Abstract
To transform the current U.S. healthcare system and industry sector is mandatory in order to mitigate and stabilize the obstacles involving most of the issues on the standard requirements and benefit that the healthcare system can provide to the U.S. populations. To achieve such objectives, proper measurements and evaluation is a must to fix the climbing healthcare out of the pocket cost, the inferior level of healthcare service through Medicaid and Medicare, and increase the overall number of insured populations by developing a healthcare system such as Affordable Care Act although it may have some obstacles and criticisms in the beginning phase. The primary focus in transforming the previous and current healthcare system is to maximize th number of access to the healthcare by the people and effective measurement in improving the quality of the healthcare service provided. Most importantly, the revised healthcare system needs to counter the fact that everyone including preexisting conditioned patients, infants, and older generations has adequate knowledge and access to the healthcare benefit.
Introduction
The essay will describe the current healthcare system precisely and coherently while discovering the role of the government within the state and local area with the reference to the profit and non-profit healthcare system. The present movements of the U.S. healthcare system are also included in the essay by casting attention to the development of technologies such as cell phones, biotechnology, healthcare informatics, and biotechnology that are deeply related to the healthcare sections in the U.S. Furthermore, it will pitch into the numerous effects created by stakeholders and various authorities by moving into education and the impact it displays on the workforce opportunities. The prominent factors that influence and restrict the healthcare advancement, along with human capital, are additionally included in the essay.
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The present phase of the U.S. healthcare fee structure and how hospitals, providers, and payers understand, manage, and prepare for the newly implementing reimbursement structure by casting awareness from the profit margin relations to the standard execution system and how the present and upcoming reimbursement plan can affect the patients in the healthcare sections in the U.S. Furthermore, the essay will concentrate into the numerous ways for the healthcare providers to successfully implementing the new reimbursement plans and creating profits by moving into increasing the incoming patient quantity from various groups and the affection it demonstrates on the major businesses with substantial number of employees.
The prominent factors that affect and restrict the evolvement of the present cost of the service arrangement, along with the healthcare providers, are encompassed in the essay as well. Lastly, it examines the internal and public elements that affect the fee generated process in the U.S. healthcare sector meanwhile supplying comprehensive analysis from the trends of the reimbursement structures in healthcare sector in the U.S.
Furthermore, this essay will assess elements of the major issues and struggles which prevent major U.S. healthcare providers to convert into the new solution-based structure in a realistic fashion. Lastly, it will examine particular methods that providers need to acquire that potentially may lead to propriate modification in healthcare arrangements in which the monetary and feasible way in generating profit margins.
Body of Paper
The current debate to elevate the number of people insured and the overall standard of U.S. healthcare system has been a primary element in the healthcare sector in the current years. Until the establishment of Affordable Care Act from the Obama administration, there were so many individuals who did not have access to healthcare coverage. The Obama administration successfully passed the Affordable Care Act in 2010 so that everyone is the U.S would have access to proper healthcare which ultimately has lowered the uninsured population number from 21.9% to 12.7% within the age group between 16 to 67 years old. The prominent role of the ACA is to improve the overall quality of the previous healthcare system and make sure that every individual has access to the healthcare coverage despite the income level, age, sex, or current health condition.
In addition, the development of the Electronic Healthcare Records structure was considered as one of the most innovative structural upgrades in the U.S. healthcare industry to expedite the process of the ACA. With both system in place, every individual in the states finally had an opportunity to enjoy a standard healthcare coverage with decreased out of pocket cost from the patients while increasing the overall benefit and qualification of the service rendered by the healthcare providers. The ACA mainly concentrates its emphasis on generating various methods to maximize the standards and quality of the healthcare service deviating from the previous quantity-based approach that would eventually cut down the entire spending in healthcare on both stakeholders’ accounts.
