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General policy making viewpoints that exist today with respect to access, cost and quality of healthcare in the United States
Delivery of health care in the United States continues to face several problems to date with regard to cost of health care, access to health care and the quality of health care provided. In the year 2000, the total U.S health care expenditure stood at 1.35 trillion U.S dollars (Hartman, Martin, Nuccio, Catlin, et al., 2010). In 2010, the figure had increased by over 90 percent to 2.57 trillion U.S dollars (Truffer, Keehan, Smith, et al., 2010). The cost of hospital care is not any different, starting at 416.9 billion dollars in 2000 and escalating to 788.9 billion dollars in 2010, a growth of more than 80 percent. These figures are the highest compared to any other developed country word wide (Anderson, Reinhardt, Hussey, and Petrosyan, 2003). Despite these alarming figures, the U.S is ranked twenty third by the OECD, Organization for Economic Cooperation and Development in life expectancy at birth, and number twenty eight in infant mortality rate (Peterson and Burton, 2007).
Despite the U.S devoting this large share of its economy to health care, over 43 million Americans were without health care insurance cover in 2008, with many more lacking adequate health insurance (Heyman, Barnes, and Schiller, 2009). This is as a result of the high cost of premium contributions. The Kaiser Survey of 2008 revealed that 29 percent of the uninsured Americans postponed health care due to these high cost concerns. (Kaiser Commission on Medicaid and the Uninsured, 2009). In addition, 7 percent of the insured population also postponed health care. Consequences of delayed or postponed medical care range from minor complications that result in more expensive treatment, to premature death. This shows that the U.S health care is a vicious cycle of high costs of health care, resulting in limited access to medical services with adverse outcomes.
Despite these issues, policy making on health care in the U.S still remains controversial. There is no consensus on what agency of the government or level of society, if any, has the sole role of developing national health policies. The U.S constitution is also silent of health care issues. This system of federalism, which involves division of responsibility and authority among several levels of government has given rise the fact that health policy decisions are made at multiple levels of society. These levels include the National government, local government, health care professionals and health institutions, payer organizations such as insurers and employees, and the public or health care consumers.
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1. Governmental agencies
The role of the government agencies in health care policy making is entrenched in the constitution. This role involves several stakeholders in the government including the executive, legislature and the judiciary. Depending on the priority of the health issue many public health care proposals are developed in the White House. This is done mainly by the congress, cabinet departments, the Office of Management and Budget (OMB), in addition to independent commissions and, agencies like the Consumer Product and Safety Commission.
Besides, the U.S Department of Health and Human Services (USDHHS) then initiates, implements and monitors the legislation after it is passed by the congress and signed by the U.S president. Public health programs at the federal level are under the accountability of the Secretary of Health and Human Services who serves as the principle health advisor to the president. The secretary then delegates this responsibility to the agencies like, the Centre for Medicare and Medicaid Services (CMS), the National Institute of Health (NIH) the Agency for Children and Families (ACF), Centre for Disease Control and Prevention (CDC) and the Agency for Abuse and Disease Registry (ATSDR). Through these bodies, the federal government implements, controls and monitors health care policies with regard, to cost, access and quality. For example, the Centre for Disease Control and Prevention (CDC), aims at reducing the economic and health burdens of chronic diseases among the American population through the “power of prevention”. In the U.S, chronic diseases account for approximately 75 percent of the total cost of health care annually. CDC aims at reducing this expenditure through early screening and appropriate follow up.
In addition, various other government agencies are also involved, for example, the Congress Budget Office. This commission provides cost estimates of bills to the Congress. This helps determine whether to implement bills or not based on feasibility levels. This commission also forecasts spending levels on health care. The Medicare Payment Advisory Commission also gives advice to the Congress regarding the Medicare program especially on payment, quality of service offered and accessibility.
The Medicaid package offers health insurance to low income Americans. However, Medicaid’s authorizing legislation includes admissibility rules and regulations. The Congress determines the amount of money dispatched to Medicaid agency since it is an entitlement program. This consequently influences the cost and hence accessibility of healthcare.
Local Public Health Agencies (LPHA) also administer public health functions such as environmental health, addressing communicable diseases and issues in children’s issues. LPHAs also carry out, tuberculosis testing, epidemiology, community assessments, immunizations, and food safety and inspections. Some also offer glaucoma screening, treatment of substance abuse, mental care services, and more. This shows that Local Public Health Agencies influence the quality, accessibility and consequently the cost of health care services.
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2. Healthcare professional associations
There are several professional associations that influence health care policy formulation relative to access, cost, and quality of health care.
The Center for Budget and Policy Priorities ensures that policy makers like the Congress put into consideration the needs of low-income Americans and families in their debates. This association also carries out research and analysis to assist in shaping public debates on tax policies and proposed budgets.
The National Association of Public Hospitals is also another lobby group that aims at providing local, regional and national activism on behalf of health facilities and health systems. It also conducts research, analysis and other associated services to improve the quality of health care.
Health care professional associations do not have the power to pass laws. Nevertheless, they influence policy making in several ways. For instance, anywhere along the continuum of a bill becoming law presents an opportunity for professional associations to commission a research to support their position on the bill. This in most cases influences policy development.
