Free Essay On Health Care Utilization Paper Grading Criteria
Health Care Utilization Grading Criteria
Health Care reform in the United States of America has elicited much debate in the recent years with people proposing it while others opposing the reforms (Andersen, 1995). Proponents to the reforms cite the many benefits it would bring in terms of access to healthcare by Americans. Opponents on the other hand do not view it as an effective way of increasing access to healthcare. Health care reforms are also a source of legislation aimed at making healthcare obtainable by the citizens of the US. Presidential reforms, in the recent years, have also been platforms used to promote reforms in healthcare although no one can agree on the best ways to implement reforms. This paper would attempt to discuss the various ways in which the reforms in health care have expanded or inhibited the access to health care and also how changes to access may effect utilization. The paper will also explain what the concepts of universal healthcare may be and how the current health care reflects or contrasts with this. Lastly, the paper will discuss the stakeholders involved in the movement towards a universal health care system and the new roles that are emerging in the industry today with healthcare expansion.
The Patient Care Act and the Affordable Care Act, dubbed as “Obamacare” by the media, was signed into law in 2010 and was designed to ensure that all Americans access healthcare at affordable rates and also to aid in the reduction of the rising costs of healthcare. Although opposed from the beginning, Obamacare creates opportunities for individuals to access affordable healthcare insurance and also increase the overall access to healthcare through the affordable health insurance cover. The reform works with the existing conditions in the health insurance industry and hence making it a target for political rivalry. Conservatives are opposed to the idea of the federal government involvement in the healthcare system. A majority of the liberal progressives in favor of healthcare reforms are opposed to it because it keeps for profit insurance companies. Obamacare was designed to be implemented in several stages over a period of time although some parts of it were implemented immediately after it was signed into law. Some of the areas implemented immediately included children staying in their parent’s plan until the age of 26 and the ending of people being denied insurance cover because of the existing health conditions. The immediate effects of the implementation inclined to be things implemented through change of policies at insurance companies.
With regards to access to healthcare, the early reforms have expanded the access to healthcare especially to the younger generations and people with chronic health problems. The younger generations have greatly benefited given that many of them have too low income that can enable them afford a health insurance. Being able to use their parents plan until 26 years of age has enabled a majority of the young people to access healthcare than ever before. Previously, the pre-existing healthcare conditions prohibited people with chronic illnesses from having new insurance plans but with the implementation of the Obamacare, many of them are able to access healthcare. With the full extent of the law going into effect in 2014, this has seen the effect of the individual and business mandates, and also the state insurance exchanges. The exchanges have allowed people to buy health insurance plans as part of larger groups in the state and hence a reduction in the rates. This has seen more people adopting this model and thus able to easily access healthcare.
Lower income families also stand to benefit greatly from the government subsidies aimed at covering their cost of premiums. For the low income families, they will surely have an increased access to healthcare due to the government subsidies that would enable them purchase insurance. It is a consensus now that the healthcare reforms have expanded the accessible to affordable health insurance to the high number of people who need it. However, for the people already having health insurance covers through their employers, stand risks to losing it if their employers think it would be easier and relatively cheaper to put their employers on the state exchange instead. The mandate requiring businesses with more than 50 employees to provide insurance health coverage may tempt smaller businesses to lay off some of their staff or convert full time employees to part-time in a way to play around the mandate. Currently, it can be said that the health reforms have expanded access to health care, but with any other government program, several years have to pass in order to know the full costs and effects of the reforms. Since we are only in 2015, a year after its full implementation, only time could conclusively tell whether the access to general healthcare has been expanded.
Different factors can predispose a population to increasingly or decreasingly utilize healthcare services. Some of these factors include the socio-economic status of a population, policies of a nation and the supply of physician services among others. Government policies aimed at increasing access to healthcare would surely have a direct effect on utilization. Health care reforms such as Obamacare, which aims at increasing access to healthcare services, will increase utilization of heath care services. The Obamacare has enabled more people, such as the younger people, people with a low social-economic status and those with chronic illnesses to access healthcare. With this expansion to the access of healthcare, more people are inclined to utilize healthcare services that include clinic visits, hospitalizations, patient care and hospitalization among others. As a result, Obamacare would increase utilization of health care services. Changes to access in healthcare would result in more people gaining entry to the healthcare system and accessing healthcare services at locations where they are provided. Any change aimed at increasing access of healthcare services would result in an increase in utilization, the vice versa is also true.
Universal healthcare in simple terms can be defined as a basic guarantee of healthcare by a government to all its citizens (Sherrow, 2009). Universal healthcare is a concept that states that states that all people obtain health services that they are in need of without suffering financial hardships when paying for them. It is a form of medical insurance that is provided by a government to all its residents. For there to be a universal health care, there needs to be an efficient and strong healthcare system, a health services financing system, access to medicines and a sufficient capacity of motivated and well-trained health workers (Sherrow, 2009). Before the enactment of the Affordable Care Act (ACA), the USA was the only nation without a universal health care system. ACA has made efforts towards achieving a universal healthcare for Americans, but it is far from achieving this goal. Obamacare gives people more coverage and expands Medicaid, which is a good thing but does not guarantee healthcare. While other countries that have successfully implemented universal healthcare through universal health systems and better ties between the patient and healthcare practices, the US system currently offers health coverage selectively. Hence, there are issues such as employer provided health coverage playing a part in employment decisions, medical expenses contributing to individual bankruptcies. Medicare does not extend to everyone as the uninsured will not be convinced to buy in to the different covers. This means that Obamacare will insure millions but will also leave many uninsured. A universal health coverage plan would offer a basic public health insurance cover and protect individuals from medical bankruptcies.
With regards to movement towards a universal healthcare system, everyone is involved. This includes the patients, healthcare professionals, employers, insurance providers and the government. This is because a change that would impact one of these components would affect the others. It is important for each and every one of these stakeholders to understand the very concept of universal health care and know the benefits it offers such as medical care for everyone and access to medicine and technologies. People learning and accepting how a universal healthcare system works would go a long way in implementing it. Public education is important in this aspect so as to ensure that every one is informed from the patients, employers, insurance companies, healthcare workers, healthcare policy makers and government officials.
Health care reforms are globally required especially with the rising costs of healthcare, a largely aging population and increased number of chronic illnesses (Andersen, 1995). With the expansion of access to healthcare services, an increased number of people would utilize the healthcare services and a sizeable workforce would be needed to meet this demand. With healthcare expansions, there would also come other roles in the healthcare industry, all aimed at providing healthcare services. The sheer logistics of an expanded healthcare would demand new roles to be able to effectively provide services. A care co-coordinator is one emerging role. This is a registered nurse who manages patient transitions through evidence-based training. A navigator, a licensed clinical professional, facilitates patient and family health in collaboration with healthcare workers and the payers. Lastly, a clinical documentation specialist role emerges and is charged with analyzing patient records, results of diagnosis and insurance claims to maximize the provision of services.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1-10.
Long, M. J. (1998). Health and healthcare in the United States. Chicago, Ill: Health Administration Press.
Sherrow, V. (2009). Universal healthcare. New York: Chelsea House.