Trends Shaping the Healthcare Industry Essay

Financial burdens greatly limit the system’s accessibility; however, many in the U.S. are unable to fully utilize either option. Census estimates from 1999 indicate that 43 million Americans live without health insurance even though 75 percent of them have a full-time job or live in a household with at least one member working full-time (Mueller, , 5) In addition to the totally uninsured, census estimates also reveal that approximately 42 million other people in the U.S. are underinsured. This means that they have some insurance, but are still unable to afford all of their needed prescriptions, tests, visits to physicians, or hospital

The U.S. healthcare system is remarkably complex, and even healthcare workers struggle to understand it. The U.S. population gets health coverage by government programs, employers, and private insurance. Notably, because of the complexity and fragmentation of the health care system, there is a percentage of the population that remains uninsured. According to CNN Money, the uninsured rate in the U.S. dropped from 18.2% in 2010 to 10.3% in 2016, this drop was under Affordable Care Act(ACA) (). The goal of the ACA was not to give health coverage to all the uninsured population, rather it was to try to decrease the percentage of the population that remained uninsured(). There is a lot of inequality in the distribution of health among the U.S. population

More and more people with medical insurance are relying on the health care system as new technologies and treatments become available. This leads to a grater number of claims for payment by insurance companies, the costs of which are passed back to health care consumers. The baby-boom generation is entering its peak health-care using period. Over eighty million Americans will turn 50 in the next 10 years. The cost of providing heath care for these individuals will be staggering

bankruptcy, lose their homes and jobs due to the inability to pay such extranomical medical

The lack of health insurance reached began to become a serious issue in the mid-1990’s reaching a crisis level in the 2000’s. Individuals without insurance turned to emergency rooms across the country to obtain care routine care, turning emergency departments into primary care facilities. In many instances, people who presented at emergency rooms for treatment could not be turned away due to various health and safety regulations; therefore, patients were seen without the ability to pay often leaving the hospitals with millions of dollars in uncollectable debt, subsequently leading to the insolvency of hundreds of hospitals across the United States.

The cost of health insurance has changed drastically over the years as it has become more expensive. Depending on personal characteristic, the cost of health insurance may vary. For instance, as individuals grow older the more expensive it becomes. In this case, health insurance is more costly because “older individuals require more health care” therefore “the cost of providing health care is rising” (Madura &Atlantic, 2012). Not only does this affect the high cost of health insurance, but the number of individuals uninsured. As stated by Madura and Atlantic (2012), “about one in every five workers is uninsured” and has increased since then because health insurance has become unaffordable. As a result, individuals tend to seek health care elsewhere as they can no longer

The U.S. health care system faces challenges that indicate that the people urgently need to be reform. Attention has rightly focused on the approximately 46 million Americans who are uninsured, and on the many insured Americans who face rapid increases in premiums and out-of-pocket costs. As Congress and the Obama administration consider ways to invest new funds to reduce the number of Americans without insurance coverage, we must simultaneously address shortfalls in the quality and efficiency of care that lead to higher costs and to poor health outcomes. To do otherwise casts doubt on the feasibility and sustainability of coverage expansions and also ensures that our current health care system will continue to have large gaps even for those with access to insurance coverage.

After the Affordable Care Act (ACA) was enacted in 2010, much of the uninsured population in the United States were finally given the access to health insurance (Shi & Singh, 2015). Prior to the passing of the Act, those who did not have insurance still managed to seek medical attention, whether paying for medical care out of their own pockets or seeking the assistance of government programs. As reported by the U.S. Census Bureau, in 2013, 13.4% of the population in the U.S. were uninsured during the entire year (Smith & Medalia, 2014). Still, a great number of uninsured who sought medical care were unable to pay for those services, this is referred as uncompensated care. In 2013 the cost incurred from

After reading Delivering Health Care in America A Systems Approach 5th edition by Leiyu Shi and Douglas A Singh, a lot of topics stood out to me, but the one topic that really touches my heart is the topic about Uninsured Americans. Health insurance is currently an important issue in the United States today. Every day we see more and more Americans become uninsured due to unemployment and an increase in premiums. This topic is very important because working in a hospital setting you see so many patients that can’t receive the care they need because of not having insurance or their insurance not covering all of their needs. Hospital administrators face multiple issues everyday in regards to uninsured patients and underinsured patients. As health

Even with employer-sponsored programs and federal programs for those who qualify, many Americans are uninsured. Over 46 million Americans had no health insurance in 2006, and 86.7 million went without health insurance at some point in 2007 and 2008 (“Health Care Issues”). Why has the number of uninsured risen so drastically and why are employer-sponsored programs dwindling?

