Internal and External Factors of US Healthcare System
In the United States healthcare is provided by a variety of organizations. The majority of them are private, but there are public ones. The most popular public insurance programs are Medicare, Medicaid, State Children’s Health Insurance Program, and TriCare. It is said that the United States is the leader of medical innovations, as they spend a lot of time and effort to develop healthcare.
Today the majority of Americans are able to derive a profit from the US healthcare system, while a range of difficulties occurs when other people want to have at least basic services. According to the research, people who are of low social level or belong to some minorities have problems with access to healthcare. It is thought that the poor quality of care in particular cases is not improving, as it is varnished by the insurance. Following this line of reasoning, people who do not have medical insurance are not likely to get an opportunity to gain some healthcare for ill-health presentation as screening or vaccination. Even disease management, which is a vital thing for people who, for example, suffer from diabetes, appears to be difficult to access. Poor access to healthcare is a serious problem not only for those who face it but also for the whole society. If a person was not able to get a flu vaccination, he or she has great chances to come down with influenza and communicate it to others. In such a way an epidemic might start.
People hope to get the best health outcomes when they refer to the health services, which means that they want to get decent quality healthcare. In order to receive good access, one needs to get entry into the system and sites where consumers can gain required services, get and keep in touch with providers of the needed services. Access to the healthcare system becomes much easier when one obtains insurance. As a rule, uninsured people have ill health and get medical care more seldom. They also need to spend a lot of money on the services, as they are extremely expensive in the US. It is commonly claimed that half of the bankruptcy issues occur because of healthcare expenditures. The quality of care received by the people without any insurance leaves much to be desired. They start facing problems in the first stages of getting care, as hospitals are likely to avoid such consumers considering them to be troubled. That is why diseases are often neglected and diagnosed only at late stages, therapeutic care is of worse quality. Such things have an adverse influence on the outcome, and people have more chances to die in the hospital. Even physical access to healthcare can bring a number of problems. The research proved that some consumers faced difficulties with finding a physician, some were not accepted by the institutions, and others were told that their coverage cannot be accepted (Gindi, Kirzinger and Cohen 4).
A negative effect can be produced on people’s health if they have no insurance for a long time. It happens because the necessity to spend much money on some treatment makes consumers delay the visit to the doctor. Today the majority of people under 65 have insurance. The number of children increased in comparison with previous years while the number of adults decreased. Most people who have health insurance are women. People with high income have more opportunities to afford insurance than those who earn less. Afro-Americans, Hispanics and American Indians turn out to be insured more rarely than European Americans. It is thought that people of a particular race have or lack some privileges. The first three mentioned ethnicities usually earn less and cannot afford health services of proper quality. Thus, the connection between demographic composition and health outcomes can be seen.
Getting health insurance seems to be the best way for people to avoid high healthcare expenditures. Nevertheless, it does not cover all consumers’ spending. Sometimes the cost of services goes beyond the payout, which sets individuals back.
To have a usual source of care is a great advantage. People who consult the same doctor in the same hospital are more likely to receive good quality care and improve health outcomes. Some preventive services are also easier to get if one keeps stability within this issue. A doctor and a nurse have a chance to learn about the consumer, adjust to his or her needs and build relationships on a trust basis. Thus, the attitude towards the patient will positively influence the quality of care. Not everyone is able to realize that something threatens health; that is the situation when a constant physician can be more conscious of the necessity of treatment. Consequently, consulting a usual source of care may prevent serious complications and save one’s life.
US healthcare system suffered two main problems that policy leaders tried to solve. They are the coverage and cost of services. Expenditures were high, but the quality appeared to be uneven. While insurance solved the first problem, quality and cost needed more attention (Rivlin 15). Innovations made in the healthcare system are aimed at the improvement of initial quality. To achieve this, medical services are going to leave fee-for-service for rewarding quality. As a consequence, healthcare institutions are supposed to provide high-quality services at an appropriate cost (Ignagni 261).
Healthcare can be paid by different means. Medicare and Medicaid have widely spread government insurance programs. Some employers provide their workers with private health insurance plans. Having no insurance, people pay their own money for such services, which is called out-of-pocket payments (Miller, Eibner and Gresenz 42).
Government programs cannot be used by everyone. For example, Medicare is available for disabled or elderly people and those who need long-term treatment. Healthcare for individuals with disabilities and poor people is funded with the help of Medicaid. If the family earns more than it is allowed in order to use Medicaid, but still there is not enough money for child’s healthcare, it is possible to refer to State Children’s Health insurance Program (Schulman, Richman and Herzlinger 2463). TriCare was made to meet the requirements of military officers and their families. It can be used even if one has already retired. Less than a half of Americans use public insurance programs for healthcare services.
Commercial healthcare insurance is also known as a private one. It can be used only if the coverage is paid in return for premiums. As a rule, individuals are provided with this type of insurance by their employers. They can pay the whole sum of the premium or its part. There are different types of commercial insurance; thus, people are able to choose the most appropriate one.
The most expensive way of receiving medical care is said to be an out-of-pocket payment. Individuals use their own savings to cover all expenditures. Very often they lack money and need to take the credit or borrow for straightening the accounts.
Payment for medical services can be provided by different means. Direct private financing mechanisms include so-called uncompensated care. There are two situations that can be referred to it. Charity care is given to patients and no remuneration is expected from them. Bad debt occurs when the expected remuneration was not received in spite of the fact that it should have been gained. When the insurance company repays providers, according to the fee schedule, the fee-for-service type of payment is used. This one is common among employees nowadays. The main characteristic of capitation is that it is focused on a person, but not a provided service. It is thought to be a good tool for controlling the costs of healthcare. Per diem is a payment for one visit. This type is very convenient for people who need a consultation without their usual institution. Global budget payment presupposes a limited sum of money that can be gained for particular services over a defined period of time. Pay for performance is determined by the resources that were used during the receiving of healthcare services and the outcomes that were achieved on completion. Pay for coordination is provided for special care coordination services, as those that can be received at home. Fee-for-service is a type of payment when the consumer pays for the definite services he or she gained. Bundled payments are used as for one-time remuneration for a number of services that are a part of treatment, which is likely to have several providers in different locations. Shared savings are provided by a group of specialists who cooperate with Medicare to provide fee-for-service indigent with health services. Gain-sharing payments are provided on the doctors’ savings. As a rule, they are working under Medicare and Medicaid Services (Carpenter 27).
Works Cited
Carpenter, Caryl. “State Health Insurance Exchanges.” Journal of Financial Service Professionals 67.3 (2013): 26-28. Print.
Gindi, Renee, Whitney Kirzinger and Robin Cohen. “Health Insurance Coverage and Adverse Experiences With Physician Availability: the United States, 2012.” NCHS Data Brief. 138.1 (2013): 1-7. CDC. Web.
Ignagni, Karen. “Health Plan Innovations in Delivery System Reforms.” The American Journal of Managed Care 19.4 (2013): 260-262. Print.
Miller, Amalia, Christine Eibner and Carole Gresenz. “Financing of Employer-Sponsored Health Insurance Plans Before and After Health Reform: What Consumers Don’t Know Won’t Hurt Them?” International Review of Law and Economics 36.1 (2013): 36-47. Print.
Rivlin, Alice. “Health Reform: What Next?” Public Administration Review 73.1 (2013): 15-20. Print.
Schulman, Kevin, Barak Richman and Regina Herzlinger. “Shifting toward Defined Contributions – Predicting the Effects.” The New England Journal of Medicine 370.26 (2014): 2462-2465. Print.