America could easily save $1 billion per year just by giving kids flu shots at pharmacies, experts say

Over the next decade, the organization projects that Medicare costs will double, subsidies to support the Affordable Care Act will jump 33% and Medicaid and Children’s Health Insurance will grow by 36%.

Zack Cooper, an associate professor of public health and economics at Yale, says when you factor in what healthcare is costing individual states, healthcare providers and average Americans, the real cost of healthcare is closer to $5 trillion a year.

The prognosis doesn’t look good for our nation’s healthcare spending. But Cooper says some targeted cures could help. He’s working with researchers nationwide to find them as director of Yale’s Health Care Affordability Lab.

So far, they’ve identified 23 small-scale fixes that could add up to $450 billion in savings.

“A lot of good can come from small changes,” he said.

Here’s a look at three of those ideas that the research team claims could save $10 billion alone — equivalent to the annual budget for the Centers for Disease Control (CDC) or the FBI.

Give kids flu vaccines at the pharmacy: $1B saved

The flu season got off to an early start this year and it’s already straining hospitals. New Jersey-based Dr. Christina Melchionne Miseo, a pediatric emergency medicine physician, has seen it at Atlantic Health Morristown Medical Center.

“This October, we saw 400 more children in our ER compared to last October, which really represents that surge kind of coming on early and quick and strong,” she told NJ.com.

It’s bad from a health perspective, but it’s also a public health issue that costs governments money. Michael Anderson, an economist at the University of California — Berkeley says there’s a simple solution: Give children flu vaccines at pharmacies.

Currently, adults can get flu vaccines at pharmacies across the U.S. but children can’t. If they do get flu shots, it’s generally once a year at the pediatrician’s office during a well-child visit — a doctor’s visit including vaccinations that many states mandate for children and youth aged three to 21, per the Center for Pediatric Medicine. Those visits are generally timed around a child’s birthday.

That timing presents a problem. Anderson noted that flu season generally starts in October. If a child’s birthday falls at a different time of year, they’re not going to show up at the pediatrician’s office when a flu shot is available or timely to protect them against the flu.

Most parents don’t set up appointments at the pediatrician’s just for their child to get a vaccine. As a father himself, Anderson gets it.

“Convenience is such a big factor,” he told Moneywise.

That’s why he recommends allowing pharmacies to offer flu shots to children: It’s convenient. Estimated savings: $1 billion by reducing cases of flu, related respiratory illnesses and even fatalities among children.

Let patients go home for rehab: $1.6B saved

According to Skilled Nursing News, $31 billion a year in Medicare payments goes to patients recuperating in nursing homes and other skilled nursing facilities after hospital stays. The goal is to help them recover strength after losing some conditioning in hospital, which requires physiotherapy and other rehabilitation.

Rachel Werner, a professor of medicine at the University of Pennsylvania, says Medicare covers 100 days of that rehabilitation, but only the first 20 days are fully covered. From the 21st day on, patients have to co-pay $217 a day.

Werner says that raises a question: Why not send patients home earlier to receive physiotherapy and other home care? Her research shows that it’s not an unsafe option, as data shows that patients who are immediately discharged home and receive care there are no likelier to die than those sent to a skilled nursing facility. And they progress just as well in recovering daily functions like bathing and dressing.

“Many patients want to go home anyway,” she noted.

Werner said just 10% of such residential rehabilitation stays were eliminated, it would save Medicare $898 million. Shortening stays for the other 90% would save another $664 million, she said, adding up to $1.56 billion in combined savings.

Pool individual and small group insurance: $3.9B saved

New York University economist Michael Dickstein proposes pooling two different types of insurance coverage to save nearly $4 billion in insurance costs. Specifically, he recommends blending these two markets:

• 22 million Americans with individual coverage (who either buy their own private plan or purchase one through the Affordable Care Act marketplace), and
• 10 million Americans with small group coverage offered through employers with fewer than 50 employees.

According to Dickstein, small group enrollees spend 26% less on healthcare but pay 7% higher premiums for the same coverage. As a result, “Healthier people are paying more for insurance than sicker people,” he said. It also means the federal government pays more in ACA subsidies for those people covered under small group coverage.