NRS 428 Topic 4 DQ 1: Research the delivery, finance, management, and sustainability methods of the US health care system
There are many different types of medical professionals working in a variety of groups, networks, and individual practices, including doctors, nurses, hospitals, and other healthcare facilities. Healthcare is another industry that can’t function well without revenue, yet it also offers services to people who can’t pay for them but still need them (Royce, 2021). In the US, financing medical care is a significant issue. Although people may have free access to healthcare in a variety of contexts, healthcare organizations and providers need to be paid in order to stay in business. Healthcare professionals work together to deliver healthcare through prevention, health promotion, and patient care. Professionals in healthcare management supervise and organize all facets of healthcare (Park, & Look, 2019). These managers make sure that healthcare facilities run efficiently for everyone involved, whether they are managing hospital operations or organizing the activities in a small private practice.
NRS 428 Topic 4 DQ 1
Financing for health care is a major concern in the United States. One means of paying for health care is through out-of-pocket payment or self-payment of services. Most Americans have neither the income nor savings to cover the full cost of health services when faced with more than a minor illness or condition (Falkner, 2018), especially the unemployed, uninsured, and older adults. For Americans to enjoy optimal health as individuals and as a population, they must have the benefit of high-quality health care services that are effectively coordinated within a strong public health system. Health care is not the only, or even the strongest, determinant of health, but it is very important.
NRS 428 Topic 4 DQ 1
For most Americans, having health insurance under a private plan or through a publicly financed program is a threshold requirement for routine access to health care. Cost, administrate burden, and discriminatory cases are some of the fundamental factors prohibiting quality patient care and health outcomes. The health care sector in the U.S. is composed of an array of clinicians, health care facilities, pharmaceuticals, insurance plans and clients. Either based in the public or private sectors, all health care practitioner, insurance agencies and purchasers of health care services are expected to work together toward achieving quality patient care and health outcomes.
NRS 428 Topic 4 DQ 1
The most effective reform to improve the effectiveness of healthcare delivery would be to retain Affordable Care Act (ACA) market reforms. From 2010 to 2016, policies in the ACA led to a steady decline in the number of uninsured Americans (Blumenthal et al., 2020). These coverage gains have led to improved health, equity, and financial well-being. Medicaid expansion helps promote the health of low-income people and people with disabilities in the U.S, which in turn improves the overall patient care and delivery. Further, the inclusion of the “Essential Health Benefits” is another ACA reform to be retained as it ensures all insured members receive quality care for essential needs. These include preventive medical services, rehabilitation services, emergency care, mental health services and outpatient medical services.
NRS 428 Topic 4 DQ 1
Reference
Blumenthal, D., Collins, S. R., & Fowler, E. J. (2020). The Affordable Care Act at 10 years—its coverage and access provisions. New England Journal of Medicine, 382(10), 963-969.
Falkner, A (Ed). (2018). Community & public health: The future of health care. Retrieved from https://lc.gcumedia.com/nrs427vn/community-and-public-health-the-future-of-health-care/v1.1
Health care is distributed in the U.S. with a variation of private and public access points. People’s health may be threatened by features of the healthcare systems such as the total amount of care and its expensiveness for people, the burden of the administration on people, or other non-clinical individual characteristics. These features may restrain people from seeking or continuing to obtain care (Schneider, 2017). The cost of health insurance and medicinal bills are some reasons patients decide not to seek regular health care.
A reform solution for health care that might improve healthcare’s monetary aspect if the government makes sure that all preventive maintenance is provided to everyone at a lower cost or no charges. The fee of providing the preventive care will be compensated with the reduction in the healthcare fee associated with the preventable illness. The healthcare cost caused by the circumstances that could have avoided or identified early can result in individuals being bankrupt caused by patients’ inability to pay the medicinal bills. It can cause the government to pay, thus resulting in a national debt increase and might generate a transferal of money from other government programs.
NRS 428 Topic 4 DQ 1
Patients, employers, government, pharmaceutical firms are the stakeholders of the health care system. The most affected by the health care reform are the nurses with an inadequate patient to nurse ratio due to the rising cost and the facilities struggling to be within the budget. Patients visit the health care facilities more frequently. It is because they do not receive the care they need. Nurses, therefore, are at risk of mental and physical health deterioration. Through health care reform, minimizing medical costs, and focusing on prevention can result in having less illness for treatment. (Larkin, 2016)
References
Larkin, D. J. (2016). The Affordable Care Act: a case study for understanding and applying complexity concepts to health care reform. Journal of evaluation in clinical practice, 133-140.
Schneider, E. C. (2017). Mirror, mirror 2017. International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care.
