Patient Protection and Affordable Care Act - Research Paper Example

? PATIENT PROTECTION AND AFFORDABLE CARE ACT PATIENT PROTECTION AND AFFORDABLE CARE ACT Introduction Over the years, successive governments have made attempts to salvage the declining quality of health care delivery and increasing cost that is associated with the health care system. Two most powerful outcomes that can be associated with the said attempts that have been made are the passage of Medicare and Medicaid in 1965. Since then, not much has been done to improve the health care system, criticizes Koplan, Liverman and Kraak, (2010). It was in line with this that the Obama government attempted a health care policy that will absolutely overhaul of the U.S. healthcare system. The product of this was the Patient Protection and Affordable Care Act (PPACA) (Husky, 2011). Indeed, the intended impact of the PPACA is clearly spelt out in its name. First, it is expected that health care delivery will take a patient centered approach whereby the interest of the patient comes first in the delivery of health care. Meanwhile, patients visit the health care facility with an intention of receiving quality health care. Secondly, it is part of the idea that the quality of health care that is received will come at a much reduced cost. This means that the exchange for quality must not necessarily be high cost. No-cost preventive services as a mainstay feature of the PPACA One major challenge that had for long prevented the health care system from achieving the goal of quality health care delivery is the pressure that the system has in handing the needs of too many people at a go. Most often, the pressure on the system results in situation where health providers are too few for the health users or health facilities are inadequate to cater for the health needs of the people (Cuellar, 2012). Through an intensive study therefore, there was an aspect of the PPACA that focused mainly on how to reduce the burden on health care system so that delivery could be improved. What was born out of this was the need for there to be enough preventive care services that ensures that health conditions are prevented rather than cured. It was for this reason that no-cost preventive services were made part of the mainstream PPACA. Currently, preventive care takes care of aspects of health care delivery such as immunizations, shots, screening, yearly check-ups and tests (Morrisey, 2007). These preventive services have been made free because the cost benefit effect of leaving them to be optional and at a cost to patients would be worse off. For example if people are made to pay to receive health services that could easily be prevented, they may feel reluctant to do so, only for their health conditions to get deteriorating to a level that will demand more cost from service providers to treat. As far as statistics is concerned, the no-cost preventive service can be said to have three major categorizations of beneficiaries. These are adult services, Women's Preventive Services ObamaCare, and Children's Preventive Services ObamaCare. The table below gives a detailed presentation of the health conditions that are covered under each of the no-cost preventive services. Adult Services Women's Preventive Services Children's Preventive Services 1 Abdominal Aortic Aneurysm one-time screening 2 Alcohol Misuse screening and counseling 3 Aspirin use 4 Blood Pressure screening for all adults 5 Cholesterol screening 6 Colorectal Cancer screening for adults over 50 7 Depression screening 8 Diabetes (Type 2) screening 9 Diet counseling 10 HIV screening 11 Immunization vaccines 12 Obesity screening 13 Sexually Transmitted Infection (STI) prevention counseling 14 Syphilis screening 15 Tobacco Use screening 1. Anemia screening 2. Breast Cancer Genetic Test Counseling (BRCA) 3. Breast Cancer Mammography screenings 4. Breast Cancer Chemoprevention counseling 5. Breastfeeding comprehensive support and counseling 6. Cervical Cancer screening 7. Chlamydia Infection screening 8. Contraception 9. Domestic and interpersonal violence screening 10. Folic Acid supplements 11. Gestational diabetes screening 12. Gonorrhea screening 13. Hepatitis B screening 14. HIV screening and counseling 15. Human Papillomavirus (HPV) DNA Test 16. Osteoporosis screening 17. Rh Incompatibility screening 18. Sexually Transmitted Infections counseling 19. Syphilis screening 20. Tobacco Use screening and interventions 21. Urinary tract 22. Well-woman visits 1. Autism screening 2. Behavioral assessments 3. Blood pressure screening 4. Cervical Dysplasia screening 5. Depression screening 6. Developmental screening 7. Dyslipidemia screening 8. Fluoride Chemoprevention supplements 9. Gonorrhea preventive medication 10. Height, Weight and Body Mass Index measurements 11. Hearing screening 12. Hematocrit or Hemoglobin screening 13. Hemoglobinopathies or sickle cell screening 14. HIV screening 15. Hypothyroidism screening 16. Immunization vaccines 17. Iron supplements 18. Lead screening 19. Medical history 20. Obesity screening and counseling 21. Oral Health risk assessment 22. Phenylketonuria (PKU) screening 23. Sexually Transmitted Infection (STI) prevention counseling and screening 24. Tuberculin testing 25. Vision screening Source: Obamacare Facts (2013) Monitoring has been said to be an