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Conflict and Change in Americas’ Health Care System

Abstract

This research paper investigates Americas’ health care policy. It discusses the conflicts and changes that have occurred in the health care system. Health conflicts have emerged because of the high cost of health care and quality of healthcare. This has caused policymakers to come up with programs that allow people to obtain insurance and get access health care. These programs include: Medicare, Medicaid, Veteran Health Care, Indian Health Service, National Institute of health, State Children’s Health Insurance Program, and Tricare. These programs enable citizens to have access to healthcare at subsidized costs. The programs have been successful. However, there is a need to improve access for all and eliminate eligibility criteria. Moreover, there is a need for improved quality, efficiency, and the number of health care providers.

Introduction

United States spends a large portion of its GDP to support healthcare provision throughout the regions. The huge support to healthcare is motivated by the need to support the healthcare needs of its citizens and promote good health. America’s healthcare system has experienced conflicts in the process of actualizing healthcare programs that enable a large number of people to access medical care. This research will investigate the conflicts and changes in America’s healthcare system, while evaluating the health care policies that have emerged in different times. It will provide a discussion of major stakeholders and recommend policy solutions that will cause reforms to the health system.

Methodology

The research will review academic literature documented on America’s healthcare system. This includes academic review, medical books and scholarly research on the healthcare system. It will investigate the policies as stipulated by the United States government.

Health Policy Research Findings

The department of health in America has worked towards making healthcare accessible and available to all. Healthcare is provided by different legal entities in the United States. They include the private and government-owned institutions. American budget has given huge allocations of the budget to the health sector to enable Americans to access affordable and quality healthcare. The private sector controls the largest section of the healthcare system. The government has facilitated healthcare by providing health insurance, which is used in the public healthcare system. Some of the health care programs that facilitate healthcare services include Medicare, Veteran Health Administration, Tricare, Children Health Insurance Program, and Medicaid (Wilper et al, 2009).

The need to deal with public health has been at the center of America’s healthcare system. Various policies have been adopted at different times to make health care accessible, affordable as well as improve the quality. Healthcare policy has forced Americans to engage in long debates over making the healthcare system better (WHO, 2011).

Dominowski (2012, p. 1) states that conflict and change in America’s health care system began in the early 20th century. This was the period when President Roosevelt implemented the National Health Insurance. He had experienced challenges in health and was believed to be informed in dealing with existing issues. After the First World War, which led to the great depression, America turned to Social Security in 1935. Social security benefited the majority of the low-income people and those who lived in poverty, like elderly people.

In 1942, President Roosevelt ordered that there would be regulation of remunerations and control of prices. This was to facilitate higher pay so that employees would be able to purchase insurance. National Health Insurance was revived, and citizens were allowed to volunteer and pay in 1945. This did not thrive because another policy on American Medical Association was created and replaced. The major concern was that healthcare was increasingly becoming costly, and those who needed it most could not access it. This included the elderly, children, disabled, and pregnant women. In 1965, Medicare was created for the elderly while Medicaid was created for the poor citizens. American Medical association was replaced despite facing political challenges (Selden and Sing, 2002).

In 1974, President Nixon gave a proposition that all employers should provide insurance for employees. This plan would have benefited all people in the region if had been implemented. This is because the proposition required all people to be insured. Nixon was faced with the Westgate Scandal, and the proposition was not enacted. Mandatory healthcare insurance was not successfully implemented. National healthcare, which persisted, was challenged by politics where citizens were misled that medical insurance deprived people of their social freedom. Consolidated Omnibus Reconciliation Act was enacted. The act enabled employees to use their employer’s insurance cover for a while after losing their employment. Medicare was further expanded in 1988 so to allow senior citizens to access prescribed medicines and care.

In 1992, President Bush caused reforms to the National Healthcare system. The actions were motivated by the reality in medical care where costs were very high, depriving Americans of their financial capabilities in the competitive world market. The reforms included tax credit on health insurance for families with low income. The tax was to empower and prompt citizens to embrace health insurance. Insurance market reforms implied that people with existing medical problems could access insurance. The policies were met by politics and did not thrive as expected. President Clinton developed a policy where employers would take the burden of paying health insurance for their employees. This plan was challenged by many people and did not succeed. Opposition from the healthcare and businesspeople argued that people should carry the burden of paying for their healthcare needs (Anderson, 2003).

In 2003, Bush was able to expand a policy that included citizens to access medicines from the Medicare Insurance Policy. President Obama has successfully implemented health policies that enable a large number of citizens to access care. The policy increased accessibility to quality healthcare in the region. President Obama received support from the people, and since that time the plan had been implemented. The Affordable Care Act of 2010 has encouraged many people to access medical care. People with preexisting medical problems should not have problems with affording services. This policy has been challenged by the Supreme Court. People are responsible for making their insurance plans. Different states in America have various facilities and options that enable all people to get quality health care.

