The current healthcare industry is impacted by many factors including, the medical culture, market pressures, and the insurance industry. The present article will review how each of these factors impact healthcare. Some solutions are suggested in this article and how they might impact the healthcare system.
Keywords: cost reduction, prevention, income, single-payor system
In today’s healthcare environment, there are many factors that effect it. Some of these factors include the medical culture, market pressures, and the insurance industry. These factors if adjusted could have major impacts on healthcare. One such way is if medical culture focused on levels of prevention rather than high-technology solutions. Another way how healthcare is impacted, is how healthcare institutions need to be solvent to survive in the current market structure. The final way in which these factors affect healthcare in how insurance impacts the healthcare industry by taking a large portion of money from healthcare.
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Many was to reduce cost and improve the health outcomes of consumers is to affect disease before it progresses to a more serious level. This progression has been mapped out by epidemiologists and health-services planners to assist with managing various healthcare conditions. (Young & Kroth, 2018, p4) One way in which change can be made is to focus care on prevention and management of various healthcare conditions. (Bae & Jamoulle, 2016, p343) Many of the prevention and management plans focus on include reduction of risk factors such as activity levels, diets, and other factors. (Giles-Corti, B., Sallis, J., Sugiyama, T., Frank, L., Lowe, M., & Owen, N., 2015, p232) These plans involve not only the healthcare communities but assistance by consumers for these interventions to have an impact on the healthcare of communities. Consumers must have invested interest in changing behaviors for prevention and management to be successful. It has been shown that these basic interventions of activity and diet can delay the onset of disease.
Another factor that influences today’s healthcare environment is market pressures. The healthcare system depends on many avenues of income. These avenues of income include government programs such as Medicare and Medicaid, private insurance, and out-of-pocket payments. Some of these avenues of income have more impact on various parts of the healthcare system. One such impact is on hospitals. Rural hospitals, which are smaller than urban hospitals, have less beds and depend on the income from Medicare and Medicaid. Another way in which income impacts the healthcare system is they type of institution, not-for-profit versus for profit. Both areas impact the institutions solvency. Hospitals that can fluctuate with the flow and demand of healthcare needs, and income levels, tend to do better than those institutions that are not able to flow in fluctuations of demand and supply and income level. This is often to do with the expectations of those institutions to reduce their level of care for indigent individuals or face closure. (Younis, M., 2003, p38) One way in which those institutions, which are impacted greatly by the fluctuations in income, are to become part of a larger network in more urban areas which helps off-set the fluctuations in income and allow access to healthcare.
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Insurance impacts the healthcare industry by taking a large portion of the healthcare dollar. One of the ways that is posited to affect this is to change the payor system. One of the ways that has been suggested to do this is to change to a single-payor system. This proposal suggests that it would decrease the amount of administrative costs currently incurred by private insurance companies. They propose that this would reduce cost by “reducing billing and paperwork costs for physicians, hospitals, and other providers.” (Woolhandler, S. & Himmelstein, D., 2017, P 587) Although initially this process would increase some costs, overall the cost would be lower than current levels and allow for more consumers to partake of healthcare benefits. These systems have been proven to work in other countries. If we are to transition to a single-payor system, it would involve some increased costs in transition of billing systems, increase in training, and decrease in overhead costs. However, in the long-run, this transition would not only decrease overall costs, but increase overall consumption of services which would lead to better health for all individuals within the society.
Many factors impact the healthcare environment today. These include the medical culture, market pressures, and the insurance industry. Dependent on how these factors affect the industry, changes could negatively or positively impact the health industry. Changes can be made within healthcare if we understand that the transition process may be a challenging process. However, the outcomes will be a benefit to all consumers as noted by these transitions in other countries.
- Bae, J. & Jamoulle, M. (2016). Primary Care Physicians’ Action Plans for Responding to Results of Screening Tests Based on the Concept of Quaternary Prevention. Journal of Preventive Medicine and Public Health, 49, pages 343-348.
- Giles-Corti, B., Sallis, J., Sugiyama, T., Frank, L., Lowe, M., & Owen, N. (2015). Translating active living research into policy and practice: One important pathway to chronic disease prevention. Journal of Public Health Policy, 36, pages 231-243.
- Young, K. M. & Kroth, P.J. (2018). Sultz & Young’s Health care USA: Understanding its organization and delivery (9th ed.). Burlington, MA: Jones & Bartlett.
- Younis, M. (2003). A Comparison Study of Urban and Small Rural Hospitals Financial and Economic Performance. Online Journal of Rural Nursing and Health Care, 3, pages 38-48.
- Woodhandler, S. & Himmelstein, D. (2017). Single-Payer Reform: The Only Way to Fulfill the President’s Pledge of More Coverage, Better Benefits, and Lower Costs. Annals of Internal Medicine, 166, pages 587-589. DOI: 10.7326/M17-0302.
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