important aspect of any national program that is designed with specific objectives set out for it to achieve (Obamacare Facts, 2013). It is in line with this that the need for a substantive body set up to purposely monitor and evaluate the achievement level of any health intervention policy is very important. In line with this, the U.S. Preventive Services Task Force (USPSTF) has been set up to be responsible for reviewing the evidence of the effectiveness of primary care and preventive system of the health services system (Morrisey, 2007). As a body that is already focused on preventive health and primary care, USPSTF comes in as a very important stakeholder for the PPACA, especially when it comes to the no-cost preventive services. As a body that does not consider cost as a factor in its recommendations, the USPSTF could be identified as having a vision that is directly in line with the PPACA’s aim of reducing cost while improving quality. Presently, part of the roles assigned to the USPSTF on the no-cost preventive service is to assign grade definitions to various aspects of the program. These grades are ranked from A to D and are distributed for all levels or components of the initiative. Through a periodic report presentation, stakeholders act on the recommendations of the task force. Transparency and program integrity Indeed the goals for which the PPACA will be defeated if effective structures are not put in place to ensure that there is transparency and integrity with the program. This is because the absence of such transparency and program integrity will take us all back to eras were service providers took undue advantage of service users to enrich themselves. It is in line with this that the PPACA has set up an alliance with a number of private, no-profit entities to be responsible for conducting comparative clinical outcome research that will reflect the level of adherence to the regulations on insurance. A very typical example of such entity that the PPACA works with is The Kaiser Family Foundation. Among other things, The Kaiser Family Foundation has outlined through a research finding that almost half the population of people who currently cater for their own insurance will become eligible for subsidies provided by the PPACA (Obamacare Facts, 2013). But for the appropriate beneficiaries to become true beneficiaries, constant monitoring on transparency must continue to take place. Even though the PPACA comes to build on existing health policy interventions such as Medicare, Medicaid and CHIP program, it does not intend to totally replace these policy interventions. To this end, there are various ways in which these existing policy interventions have been given integrative provisions. First and foremost, an individual mandate is required only for people who are not covered under such previous policies, including Medicare to seek an approved private-insurance policy. This means that these existing interventions have been integrated as payment options for the PPACA. This notwithstanding, it is important to mention that there are structures that have been put in place to ensure that there are reforms to the integrated provisions that ensure that payment systems under these interventions restructured such as exists with the Medicare reimbursements, which has been shifted from fee-for-service to bundled payments (Husky, 2011). Consequently, the PPACA integrates Medicare, Medicaid and CHIP program to make them even more effective and cost efficient. Apart from targeting the Medicare, Medicaid and CHIP program for internally reduced cost of access, there are also structures and programs that are aimed at reducing fraud and waste in these existing policy interventions as a way of ensuring that the cost in funding them is brought down drastically. In one such program, there is the establishment of the minimum standards for health insurance policies, which has been tailored in a way that allocates resource investment avenues for funds that come under the new intervention program. This was various service providers are given regulated investment procedures to seek instead of gaining absolute autonomy to decide on the use of their resources (Koplan, Liverman and Kraak, 2010). There have also been changes to insurance standards that now ensure that under regulations specified in law and under the Secretary of Health and Human Services, proper screening procedures are for in place for health care providers. Typical examples of these include ban on price discrimination and ban on the ability to drop policyholders who fall sick (Cuellar, 2012). References Cuellar, N. G. (2012). Conversations in complementary and alternative medicine: Insights and perspectives from leading practitioners. Sudbury, Massachusetts: Jones and Bartlett Publishers. Husky, K. (2011). Relief from post-traumatic stress may be hours away. McClatchy-Tribune Business News. January 19, 2011. Retrieved from ProQuest. Koplan, J.P., C.T. Liverman, and V.I. Kraak, (2010). Preventing childhood obesity: health in the balance: executive summary. J Am Diet Assoc, 105(1): p. 131-8. Morrisey, M.A. (2007). Health Insurance. New York: Health Administration Press. Obamacare Facts (2013). Obamacare Preventive Care. Accessed November 25,2013 from http://obamacarefacts.com/obamacare-preventive-care.php Read More