The government initiated programs that would enable people to access medical care because a large number of its population was in need of quality care which was not affordable. Moreover, medical care was revealed as one of the causes of bankruptcy because of the enormous medical expenses. The cost of health was high, and some of the people could not access medical care.

Conflicts in the healthcare system emerged because of the existing health policies. There was a need to reform the health care system so that American citizens could access healthcare, get the right care, obtain fairness and equality, have quality, and efficient healthcare. Additionally, it was necessary to enable choice, cost-effective, affordable, quality, valuable, and efficient care in all institutions. Conflict led to the debate in the United States about healthcare. There were complaints that the delivery of the health care system was not giving equivalent value to the costs spent. There was a concern about increased infant mortality rate and reduced life expectancy compared to the other developed countries. The cost of health care is very high in the United States and is not guaranteed for all citizens. The most appropriate way to access medical care is by getting medical insurance. Those who do not have medical insurance cannot benefit from medical care. This leads to the loss of lives. Those who are without medical insurance depend on charity. Charity may come in the form of initiatives from religious organizations, non-profit organizations, donations, and funds from government subsidiaries. Some states have programs where patients who cannot pay for their medical care are funded. The majority of these people are the poor and the elderly.

The healthcare system is funded by the government and insurance plans. Majority of American citizens are insured through several schemes including employment insurance schemes, next of kin or parent schemes, individual arrangements, or government programs. The challenge with the insurance is that there are laid down requirements for eligibility. The conflict emerges because not all Americans are eligible even for the government programs. Some of the insurance programs and companies pay a percentage of the hospital expenses while the city pays the other percentage.

Other conflicts emerge because the medical insurance does not cover all aspects that need health care. Some insurance companies and government programs require one to purchase insurance for eye care, dental care, maternity, prescription, and other specialized care services. Citizens can only access healthcare facilities for which they are covered with insurance. The patient is required to pay for the facilities separately. However, the insurance makes these services affordable to people. The cost of consultation for one with insurance is lower than for those who pay from the pocket. This is because the insurance companies negotiate discounts for their patients. The negotiations have caused another challenge, where some health care providers deny patients care because of their insurance company or program. Consequently, those who are with government insurance or who negotiate costs with insurance companies may find it difficult to obtain specialized medical services.

The Emergency Medical Treatment and Active Labor Act are concerned with the challenges experienced in the healthcare system because of problems in funding. This act stipulates that all health care institutions should provide care to all patients without discriminating against them because of their ability to meet the costs of emergency cases. The act does not cover individuals who are unable to pay for their healthcare outside the emergency room. The act does not include access to preventive care or access to a physician who provides primary care. Emergency care is more costly than regular visits to the consultation. In most cases, this results from the lack of continuing care for an existing ailment. Emergency care also involves accidents. Emergency rooms are often busy, and separated from regular care where people do not stand in a queue. It has been noted that the emergency department is often busy and sometimes ambulances are redirected (Christopher, 2001).

There are other conflicts that emerge because the healthcare providers, and healthcare institutions receive remuneration and pay according to the quality of work they make available. This means that many tests are being done on patients when they visit hospitals. The incentives argue that it is safe to have more tests than when no tests are done. This leads to a conflict of interest. There is a need to have a limitation on the liabilities of the hospital as well as the healthcare providers. The contrast of the conflicting interests is that a number of American citizens lose their lives in hospitals because of neglect from the healthcare providers in the hospital. A large number of tests are conducted because patients are under insurance cover. The costs incurred in the number of tests are extended to the patients when the cost of purchasing an insurance cover is increased. The insurance companies encourage people to pay premiums, and when they suffer from terminal ailments, they withdraw the cover. Patients suffering from heart disease, HIV, and cancer do not enjoy insurance cover for such ailments. The healthcare system and the insurance companies work hand in hand, yet both are profit-oriented companies.

Majority of the healthcare facilities are owned by the private sector, and this dictates how healthcare services are distributed. Other shareholders in healthcare facilities include states, counties, and the federal government. There is a lack of a national system of government where all citizens are eligible to access healthcare. Some of the local hospitals owned by the government are open to all.

Different groups of people get healthcare from different organizations. The military healthcare service, through the department of defense, offers services where the military personnel receive healthcare. The healthcare is funded by the military department. Veteran Administration Hospitals are funded by the Veteran Health Administration. Veterans are eligible for health services they have not accessed when serving. Recognized tribes from the Native Americans get healthcare services from Indian Health Service. Hospices are hospitals providing specialized care to the terminally ill patients. Hospices are given charity for patients who may not live long due to their conditions. The government partly funds hospitals that deal with prenatal care and family planning.

