The healthcare landscape and provision of healthcare has undergone significant transformation over the past decade(s) in response to healthcare reforms, policy agendas, advancing technologies, and shifting consumer needs. Although a vast number of Americans still struggle without health insurance, the opportunities opened up in the healthcare marketplace through health reforms have led to an influx of patients seeking care, in turn, creating a disparity between primary care supply and demand. Recognizing that today’s consumers often seek care from sources other than traditional or conventional health care options such as the doctor’s office, many health systems have evolved to meet this demand as seen through the growing array of health care
The United States has a unique system of healthcare delivery, it is complex and massive. Twenty-five years ago; American citizens had guaranteed insurance, meaning the patient could see any physician and the insurance companies and patients would share the cost. But today, 187.4 million Americans have private health insurance coverage (Medicaid, 2014). The subsystems of American health care delivery are Managed care, military, vulnerable populations and integrated delivery
While the Kaiser Family Foundation (2013) provides a workable summary of the general points of the Affordable Care Act and documents abound regarding services that are currently covered under the Affordable Care Act, even eligibility specialists are left puzzled about what services will be covered or requirements needed for coverage, next month, in three months, or in a year (Pattie, personal communication, 2017) given the current political environment. Historically, fragmentation of services “each functioning well within its specialized sphere, but failing to address the needs of the whole person,” (HCQA, 2015, p.3) drive up healthcare costs, especially for the patient with complex needs. Consequently, health care now talks about patient centered, integrated care based in the
In the cold winter season, more people are going to come down with the flu or pneumonia causing an increase in demand for certain antibiotics and medical care (supply) necessary to treat these ailments. If physicians and/or hospitals do not increase their supply, this will cause a shortage in medical care available meaning the price for care will increase. This is, at its very basic, an example of supply and demand.
How does the design of the payment system affect individual’s choice of provider? How might Americans be reoriented to using primary care, rather than costlier services?
The current health care sector is too costly and too fragmented with a lot of variation in care even with established evidence based guidelines. Providers lack the tools, support and information they need to offer the coordinated health management that can reduce cost and improve outcomes. Primary Care Physicians are constrained in their abilities to perform any proactive care that involves avoiding Hospital or ER visits, and influencing healthy lifestyles.
Every individual in the world deserves to enjoy health and wellness. Maintaining or achieving proper health needs enables individuals to be productive at work and leisure. Traditionally, many people have had barriers obtaining adequate healthcare due to economic constraints or personal inconveniences. Despite impressive technological advances in medicine, the challenge of delivering quality healthcare to the Americans continues to be debated amongst the nation’s political and healthcare leaders. The aging baby-boomers and the increased number of uninsured people add to the equation of population growth which results in limited access to primary healthcare for the entire public. On the
Health System Reform in the United States: Impact of Rising Premiums and Opportunities for System Improvements to Enhance Access to Healthcare Services
The United States of America has been known to be one of the most advanced countries in terms of our quality of medicine, medical programs, and medical advances. A person can walk into nearly any emergency room without the fear of being turned away or not getting care. With so many resources and cutting edge technology, it’s hard to believe that this health care system does not function to suit the needs of the populations that are most in need of care. Gaining access to long term, continuous health care has become an arduous task, especially over the past two years. Finding a primary care provider seems impossible nowadays, whether a person is insured or uninsured.
There is expected to be roughly 17 million individuals becoming newly insured through the Medicaid Expansion of the PPACA by 2019 (Carrier, Yee, & Stark, 2011). The expansion of Medicaid will create a major supply and demand issue within the health care services. Simply put, the demand for primary care services will exceed the capacity of the current primary care infrastructure. This will only add to health care spending because the newly insured individuals will not have many options to obtain primary care services and they may be forced to use inappropriate services such
The health care system must change to improve our nation’s health and takes strong steps to address the unsustainable growth of health care costs in America. We still have a long way to go before our health system become effective. We still have population that do not have insurance, have difficulties accessing their health care, or their needs are not met within the healthcare system. It is an investment in prevention and wellness and increasing access to primary care physician.
Health care in the United States is driven by a patchwork of services and financing. Americans access health care services in a variety of ways — from private physicians’ offices, to public hospitals, to safety-net providers. This diverse network of health care providers is supported by an equally diverse set of funding streams. The United States spends almost twice as much on health care as any other country, topping $2 trillion each year. (WHO.INT 2000) However, even with overall spending amounting to more than $7,400 per person, millions of individuals cannot access the health care services they need.(Foundation 2009) So when the Patient Protection and Affordable Care Act (a.k.a the Affordable Care Act or ACA) was passed in the summer
The United States (US) is distinguished for its medical advances, leading technology and astonishing discoveries in various science fields. These advancements in the health care ground have impacted and improved the health care delivery of several in the nation. The US is found among the wealthiest, most developed countries around the world; however, it is the only developed country that fails to provide universal health care to its people. Health care in the US is described as fragmented, inaccessible, and expensive. Diebel (2015) compared the health system in the US to other nations and supported that it is extremely overpriced, yet the end result does not always support its cost. Lack of coverage, high copayments plus deductibles force Americans to postpone seeking medical attention resulting in undiagnosed health conditions and complications of current diseases. In 2010, under President Obama’s mandate, Americans witnessed the birth of a controversial legislation, The Patient Protection and Affordable Care Act (PPACA). The goal of the PPACA is to improve just about every aspect of the system such the health of Americans, health care access and quality, while reversing the health care expenditure (Hahn and Sheingold, 2014). The aim of this paper is to discuss the PPACA and the Medicaid Expansion under the PPACA including its risks and benefits; as well as, the impact of the expansion in the healthcare delivery
In a survey conducted in 2003, it highlighted that the recurrent problem is the reimbursement rate from Medicaid to the physician (O’Shea, 2007). The Center for Studying Health System Change (HSC) show that 21% of physicians that state they accept Medicaid have reported they will not accept a new Medicaid patient in 2004-2005(O’Shea, 2007). This number would only logically be assumed to have risen in 2013 A survey conducted by the U.S. National Health reported that researchers have found two standout trends among Medicaid beneficiaries: they have more difficulty getting primary care and specialty care and they visit hospital emergency departments more often than those with private insurance (Seaberg, 2012). The lack of primary and specialty care access is mostly contributed to the following barriers; unable to reach the MD by phone, not having a timely appointment with the MD and lastly unable to find a specialty MD that will accept Medicaid. In a recent report released by the Partnership to Fight Chronic Disease, it stated that about 30% of Medicaid patients experience “extreme uncoordinated care”, there is a strong correlation between this situation and higher Medicaid spending and less quality of care given (Bush, 2012). After January 1st 2013, healthcare providers have experienced a 2% reduction in payments for Medicaid beneficiary, this will only create more of a problem for these patients to seek the
As a growing number of Americans find themselves without health insurance, it is demanded that the United States explore innovative policies aimed at extending coverage. The high cost of expanding coverage raises many questions about how best to improve access while preserving individual choice and maintaining quality of care. Differing viewpoints among policymakers, insurers, doctors, hospital administrators, employers, public health advocates, and health policy researchers provide a complete picture of the current and desired state of American healthcare.
There are many issues that are causing changings in the healthcare system. Population aging, rapidly increasing costs of healthcare and the growing burden of chronic disease are challenges to health systems worldwide. To meet these challenges will require new approaches to healthcare delivery and comprehensive population health management. Many states are not prepared to tackle this issue yet. The US has the most expensive healthcare system in the world with health status indicators that are only average in comparison