Consequently, the ACA’s main objectives are to assure that every citizen has proper healthcare coverage and raise the qualification of the service provided despite an individual’s financial or social status. On the other hands, the successfully implanted healthcare system through the Electronic Healthcare Records had substantially reduced the fraudulent activities of the secondary middle entities from cheating patients by providing minimum coverage while applying one of the highest premium or out of the cost expense. The ACA healthcare system further decreases the healthcare cost, standards, and the overall choices of the insurance entity pool with the support of developing new cost-effective regulations and evaluation structures to benefit both individual and public healthcare sectors.
It is a remarkable improvement in healthcare industry that millions of individuals in the U.S. finally were able to obtain his/her with minimum expense depends on the income level which created exponentially spiked enrollment numbers through the roof and naturally decreased the uninsured quantity in the country. The new healthcare regulation assured that individuals do not have to concern about the limit when it comes to needed healthcare coverage that enormously benefits patients with preexisting conditions or chronic health issues. Although continuing addition and modification to the ACA is mandatory throughout the years so that individuals can enjoy efficient, extensive, and cost-effective healthcare system without worrying about the financial and current health status.
The agreement to execute and apply the Electronic Healthcare Records that coincides with ACA is considered as one of the best governmental decision in healthcare history to benefit millions of people without previous healthcare coverage or patients who could not get proper treatment through healthcare insurance due to the preexisting conditions. The collaboration of ACA and HER aims to benefit both individual and other stakeholders in a long-term project. Especially the development of innovative technology in healthcare system that transforms the previous record keeping system depending solely on the paper to the flawless and seamless electronic formation enabling providers and government to store limitless stakeholders’ information will eventually support the healthcare providers such as private doctors and public hospitals in tracking and keeping patient data, so that they can provide faster and accurate services for the patients. With the proper execution of utilizing HER system, the overall healthcare providers will have simple and efficient management structure in transmitting and receiving patient data that results in maximum accuracy across the healthcare providers standpoint.
Majority of the healthcare providers such as doctors and hospitals can share patient and billing information with the government and among themselves more effectively in a real time. The patient information can be universally reviewed, shared, and transferred from any computer with internet connection no matter where the healthcare providers are located. In addition, healthcare providers voluntarily update patient data that allows physicians to have up-to-date examination outcome, pre-examination scheduling, and any imperative requirements to provide the utmost services for the patients. (Emmanuel, Tanden, Altman, & Armstrong, 2012).
Prior to the era of ACA and HER structure, more than 97,670 patients had deceased yearly as the outcome of the mistakes in data recording and inadequate patient intake form management. With the rapid development of the technology in healthcare industry, the overall quality of patient treatment and security of patient data has enhanced tremendously while patients’ experience at a doctor’s office or hospital has improved the duration in setting up an appointment, performing examination, and transferring information from in and out of network providers. Furthermore, providers can efficiently store and transfer the insurance claims to the proper departments within the government making the process easier and faster to collect the reimbursement.
In addition, there are substantial public discussions related to the possible and definite application of medical technology that produces distinct point of views on worthiness of individual’s life compare to the advancement of medical technologies, and such debates tend to produce additional concerns about the medical ethics in regulation and communication. Despite the fact that arguments arise from almost identical issues that revolves around the medical technologies, “the overall association between medical ethics and healthcare technology assessment (HTA) have been ambiguous and equivocal.” (NG, T.,2007) In contrast, the binary relationship must be specified through the HTA in a particular structure that displays and study any possible impermanent and permanent repercussion of the medical technology advancement, according to the European group research. Such inclusive way to monitor the potential technological consequences always tends to prioritize the influence on the medical ethics.
Throughout the years, the government has tried several methods in order to decrease the overall financial burdens for the patients. With the adequate implementation of ACA, HER, and HTA system in place, both patients and providers have experienced tremendous reduction to the out of pocket cost and uninsured patients throughout the U.S.
The objectives and processes of applying ACA for years have finally initiated to display the results that both the standards and high-quality treatment have improved leaps and bound for the patients. Here is a research performed by Gallup which demonstrates the improvement in quantity of uninsured people in the U.S. due to the development and implementation of ACA which utilizes the HER and HTA.