NRS 428 Topic 4 DQ 1
Although the US government is investing more money in the healthcare system, there has not been much progress. There are serious issues with the American healthcare system that require immediate correction. The current health system focuses on those without insurance, who must pay hefty premiums and out-of-pocket expenses. The United States is the country that spends the most per person on healthcare. In 2018, the US spent $3.6 trillion, or about 18%, of its gross domestic product on healthcare. Prescription medications made up 9 percent of expenses, physician and clinical services made up 20 percent, hospital services made up 33 percent, and other professional services made up 3 percent (Crowley, 2020).
For the health system to be effective for both public health and individual health care, the primary goal of the health system is to meet the demands of the population in terms of health care needs. Primary and preventive care should be prioritized. Additionally, the U.S. health care system is decentralized with numerous public and private entry points. Government agencies, community nonprofit organizations, and faith-based organizations work together in the public health system. Among the services provided by private healthcare are inpatient care, outpatient care, ambulatory care, long-term or residential care, mental health care, home health services, wellness centers, and alternative medicine.
NRS 428 Topic 4 DQ 1
There are two types of private institutions: for-profit and nonprofit. For-profit institutions make up the majority of private institutions (Green, 2018). Medical doctors, nurse practitioners, nurses, and other auxiliary workers provide both private and public health care. They provide this care directly to their patients or clients.
The issue of healthcare reform is one of the most important to voters. As our population ages, illnesses become more complex, and health care costs rise, the government must find a new way to deliver healthcare. According to a recent 11-country study by the Commonwealth Fund, your level of income determines the quality of the healthcare you receive significantly more in the United States than in other developed countries. Besides the Affordable Care Act (ACA), there is a large population that exists uninsured. Even though the United States has achieved great strides, our health system still falls behind those of other nations, particularly in terms of fairness, primary care, cost, and access to care. Stakeholders and the government should invest more funds in primary care, preventive care, and reducing disparities in health care, such as housing, education, nutrition, and transportation. As a result, health care costs can be reduced and our population can be healthier as a whole (Commonwealth Fund, 2017).
NRS 428 Topic 4 DQ 1
Finally, the ACA has partially improved the U.S. healthcare system because it includes provisions such as coverage for the uninsured, measures to reduce costs and improve efficiency, preventative care, extending coverage to dependents under 26, and prohibiting discrimination on the basis of preexisting conditions (Green, 2018). Meanwhile, insurance premiums continue to rise as healthcare costs rise daily, and more and more re-hospitalizations are occurring in vulnerable populations.
References:
Crowley, R., Daniel, H., Cooney, T. G., & Engel, L. S. (2020). Envisioning a better U.S. health care system for all: Coverage and cost of care. Annals of Internal Medicine, 172(2), S7-S32.
https://doi.org/10.7326/M19-2415
Green, S. Z. (2018). Green, S. Z. (2018). Community & Public Health: The Future of Health Care. In Grand Canyon University (Ed.), The Environment, Policy, and Health Effectiveness.
https://lc.gcumedia.com/nrs427vn/community-and-public-health-the-future-of-health-care/v1.1/#/chapter/4
NRS 428 Topic 4 DQ 1
The Commonwealth Fund. (2017, July 14). New 11-country study: U.S. health care system has widest gap between people with higher and lower incomes. Retrieved from
http://www.commonwealthfund.org/publications/press-releases/2017/jul/mirror-mirror-press-release
Replies
Finance is one crucial aspect of the United States medical sector that influences Americans’ well-being and healthcare outcomes. The US health system combines public and private insurers and for-profit and nonprofit medical providers, massively diversifying its payment system. The federal administration provides funding for disadvantaged groups to enhance access to medical care through Medicare, focusing on adults aged 65 and above and some individuals with disabilities (El-Nahal, 2020). States also manage the Medicaid program that targets veterans, low-income households, and underprivileged children. Medicaid focuses on local coverage and a safety net, ensuring families earning the minimum wage and unemployed ones receive medical care. The creation and implementation of the Affordable Care Act (ACA) enhanced the government’s involvement in medical delivery, significantly reducing the uninsured rate (Seo et al., 2019).
ALSO READ:NRS 428 Topic 4 DQ 2 What are the most important elements of the Affordable Care Act in relation to community and public health?
NRS 428 Topic 4 DQ 1
The above outlook demonstrates that the federal and state government play a crucial role in sustaining American medical systems through payment. Nonetheless, private insurance is also a dominant form of coverage in the US healthcare sector. Private plans are primarily provided by employers, limiting them to those with formal jobs. Nonetheless, public and private insurers determine benefit and cost-sharing structures based on national and state laws. Thus, the financial dynamics of the American medical sector are essential in sustaining healthcare delivery.
