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapters\/171\/revisions"}],"predecessor-version":[{"id":565,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapters\/171\/revisions\/565"}],"part":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/parts\/164"}],"metadata":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapters\/171\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/wp\/v2\/media?parent=171"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapter-type?post=171"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/wp\/v2\/contributor?post=171"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/wp\/v2\/license?post=171"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}