Health Care Reform in the US

Health Care Reform in the US

Zieff et al. (2020) report that the USA has not embraced universal health coverage. Its healthcare system embraces both private and public insurers. These insurers formulate their benefits packages based on the existing regulations. Employer-provided private insurance accounts for the majority of healthcare coverage. This paper explores the current healthcare system, identifies aspects that should be maintained and those that should be changed, and explores potential innovations.

Elements of the Current System to Keep

Firstly, the current healthcare system emphasizes the delivery of quality healthcare services. Healthcare facilities in the USA have pertinent modern medical equipment, healthcare technology, and competent healthcare providers and specialists (ISPOR.org, 2022). Modern medical equipment facilitates accurate diagnosis and management of patients with various acute and chronic conditions (ISPOR.org, 2022). Healthcare facilities have embraced the meaningful use of technology by embracing telemedicine and telehealth services (Tikkanen et al., 2020). Healthcare technology has improved the quality of care by optimizing workflows and creating flexibility in care delivery. I would keep this element to ensure that quality healthcare services are provided to improve patient safety.

Secondly, the healthcare system of the USA has minimal waiting times for complex procedures. This is attributed to the ease of access to various specialists in the USA. Clintoncourier.net (2020) reports that in Canada, approximately 57 percent of patients must wait for at least four weeks to be served by specialists. On the other hand, this percentage is approximately 23 in the USA (Clintoncourier.net, 2020). As such, specialists are easily accessed in the USA, hence shorter waiting times. Short waiting times are necessary because patients access healthcare services promptly. Timely access to quality healthcare services is associated with better patient outcomes.

Thirdly, the healthcare system provides different coverage options in Medicare. These different options are individualized and are dependent on the person’s preferences. Flexibility in coverage options allows more people to enroll and access healthcare services. Furthermore, it creates flexibility in coverage based on an individual’s budget. For example, individuals covered by Plan K pay approximately 77 dollars monthly, whereas those covered by Plan G pay approximately 145 dollars monthly (Medicare.gov, n.d.).

Elements to Change

Firstly, the current healthcare system limits insurance coverage for Americans. In this context, the majority of individuals benefit from the private insurance that employers provide. This implies that the unemployed population has limited access to coverage and is likely to incur high healthcare costs. Tikkanen et al. (2020) report that in 2018, approximately 92 percent of people living in the USA were insured. Out of this population, the employer provides 55 percent of the coverage (Tikkanen et al., 2020). This implies that 55 percent of the population is at risk of losing healthcare coverage in the event of retrenchment. The remaining 37 percent of the population benefits from public insurance (Tikkanen et al., 2020). Also, approximately 8 percent of the population remains uninsured (Tikkanen et al., 2020). This population comprises individuals with low socioeconomic statuses, such as immigrants and minorities. The uninsured population uses the out-of-pocket payment method. Mostly, they are unable to access healthcare services due to the high treatment costs. This element can be changed by advocating for universal health coverage (UHC). UHC will ensure that all Americans have access to cost-effective, quality healthcare services.

Secondly, the healthcare system allows healthcare facilities to determine the cost of medical services. Lack of standardized prices and billing are associated with high healthcare costs. For instance, out-of-network providers (OONP) are likely to charge high treatment costs. By so doing, patients may face unexpected medical bills that force them to incur out-of-pocket expenses. The billing of network providers and OONP should be standardized to ensure that patients benefit maximally from their insurance plans. The lack of standardized prices is likely to create a healthcare system where providers prioritize profits. As such, healthcare costs increase, and access to healthcare is limited.

Thirdly, Tikkanen et al. (2020) report that disparities exist in the current healthcare system. An evaluation of quality measures revealed that African Americans, American Indians, and native Hawaiians received low-quality healthcare services compared to whites (Tikkanen et al., 2020). Among these ethnicities, Asian Americans and Hispanic Americans received the worst quality healthcare services (Tikkanen et al., 2020). These disparities can be mitigated by focusing on preventive healthcare and addressing the social determinants of health. Addressing these disparities will improve access to quality care and give the population a better quality of life.

Payment for Healthcare

In this context, the healthcare costs would be paid for by government-sponsored insurance and private health insurance. In the USA, this would be accomplished via Medicaid, Medicare, and other programs such as the Veterans Health Administration (Tikkanen et al., 2020). Public insurance will be the major payment model. Employers will be required to allow both private and public coverage for their employees. Public insurance will target individuals with low socioeconomic statuses. It will be comprehensive and will not be stratified into different plans. Insured individuals will benefit from a wide range of healthcare services. Furthermore, public insurance will establish a fixed amount to be paid by covered individuals. This proposition seeks to eliminate current plans that may limit access to healthcare services by individuals who cannot afford a specific plan. Private insurers will be required to work in concert with the government to ensure that more people are insured. The government will control and manage marketplaces that offer private coverage.

Innovations

The insurance system in the USA should be transformed into a single-payer system. In this scenario, the government will be responsible for providing healthcare coverage for Americans. This coverage will entail essential healthcare services accessed by the majority of the population. By so doing, the government will ensure that all Americans have equal access to affordable and quality healthcare services. This system will allow the government to determine the rates of reimbursement, prices of medication, and the quality of healthcare services. As such, the high healthcare costs experienced in the USA and the existing disparities will be reduced by this system.

Secondly, the local, state, and federal governments should collaborate with local healthcare facilities to expand the use of telehealth and telemedicine. Telehealth and telemedicine will transform the delivery of healthcare services to people in remote areas. These strategies will optimize patient follow-up, eliminate physical barriers, and improve access to healthcare services (Bitar & Alismail, 2021). Successful implementation of these services will require a concerted effort among healthcare providers and patients. Healthcare providers and patients should be trained on the appropriate use of these technologies.

Conclusion

The current healthcare system emphasizes quality, is characterized by minimal waiting times, and allows individuals to select various plans in Medicare. However, the healthcare system lacks standardized prices, has disparities in access to care, and limits insurance coverage. Various stakeholders should collaborate to achieve a single-payer system and expand the use of telehealth and telemedicine to reform the healthcare system.

References

Bitar, H., & Alismail, S. (2021). The role of eHealth, telehealth, and telemedicine for chronic disease patients during COVID-19 pandemic: A rapid systematic review. Digital Health, 7, 1–19. https://doi.org/10.1177/20552076211009396

Clintoncourier.net. (2020). The Pros and Cons of the US Healthcare Model (the Direct-Fee System). https://www.theclintoncourier.net/2020/09/14/the-pros-and-cons-of-the-us-health-care-model-the-direct-fee-system/

ISPOR.org. (2022). US Healthcare System Overview-Background. https://www.ispor.org/heor-resources/more-heor-resources/us-healthcare-system-overview/us-healthcare-system-overview-background-page-1

Medicare.gov. (n.d.). How to compare Medigap policies. https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies

Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, A. G. (2020). International Health Care System Profiles United States. https://www.commonwealthfund.org/international-health-policy-center/countries/united-states#innovations

Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020). Universal healthcare in the United States of America: A healthy debate. Medicina (Lithuania), 56(11), 1–7. https://doi.org/10.3390/

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Consider what an ideal U.S. healthcare system might look like.

Step 2: Write a 4-5 page paper that addresses the following:

If you were designing a new system:

Health Care Reform in the US

What elements of the current system would you keep and why?
What elements would you change and why?
How would health care be paid for?
What innovative ideas can you envision?
Be specific and explain your responses. Use a minimum of three scholarly references to back up your ideas. Make sure you properly cite references in APA format.