Many Americans struggle to access medical services despite the vast budgetary allocation by the federal and state administrations to health departments. The constant rise in medical costs is a concern for all Americans and could be addressed through reforms in physician remuneration and hospital reimbursement models. The policy introduces value-based care, which requires medical professionals and institutions to be paid based on patients’ outcomes rather than the number of procedures they perform (Teisberg et al., 2020). The reform will drive caregivers to develop innovative clinical practices to promote patients’ well-being.
NRS 428 Topic 4 DQ 1
Creative health solutions would also promote efficiency and boost the well-being of all stakeholders, including patients, families, health professionals, insurance providers, and the government. For instance, reduced medical expenses will enhance healthcare access, lower hospital reimbursements, and reduce government spending. Additionally, improving medical outcomes would boost physicians’ and hospitals’ earnings. Thus, the value-based healthcare delivery model would massively transform the American medical system.
References
El-Nahal, W. (2020). An Overview of Medicare for clinicians. Journal of General Internal Medicine, 35(12), 3702–3706. https://doi.org/10.1007/s11606-019-05327-6.
Seo, V., Baggett, T.P., Thorndike, A.N. et al. (2019). Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act. BMC Health Services Research, 19(291). https://doi.org/10.1186/s12913-019-4124-z.
Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care: A strategic framework. Academic Medicine: Journal of the Association of American Medical Colleges, 95(5), 682–685. https://doi.org/10.1097/ACM.0000000000003122.
Replies
NRS 428 Topic 4 DQ 1
The United States (U.S.) health care system consists of both public and private healthcare programs. The U.S. public healthcare programs are funded at the federal, state, or local level. Private healthcare is privately financed by individuals (Green, 2018). The cost of healthcare has increased significantly making it difficult for most Americans to access quality care. Public funded healthcare programs have eligibility requirements that can limit the services the public receives. Low-income families and individuals are eligible for public funded healthcare through Medicaid, Children’s Health Insurance Program (CHIP) and Medicare.
However, not everyone qualifies for public healthcare coverage due to the low-income requirements, leaving most Americans paying for private insurance either through their employer or privately. The ACA was expected to help everyone have access and afford health insurance. However, there are still a high number of individuals without health insurance (Green, 2018). Having health insurance does not exempt individuals from paying out of pocket for services and consequently the increasing costs of healthcare services has made it difficult to access quality, preventative care for most.
NRS 428 Topic 4 DQ 1
Increase in prescriptions and healthcare costs has made it difficult for individuals to pay those out-of-pocket expenses. There needs to be an emphasis on what is causing the increase in healthcare costs. According to the article by Stephen Miller, the cost of healthcare increased by six percent last year and is continually increasing. Increase in healthcare costs are largely due to the pandemic, delayed preventative care services, increase in chronic illnesses, increase in long-term care services needed: nursing shortages, increase in medications and medical supply demands (Miller, 2021).
Healthcare reform should include decrease cost in health services and increase in wellness programs including quality access to healthcare for everyone, prevention programs, increase funding for nursing programs and education to promote wellness and decrease chronic illnesses. Increasing prevention programs and early detection of illness can help reduce chronic conditions and decrease long-term healthcare costs. Stakeholders directly involved in healthcare reform are public health leaders, boards, healthcare agencies or organizations, and policy makers at the local, state, and national level.
References:
Green, Sue Z. (Ed). (2018). Community & public health: The future of health care. https://lc.gcumedia.com/nrs427vn/community-and-public-health-the-future-of-health-care/v1.1/
Miller, Stephen (2021). Society for Human Resource Management: Inflation, Other Factors, Drive Up Healthcare Costs. Inflation, Other Factors, Drive Up Health Care Costs (shrm.org)
Affordable care act gives middle class families better health security by putting in place comprehensive health insurance reforms that will hold insurance companies accountable, lower health care costs, guarantee more choice, and enhance the quality of care for all Americans.
NRS 428 Topic 4 DQ 1
Here are some of the most important ways health care reform will benefit middle class Americans, several of which are already in place:
Ending insurance industry abuses: The patients’ bill of Rights puts consumers, not insurance companies, in control of their health care. Insurance companies can no longer deny coverage to children with existing conditions, cancel coverage when people get sick, and place lifetime dollar limits on the amount of care you can get.
