Evaluation Of A State 's Health Care System And The Gobeille V. Liberty Mutual Case Essay

The Federal Government became increasingly involved in health provision following the Second World War, with a focus on ensuring access and equity to health care. When Medicare was implemented in 1984, the Federal Government, States and Territories agreed to provide free health care for all Australians in all public hospitals.

As Americans we should all be afforded access to healthcare. Access to healthcare is an individual right according to the human rights amendment. The human right to health guarantees a system of health protection for all. The human right to health means that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services, sanitation, adequate food, decent housing, healthy working conditions and a clean environment (What is the Human Right to Health and Health Care, 2015). However there are strengths and weaknesses to every healthcare system and the U.S. Healthcare system is not exempt. I plan to discuss the strengths and weaknesses of the U. S. Healthcare system (What is the Human Right to Health and Health Care, 2015).

The U.S. health care system is way more complex than what meets the eye. A major difference between the health care system in the U.S. and other nations, is that the U.S. does not have universal health care. Lack of a universal health care opens up the doors for competition amongst insurance, physicians, technology, hospitals and outpatient services.

rehend the PPACA, one must understand the history of the United States’ health care system. The most successful and known reform would be the passage of Medicare and Medicaid. President Johnson’s main objective with his program was to provide health insurance to those over 65 years old, who otherwise wouldn’t be able to receive coverage due to retirement or being financially unfit to purchase health insurance. It has since been expanded to cover those with disabilities, and lower income families (“Overview,” 2015). Brady (2015) examines President Clinton’s attempt to massively overhaul health care in the United States. His plan, the Health Security Act (HSA), required employers to offer health insurance to their employees, and mandated that every US citizen purchase health insurance. This plan would have most likely expand health insurance to many more Americans; however, many feared the large tax increases, restricted options for patients, and with the lack of general support for the bill, it failed in Congress and was never implemented (p. 628). President Clinton’s failed attempt at health care reform opened up the door to future reforms, and it even shared multiple similarities to the PPACA. Smith (2015) updates the history of the health care system in America stating that “In the mid-2000s, America’s uninsured population swelled to nearly 47 million, representing about 16 percent of the population” and how “16 million Americans […] were underinsured” (p. 2). People

The benefits and drawbacks of having state health programs verses one that is uniform across the country can vary on a broad basis. Medicare and Medicaid are state and federally funded health programs; programs that must be fair and allow access to everyone across the country that are enrolled and eligible to receive such benefits. In addition, these programs have unlimited caps so that there is flexibility to continue financing care without delay. The Medicare program was designed to provide access to health care for those who are not able to afford appropriate health care and meet the needs of vulnerable communities. If it were not for the assistance of the federal government in providing states the necessary funds to continue providing health

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

The United States health care system is lacking the needs to create a reliable system to achieve quality, access, cost, and educate for the consumers. Despite the efforts of the government to find a common ground to meet the standard for the societies, the system has yet to have a major improvement. These issues must be reexamined to fix the broken system. The United States health care expenditure is another issue that needs to be addressed to achieve the future goals of the healthcare system in the United States. Healthcare societies will need to interact differently by incorporating consumer’s empowerment, technology, and education to meet the future goals of the health care system. Also, the consumer must be highly educated on the purpose of preventive care to lower the risk of chronic diseases which account for a lot health care spending. The process of correcting the United States health care system will take time and effort from all individual to achieve greatness.

The Arkansas Health Care Payment Improvement Initiative (“AHCPII”) is one part of the health care innovations the state has implemented with the aim of “increas[ing] health care quality and reducing the costs of care.” The AHCPII’s intent is to shift Arkansas’s payment system from “one that primarily rewards service volume to one that rewards desired outcomes, particularly with respect to quality and affordability.” Applying to Medicaid, Medicare, and private payers, payment innovation will move away from fee-for-service health care (where quantity all too often trumps quality) to pay for quality. In doing so, the hope is that Arkansas will gain a “new, sustainable model of financing” with the help of a multi-payer leadership and support.

Finally, in a February 2012 proposed regulation, CMS proposed that state Medicaid agencies reimburse pharmacies for retail drugs based on actual acquisition cost. CMS recognized, however, that states may not be able to determine the actual price paid by a pharmacy for a drug billed to Medicaid, so it suggested that states survey pharmacies or rely on other data to calculate an average acquisition cost for drugs purchased and billed by retail community pharmacies. The article reviewed the association between benefit caps, prescription drug use, and the costs associated. It also detailed drug cost sharing, additional medical costs, and specific health outcomes. Using observational data, the studies analyzed the changes and did a cost comparison of outcomes at two points of time, before and after the pharmaceutical benefits changed. The article detailed the impact of pharmaceutical drugs was often difficult to analyze because some data analyzed utilization while others analyzed actual pharmaceutical spending. The data surrounding utilization compared as many as five factors such proportion

H. (04/2015). Comprehensive Health Insurance: Billing, Coding & Reimbursement, VitalSource for Allen School of Health Sciences, 1st Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323131503/

The negative impacts of healthcare reform to health systems are significant in that health systems are preparing their resources on developing Accountable Care Organizations (ACO) for bundled payments and population-based reimbursement. In this economy the impact to health systems may require healthcare systems to figure out ways to continue to keep positive financial performance due to the cost-reduction of healthcare reform. For some time now, health systems have subsidized their losses from the Medicare and Medicaid systems by contracting with commercial payers for their premium rates. As a result of the healthcare reform, cost shifting will shrink. Another negative impact over the next few years will be the large shift in health plan enrollment. Less people will be covered by highly

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

The Patient Protection and Affordable Care Act (ACA) is the 2010 health reform act that could extend insurance coverage to as many as 32 million Americans, which also included policies that affect the quality of coverage insurers must offer (Knickman & Kovner, 2015). In addition to this, the ACA created a range of programs focused on furthering change in how medical care is organized and delivered, with a goal of reducing costs and improving quality and outcomes (Knickman & Kovner, 2015). However, these goals come at a cost. The purpose of this paper is to analyze the impact the ACA had on the population it affected in the United States as a nation, but specifically in the state of North Carolina;

North Carolina Institute of Medicine (NCIOM). Examining the Impact of the Patient Protection and Affordable Care Act in North Carolina, 2012. Retrieved from http://www.nciom.org