Another conflict occurs between equality and quality care. The disparity in healthcare services in different healthcare institutions is very different leading to varying outcomes. The medical resources are not equally distributed. The number of healthcare providers in health institutions is very low compared to the number of patients. The hospitals offer different amenities and income for the healthcare providers, who select the most favorable opportunity. The Affordable Care Act has caused many people to access healthcare. This increases the load of work for the healthcare workers. The uninsured citizens are likely to delay medical intervention and only access it in the time of emergency. Delayed medical intervention may lead to other complications or development of related ailments (Fuchs, 2004).

Care coordination is an area of conflict. Patients do not follow up on one line of care and do not keep track of their health care. Patients take a long time waiting for their diagnosis and undergoing tests. Patients lose medical documents and end up undergoing some tests when the test results are lost. The patients may not always have a smooth interaction with those who provide them with the necessary care. Patients often get offended due to the kind of treatment they get while receiving healthcare services. Additionally, there are additional administrative costs that are involved in the healthcare system. The hospital, insurance companies, government, and the patients need to go through the administration before healthcare provision is complete. Administrative costs vary from one institution to another (Wennberg and Wennberg, 2003). This means that some people pay more administrative costs than others.

There are public programs that support medical care. The programs cover children, elderly, veterans, the disabled, and those who live in poverty. Medicare is a government program where those who are older than sixty-five years of age and the disabled can be covered. Medicaid is administered by the states and allows people with low income to access medical care. It covers pregnant women, the disabled, and the children. The insurance program targets children who cannot afford costly healthcare. Tricare is a medical insurance for military personnel, which enables them to access healthcare services from civilian hospitals. Veteran Administration is a program that enables veterans access healthcare, together with their family, and survivors in hospitals. National Institute of Health gives medical care to patients who enroll themselves for research purposes and do not pay. There are various community clinics that are funded by the government.

Pharmaceuticals and medical equipment are manufactured by privately-owned companies. Both the public and private sectors participation in the research by funding research. The American healthcare system gives research a lot of importance. Changes and growth in the healthcare sector are facilitated by increased funding in hospitals through insurance and changes in technology (Wennberg et al, 2006).

Healthcare and Education Act of 2010 is a policy that promotes healthcare reform. The objective is to facilitate healthcare information that will benefit citizens. Information enables citizens to know their rights, entitlement, opportunities, and healthcare facilities that are available in the healthcare system.

Conclusion

The American health care system has developed policies that enable access to affordable and quality health care. The policies emerged because of the high cost of healthcare. Because very few people could access health care, different policies were adopted at different times to alleviate the cost and to make it accessible to many. The policies have encouraged people to get insurance covers and access health care at a subsidized cost. Programs such as Medicare, Medicaid, Veteran Health Care, Indian Health Service, National Institute of health, State Children’s Health Insurance Program, and Tricare have enabled people with low income, disabled, pregnant mothers, children and the elderly citizens to get health care. Those who cannot afford healthcare benefit from government programs, donations, and charity from different organizations. Policies have enabled people to access emergency medical care, even when they are not able to pay for it. The policies have also enabled quality and improved care because of supportive funding from the government.

Recommendations

With the new policies in place, the number of patients visiting hospitals is likely to increase. It is necessary to have more healthcare providers recruited in the hospitals to help provide services when necessary. Doctors can follow ethics and avoid unnecessary tests that are used to generate more profit. The hospitals should emphasize quality care and efficiency in providing health care. There is a need for a program that will enable all citizens’ access care, irrespective of their economic status (US Department of Health and Human Services, 2004).

Reference List

Anderson, G. F., Reinhardt, U. E., Hussey, P. S. and Petrosyan, V. (2003). “It’s The Prices, Stupid: Why The United States Is So Different From Other Countries”, Health Affairs, 22, 3.

Christopher, J.L., Murray, K. K., and Nicole, V., (2001). “People’s Experience Versus People’s Expectations”, Health Affair.

Dominowski, M. W. (2012). Health care policy in America: a political history, Web.

Fuchs, V. R. (2004). Perspective: More variation in use of case, more flat-of-the-curve medicine. Health Affairs 104.

Selden, T. M., and Sing, M. (2008). “The Distribution Of Public Spending For Health Care In The United States, 2002,” Health Affairs 27, 5, 349-359.

US Department of Health and Human Services (2004). Health care in America: Trends in Utilization. Web.

Wennberg, D. E., and Wennberg J. E. (2003). Perspective: Addressing variations: Is there hope for the future? Health Affairs 3, 614-617.

Wennberg, J. E., and E. S. Fisher, and S. M. Sharp. 2006. The care of patients with severe chronic illness. Lebanon, NH: The Dartmouth Atlas of Health Care.

WHO (2011). World health statistics 2011. Geneva: World Health Organization.

Wilper, A. P., Woolhandler, S., Lasser, K. E., McCormick, D., Bor, D. H., & Himmelstein, D. U. (2009). “Health insurance and mortality in US adults”. American Journal of Public Health 99, 12: 2289–229.