In response to your peers, highlight in detail and discuss which aspects of healthcare are best regulated by the states and which by the federal government. Define the strengths and weaknesses of placing regulatory authority at each level of government. Finally, illustrate the arguments for and against private regulation of healthcare and health insurance.
The government’s role in healthcare is multi-faceted. On one hand you have the government handling the rules and regulations and on the other hand, you have the government standardizing patient safety and care. In the past, the government has developed the Medicare and Medicaid Act and now the Affordable Care Act to name a few over the last four decades. Another important role the government plays in healthcare is in the management of financial costs. According to the article I read, “Federal government influence has resulted in public programs that, in 2008, led to expenditures of $1.11 trillion (Straube, 2013, p.39)”. The government also plays the role of the nation’s largest payer for healthcare and the largest provider of care.
Health insurance impacts healthcare delivery immensely. If you do not have health insurance, 9 times out of 10, you will not seek out care for any health related problems. Another point is if you do not have insurance, you do not have access to most healthcare specialists for care. Most offices make you pay upfront before any services are rendered. Some changes that have affected individual healthcare coverage are “rise in managed care, changes in eligibility criteria for public programs, changes in the availability of employer-sponsored health insurance (Zuvekas, 1999, p.271)”. If there isn’t adequate access to healthcare, there will not be good health outcomes.
One way to reduce the number of uninsured, maximize quality and access and minimize costs is the passing of the Affordable Care Act of 2010. I know that it is a debated topic. I found an article published in a journal written by President Barak Obama in 2016. He points out some important facts before the ACA was enacted such as, “In 2008, the United States devoted 16% of the economy to health care, an increase of almost one-quarter since 1998 (when 13% of the economy was spent on health care), yet much of that spending did not translate into better outcomes for patients. And 1 in 7 Americans were without health insurance coverage (Obama, 2016, p. 526)”. The President established a council called the National Prevention, Health Promotion and Public Health Council, in 2011 they released a report that was focused on “building healthy and safe community environments, expanding quality preventative services in clinical and community settings, empowering people to make healthy choices, and eliminating health disparities (Straube, 2013, p.540)”. Some positives since the ACA became law are “the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, with most of that decline occurring after the law’s main coverage provisions took effect in 2014. The number of uninsured individuals in the United States has declined from 49 million in 2010 to 29 million in 2015. This is by far the largest decline in the uninsured rate since the creation of Medicare and Medicaid 5 decades ago. Recent analyses have concluded these gains are primarily because of the ACA, rather than other factors such as the ongoing economic recovery (Obama, 2016, p.527)”.
Prevention is another key point to minimize overall cost and improve quality of life. Chronic disease is a major contributor to healthcare expenditures and, although prevention and health promotion efforts have not been optimal, they can play an important role in improving health outcomes (Straube, 2013, p.41)”. Healthcare reimbursement can also improve using the following avenues value-based purchasing (VBP), pay-for-performance (P4P), withholding penalties, gain-sharing, accountable health care organizations (ACOs), and medical homes (Straube, 2013).
Obama, B. (2016). United States Health Care Reform: Progress to Date and Next Steps. JAMA, 316(5), 525-532. doi:10.1001/jama.2016.9797
Straube, B.M. (2013). A Role for Government: An Observation on Federal Healthcare Efforts in Prevention . American Journal of Preventative Medicine, 44(1), S39-S42. https://doi.org/10.1016/j.amepre.2012.09.009
Zuvekas, S. H., & Weinick, R. M. (1999). Changes in access to care, 1977-1996: the role of health insurance. Health services research, 34(1 Pt 2), 271–279. PMID: 10199674
The government plays several different roles in the American health care system, including regulator, the purchaser of care, provider of health care services, research, demonstrations, and education and training programs for health care professionals. Due to tax cuts over the past six years, universal funding coverage will likely require tax increases. National healthcare reform cannot be achieved unless the federal government prioritizes healthcare more than tax cuts or other spending priorities (Commonwealth Fund, 2006).
The government impacts healthcare organizations by ensuring access to quality care for lower-income populations. They do this by regulating the healthcare markets, supporting the acquisition of new knowledge, developing and evaluating health technologies and practices, monitoring healthcare quality, informing healthcare decision-makers, and developing the healthcare workforce. They are responsible for protecting society by delivery of high-quality health care.
Per the CDC, Health insurance coverage is an essential determinant of access to health care. Uninsured patients are substantially less likely to have a usual source of health care or a recent health care visit than insured patients. Low-income and uninsured people are less likely to have a regular source of care. For example, uninsured people are less likely to receive the proper medical treatment compared to someone with health insurance. Uninsured people are more at risk of receiving poor quality care, such as delayed notification of abnormal laboratory test results.
We can reduce the number of uninsured people while maximizing quality and access and minimizing cost by recognizing federal financing and leadership need. Per the National Library of medicine, some solutions for affordable health insurance are legislations to match state funding. By allowing small businesses and uninsured people to purchase coverage through the Federal Employees Health Benefits program. Allow businesses to provide health benefits to all employees or contribute towards coverage.
Davis K. (2007). Uninsured in America: problems and possible solutions. BMJ (Clinical research ed.), 334(7589), 346–348. https://doi.org/10.1136/bmj.39091.493588.BE
Janet M. Corrigan, Jill Eden, and Barbara M. Smith, Editors; Committee on Enhancing Federal Healthcare Quality Programs; Institute of Medicine. (n.d.). Read “Leadership by Example: Coordinating Government Roles in Improving Health Care Quality” at NAP.edu. Retrieved September 15, 2022, from https://nap.nationalacademies.org/read/10537/chapter/5
Tang, N., Eisenberg, J. M., & Meyer, G. S. (2004). The roles of government in improving health care quality and safety. Joint Commission journal on quality and safety, 30(1), 47–55. https://doi.org/10.1016/s1549-3741(04)30006-7
Health Insurance and Access to Care. (2017, February). https://www.cdc.gov. https://www.cdc.gov/nchs/data/factsheets/factsheet_hiac.pdf
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