According to the survey, the number of people who newly have access to particular type of healthcare insurance has substantially increased by almost 7% in early 2015 from 12% in late 2013.
For many years, having a quality healthcare has been considered as prestige options for a lot of people in the U.S. Majority of private insurance companies main target was to increase the number of patients with premium plans rather than to focus on the standards and treatment quality that were rendered by the providers in the healthcare industry. It was the ACA that successfully transformed such paradigm of profit driven healthcare insurance market to treatment and quality focused industry although there had been so much push back and resistance. The ACA has allowed the maximizing the healthcare coverage, reducing out of the pocket cost, and treatment quality of a patient. Additionally, the ACA has raised the guideline and acumenship of the pharmaceutical industry at the same time. ("The Affordable Care Act is Working,” 2015).
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Specifically, the ACA has resolved much debated issues that involved sex, age, ethnicity, and current health conditions of a patient. Many minority groups such as Asians, African Americans, and Hispanics now have access to the healthcare coverage and dedicated to the tremendous increase in the rate of overall healthcare insured. In addition, many females who were denied of proper preventive measurement previously are allowed to take the benefit of the ACA which implemented a firm healthcare clause that inhibit any private or state healthcare providers to differentiate or discriminate anyone as long as the individual requests the healthcare coverage.
The ACA successfully has broadened is territory in both private and public healthcare sectors including the biggest healthcare sector, Medicaid. More than 12 million people found new ways to obtain the healthcare coverage while a lot of healthcare providers such as private doctors and hospitals were required to contribute to the quality healthcare treatments. Practically, most of the individuals who make less than medium income would be offered with the best benefit of the ACA or anyone who makes average income less than 140% of the poverty guideline set by the government.
Many of the untimely deaths of the average people who did not have access to the healthcare coverage have substantially decreased after the introduction of the ACA especially the patients with preexisting conditions or from low income families. Achieving cost effective healthcare coverage plans is one of the greatest accomplishments of the U.S. administration. Prior to the implementation of ACA, the private healthcare insurance companies had monopolized the majority of the healthcare market that led to high cost premium and much debated discrimination when it came to patients with preexisting conditions, infants, and older patients who were considered as greater risks in providing additional treatment from the insurers’ perspective.
In the present time, parents have an option to include their children up to age 26 within the parents’ network that eventually allows the ACA to expand its healthcare coverage territory even further. (Hamel, 2015).
The successful implementation of the ACA is leading to overall reduction of sudden healthcare cost escalation related to the proper cost management in the Medicaid and Medicare sector. Particularly, the expansion of the ACA through Medicare which is the largest healthcare sector in the U.S. has the potential to make the process easier and simpler in creating efficient treatment environment and assure the application of standard results of the healthcare industry. (Sebelius, 2013).
In many developed countries including the U.S., the preexisting conditions and chronic illnesses are considered as enormous issues to resolve that would eventually lead to the success of healthcare programs such as the ACA. Such preexisting conditions or chronic illnesses generally have increased the fatality rate, down graded society health conditions, and prevented the efficient growth of the healthcare market for years. Cigarette, drug and alcohol abuse, and limited access to the healthcare coverage are prominent source of the chronic illnesses in the U.S. Constructing and implementing adequate estimates to minimize such preexisting and chronic illnesses are very crucial to expand the general healthcare market that essentially will lead to benefit overall well-being of patients. (Bauer, Briss, Goodman, & Bowman, 2014).
The proper implementation of tobacco deterrence measurements from the U.S. healthcare industry that successfully has decreased many cases of long-term illnesses and fatality rates in the U.S. by aiming to support and prevent individuals to get dependent on drugs, alcohols, and tobaccos. One of the leading institutions that initiated such movements is the American Lung Association that supported and assisted patients who struggled with addiction issues involving cigarettes and alcohol. ("Tobacco Cessation & Prevention,” 2016).