Expanding coverage for women: In July 2011, the U.S. Department of Health and Human Services announced historic new guidelines that will help meet women’s health needs. Beginning August 1, 2012, women’s preventive services will be covered with no cost sharing in new health plans. These additional services include, among others, well-woman visits, gestational diabetes screening, breastfeeding support, domestic violence screening, contraception, HPV DNA testing, and HIV screening and counseling. These preventive services help women stay healthy, and because they enhance long-term detection and treatment, they also reduce long-term health costs.
NRS 428 Topic 4 DQ 1
Coverage for those who need it most: Uninsured people with a pre-existing condition now have a guaranteed, affordable health insurance options.The Pre-Existing Condition Insurance Plan (PCIP) provides coverage until 2014, when you will have access to affordable health insurance choices through an Exchange, and you can no longer be discriminated against based on a pre-existing condition.
Sticking Up for Seniors: The law ensures that we continue to protect seniors’ guaranteed Medicare benefits while taking important steps to fight waste, fraud, and abuse. The new law will close the prescription drug coverage gap known as the “donut hole” completely by 2020. In 2010, 4 million people with Medicare who fell into the “donut hole” received $250 rebate checks. In 2011, people with Medicare in the donut hole receive a 50 percent discount on their covered brand name prescription drugs. In addition, people with Medicare are now eligible for an annual wellness visit and free preventive services. such as mammograms and colonoscopies.
Helping small business protect their workers: small businesses may be eligible for tax credits, making it easier for them to provide coverage to their workers. Small businesses can learn more about their health insurance options via the insuranceI. In 2014, the amount of the tax credit will increase, and a new health care marketplace will ensure American businesses can offer quality, affordable health care coverage options.
NRS 428 Topic 4 DQ 1
Easy to understand your options: Starting in March 2012, consumers will have an important new tool to understand their coverage. Health insurers and employers who offer coverage to their workers must provide clear and consistent information about your health plan – similar to the kind of nutritional information you find on the food you buy at the grocery store. Specifically, you will have access to an easy-to-understand Summary of Benefits and Coverage, which will include basic information that every person should have, including: What is my annual premium? What is my annual deductible? What services are NOT covered by my policy? What will my costs be if I go to a provider in my network versus one that is not in my network? Coverage examples will illustrate what you pay in certain circumstances.
Putting Patients First: New regulations require health insurers to spend 80 to 85 percent of consumers’ premiums on direct care for patients and efforts to improve care quality. This regulation, known as the “medical loss ratio” provision of the Affordable Care Act, will make the insurance marketplace more transparent and make it easier for consumers to purchase plans that provide better value for their money. Proposed premium increases of 10 percent or more will also be subject to new scrutiny.
NRS 428 Topic 4 DQ 1
Reference:
https://obamawhitehouse.archives.gov/economy/…
https://obamawhitehouse.archives.gov/economy/…
The United States healthcare system is a primarily fee-for-service based system. In a fee-for-service system, providers and healthcare teams work as businesses that charge for each respective service. This model has many detrimental effects — “it creates incentives to raise prices and push up volumes, shortages of poorly compensated services such as primary care and behavioral health, and an undersupply of services in less financially attractive poor and rural communities.” (Blumenthal et al., 2020). This has been seen more and more in present days. Patients are sen as dollar signs rather than as humans. Increasing healthcare and insurance costs, rising prices on medical bills, and a mentality that revolves around getting patients in and out as quickly as possible in order to maximize volumes and, in turn, revenues, has created a system of inadequate and disproportionate healthcare that has become extremely ineffective. One proposal that could fix this situation is a transition to a single-payer universal healthcare system. This system is under a single company or entity — usually a government funded body. This system, which is widely used in other countries, can lower overall care costs and mitigate wasteful spending. Research has shown numerous advantages over the current fee-for-service system, including adequately “addressing the growing chronic disease crisis; mitigating the economic costs associated with said crisis; reducing the vast health disparities that exist between differing SES segments of the population; and increasing opportunities for preventive health initiatives.” (Zieff et al., 2020). These changes could also influence stakeholders. Their overall roles could potentially be altered, as the system reform would create new scenarios regarding compensation or reimbursement for services. One detriment for the citizens of the United States could be a potential tax increase as government investment would potentially increase in a transition to a single-payer system. Do the risks outweigh the benefits? Arguments can be made for either side, but one thing is certain: single-payer healthcare systems would allow low socioeconomic status individuals to get the necessary care they not only need, but also deserve.
References:
Blumenthal, D., Fowler, E. J., Abrams, M., & Collins, S. R. (2020). Covid-19 — implications for the health care system. New England Journal of Medicine, 383(15), 1483–1488. https://doi.org/10.1056/nejmsb2021088
Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020, October 30). Universal Healthcare in the United States of America: A healthy debate. Medicina (Kaunas, Lithuania). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692272/