According to the Federal Bureau of Investigation (FBI) “health care fraud costs the country an estimated $80 billion dollars a year” ("Health Care Fraud," n.d., p. 1). Because health care costs continue to rise more rapidly than the rate of inflation the threat of health care fraud continues to rise. The Affordable Health Care Act has put new policies in place to identify and stop health care fraud. The FBI along with other government, insurance, and public agencies have joined together to combat fraud at every level. New rules in identifying, investigating, and prosecuting fraud before payments are made to medical providers could save billions of

(Jones and Jing) Though citizens might not see the effects of health care fraud directly, everyone is impacted in one way or another either through increased taxes, high insurance costs, or the inability to afford health care coverage. While we all hear about major frauds in the system, a majority of the frauds are small and usually go through undetected, unreported, or seriously underreported. (Sparrow) These small frauds add up to be a huge problem. There is a large spectrum of frauds in the health-care systems ranging from the theft of a wheelchair, to organized crime groups that steal patient information and bill for phantom services in multimillion-dollar schemes. (Jones and Jing) In many cases, the fraud is minor but all the small scams add up to an enormous loss to the public. For example, the frequent occurrences of forging of a doctor’s signature on a prescription accounts for billions of dollars lost each year. (Jones and Jing) One of the most common crimes involves billing for services that were never performed. This involves a health care provider submitting a false claim to be paid for a patient that was never treated or adding on services to a patient. For example a doctor may obtain names of other people such as a patients spouse or child who are covered by insurance and put in a claim for them as well as the actual patient. (FBI) Another common fraudulent activity involves upcoding of services. This is when a healthcare

One of the greatest changes in healthcare in the past ten years has been the rise of managed care, much to the displeasure of many patients and physicians alike. Managed care arose out of concern about spiraling healthcare costs and was designed to encourage physicians to give patients treatments that were cost-effective out of their own financial interests. "The consumer strategy was directed at imposing some barriers to use by levying various forms of co-insurance. The most common approaches used either deductibles (where the consumer paid the first portion of the bill a technique familiar in other types of insurance) or co-payments (where the consumer paid a portion of the bill and the insurance company the rest) or a combination of both' (Kane et al 1994). Managed care has given health insurance companies an increasingly significant voice in how treatment is administered and allocated. Managed care has proliferated in the past decade despite considerable criticism of the practice of 'nickel and diming' patients as well as the considerable bureaucratic red tape it is has generated. Also, research indicates that healthy, well-insured patients tend to over-consume care without meaningful co-pays but poorer, sicker patients can be deterred even by moderate co-payments and suffer negative health consequences (Kane et al 1994). However, managed care has not gone away and is a reality that all healthcare

Part A: There has been an indisputable growing trend in consumerism in the healthcare industry. The shift of patient to consumer has begun to take effect. The relationship between patient and consumer are closely related and complicated, “A patient is also a healthcare consumer, but a consumer is not necessarily a patient” (Jayanthi, 2015, para. 2). The definition of patient is arguable, Medicinenet.com varyingly defines a patient as a person requiring medical care, receiving treatment, under a physician’s care, waiting for treatment and care, a person receiving care by a licensed professional (2016). A consumer’s role as described by Thomas in the rise of product differentiation and consumerism, had to be introduced and educated of a good and service, have awareness of purchase opportunities, and standardization of goods and service where the consumer was to be persuaded to choose one or the other (2015, p3). Margolis is quoted, “Patients…receive care, while consumers make choices” (In Jayanthi, 2015, para. 4)

The Healthcare Industry in our country is run more like a business than any other healthcare system in the world. Insurance companies have a big impact on patient care and treatment by dictating which test or treatments will be reimbursed. The hospital administrators are constantly reviewing budgets and patient 's length of stay to ensure that they remain profitable and viable. Nurse to patient ratio has been a topic of high interest in the past few years. Depending on where the nurse works, they will have a range of 30 to 50 patients during one shift, not to mention the admissions and discharges. As the work load of a nurse increases, corners will be cut to keep up with the pace of the environment. Is there a relationship between the number of patients that a nurse cares for and the outcome the patient has along with the length of stay and costs of hospitalization? A nurse can be educated and versatile in their skill, but if they are overworked and have many patients, their time and interaction with each patient is limited and short, there will be a negative effect on the patient 's outcome. Many factors influence the care the nurse provides to their patients. The nurse can be overwhelmed when the floor or unit is short staffed. This will increase the workload as the workload increases, the nurses will have to critically think of ways to provide care quickly and efficiently. Patient interaction time will decrease. Low morality leads to stress, leads to decrease