Preventive initiative in overweight conditions and exercise arrangements tend to enhance people’s well-being since the initiative encourages proper food consumption and physical projects that greatly prevents possible overweight that in long-term develops into additional and higher healthcare cost. Such preventive measurements in regards to overweight, tobacco, and any other additions can change and transform welfare of the people and overall daily habits that are deeply related to maintaining individuals’ health and reducing potential health crisis.
Thanks to the rapid expansion of innovative technology in medical field, many chronic illnesses can be prevented utilizing pre-examination, promoting immunization, and motivate individuals to take parts in some of the healthcare initiatives as early as possible.
Moreover, the government is involved with promoting general learning culture in healthcare management to further eliminate or minimize any potential health risks that include alcohol, cigarettes, and substance abuse.
The expansion of Medicare consistently encompasses in expanding as the baby boomer generation grows older. However, within the similar time dimension, the expenditure of Medicaid continues to display even faster expansion rate year after year. Such healthcare development and tendency will “persist to exist as the generation of baby boomers stay on maturing and the inflation of Medicaid approved in the ACA (Affordable Care Act) is thoroughly materialized in the U.S.” (RevCycleIntelligence, 2019)
Such transition in revenue infusing and compounding can affect a hospital’s profit margin because Medicaid / Medicare patients are considered as unprofitable segments within healthcare sector. According to a research in 2011, “the general providers’ profit ratio from Medicare individuals was roughly 4.9%. An expanding magnitude of Medicare trade places substantial financial burden on provider profits.” (Lagasse, J., 2018)
Many private and public healthcare institutions should arrange a restructuring transformation to properly ready themselves for the rapidly changing healthcare market. Adequately preparing advanced equipment and technological upgrades for the providers, promoting continuing education and ongoing training for the physicians, and encouraging well-funded scientific research for current and new wave of illnesses to better service the patients.
The previous healthcare system had costed the government far more financial burdens since improperly screened and examined patients tend to develop more serious physical issues that would require advanced and longer treatment for the individuals. In order to reduce such discouraging cycles, proper preventive programs must be developed and implemented based on long-term objectives to reduce chronic illnesses and treat preexisting conditions more effectively. (Emmanuel, Tanden, Altman, & Armstrong, 2012).
Conclusion and Recommendation
The U.S. healthcare providers have gone through a remarkable shift change and improvement in the present healthcare system for many years. The system is requiring that healthcare providers to completely revamp the present medical screening structures that fail to efficiently offer the standard medical treatments that majority individuals are entitled to encounter while the doctors and hospitals successfully have been able to collect the costs from the insurance companies or federal sectors without offering adequate healthcare treatments to individuals in both preemptive evaluations and chronic illnesses. The ACA and current healthcare service market try to change the all-inclusive paradigm of the missing gaps that barricade amplifying standard treatments and motivating healthcare providers to truly comprehend the individuals simultaneously building up projective treatment plans for the current and future individuals.
The on-going ramification from the perspectives of the healthcare doctors and hospitals will overall reduce the loopholes of the private insurance companies that has primary goal in making profits through just increasing quantity of the patients rather than improving the medical service rendered. Continuing efforts by the healthcare providers focusing on the long-term projects in establishing enhanced treatments and well-being of the patients will eventually lead to successful reimbursements and successful growth of the healthcare industry that will have potential to provide healthcare coverage to every individual without discriminating or filtering patients based on his/her gender, age, ethnicity, preexisting conditions, or chronic illness. Consequently, overall adjustments must be associated with the healthcare sector to ensure that the providers’ services become more stable and effective.
The U.S. healthcare industry must concentrate to enhance the way service and treatment is rendered to individuals to ensure that the overall financial cost of the government and out of the pocket expense of patients can be reduced. Such bold movements must collaborate with the private sector providers’ agreements to shift the current trends of profit-based operations to quality care systems that will lead to higher paid out and upgraded processing system.
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