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Health care professional associations have various tools that they use to develop strategies for lobbying. One of them is initiating grassroots campaign mobilizing their members to contact with policy makers with policy messages. The other tool is to use the “grass tops” strategy. This involves harnessing the influence of prominent individuals and community leaders. Whatever the method they use, professional associations are indispensable parts of the policy making process.
3. Direct or indirect health care providing organizations
Direct care organizations refer to those health facilities that provide health care directly to the patient such as hospitals, laboratories, long-term health care facilities etc. On the other hand, indirect health care organizations are those health care facilities that provide health care services but not directly to patients such as pharmaceutical companies.
For instance, the Pharmaceutical Research and Manufacturers of America encourage the innovation of new, effective medicines for patients by biotechnology or pharmaceutical research companies. They do this through advocating for public policies, which in turn, improves the effectiveness of health care and consequently lowers the cost.
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4. Politicians, political parties, The President and the Congress
The federal government has no monopoly in health care policy making. Indeed, most health care policies are made at the state level. Different states in the U.S have varying policy making structures. Nevertheless, Article 1 of the constitution mandates the Congress rights to enact “necessary laws”. For example, in 2001, the Medicaid, Medicare and SCHIP Benefits Improvement and Protection Act were passed by Congress. The Congress also passed the Prospective Payment System which included a new Medicaid compensation system for federally eligible health centers. This meant that only the centres that were deemed qualified would provide Medicaid services to the American citizens, hence influencing accessibility. Moreover, the statute also required each one of these health centres to calculate a standard per-visit cost from their 1999 and 2000 average costs. The cost of health care would thus be determined in subsequent years by a “Medicare Economic Index”. This index was an inflationary factor which would be added to the baseline rate averaged between the year 1999 and 2000. The main disadvantage of this legislation by the Congress was that it left so many considerations unclear. For example, if a health center was opened in 2000, or after, how would they calculate their baseline? The main disadvantage about this form of legislation, especially in health care policies, is that most decisions are not made with the public interest in mind, but purely, politically motivated.
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Most policies in the United Sates are enacted through a democratic system where the general population votes for what best policy suites their community, state or country. By voting in politicians who share similar ideologies on the state and future of health care in America, they can also influence policy making with regard to its cost, quality and accessibility. The patients are the beneficiaries of health care policies and, therefore, are best suited to make decisions about them. However, these decisions must be guided by public awareness and appropriate research by independent bodies.
The future direction of the U.S healthcare policy
The Patient Protection and Affordable Care Act (PPACA) estimate to assist 28 million Americans have health insurance cover by 2016. However, Heyman, Barnes, and Schiller (2009) argue that the impact of this legislation on cost of health care is not certain. Dealing with this trifecta of cost, quality and access simultaneously will be a tough challenge. Conceptually, however, improving the efficiency of American health care providers is one of the best approaches to this challenge. For instance, increasing the efficiency of health care providers will consequently reduce health care costs. The savings realized from this efficiency can then be passed on to consumers in the form of reductions on prices of health care or lower health insurance premiums. This would, in turn, increase access to health care potentially.
In March 2010, President Barrack Obama amended the Health Care and Education Reconciliation Act. This amendment proposes reforms such as expanding Medicaid eligibility, providing incentives to businesses to provide benefits in health care to employees, subsidizing insurance premiums and prohibiting insurers from denying coverage to individuals on the basis of pre-existing conditions. The amendment also emboldens states to set up health insurance exchanges. This enables adults who are not insured, and small businesses access to insurance cover from many private insurers. This is meant to increase the supply of insurance suppliers in the U.S health care system hence improve the quality and lower the cost of premiums.
Eventually, more efficient health care processes will result in better quality. This is generally referred to as Total Quality Management (TQM). It involves simultaneously increasing quality and decreasing cost of services offered.
Social, cultural, economic, ethical, regulatory implications and changes required to improve access to health care, improve the quality of health care and lower the cost of health care in the United States.
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Economically, the enactment of the exchanges and the expansion of Medicaid mean that more than 30 million Americans who would otherwise be uninsured are now covered as a result of the reform. This coverage will improve both the economic well-being of individuals and families and also the economy of the United States. Research shows that uninsured individuals are prone to poor medical care, poor health status and lower life expectancies. This economic benefit would also spill over to labor markets in the form of increased productivity and decreased absenteeism.
Ethically, an efficient healthcare system will ensure that basic professional obligations to humanity are adhered to according to the various medical oaths and codes of ethics.
Socially, these reforms will support efforts to improve access and quality of health care in the society. An efficient health care system will also guarantee a reduction in infant mortality rates, access to emergency and other basic health care for all. These reforms will also reduce the growth of health care costs. Consequently, this will reduce unemployment rates that are normally consistent with high inflation rates. This, in turn, improves the standard of living among the American population by freeing up resources that can be used to produce other goods and services.
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Regulatory implications in the provision of affordable, timely and quality health care is determined by many factors. For example, the United States constitution does not give the mandate to the legislature or executive to protect public health. This area is primarily under the jurisdiction of the states. Consequently, the president and the congress cannot oblige the states to establish medical emergencies preparedness plans. The only thing the federal government can do is provide incentives to states in return for these plans. For these reforms to take place, therefore, every stakeholder in the health sector must be willing to play their part regardless of loopholes in the legislation or not.
Various changes in the health sector are required to achieve this target. For instance, insurance companies should no longer drop clients when they become sick. In addition, insurance companies should be prohibited from charging deductibles for the majority of preventive care.
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