Healthcare Coverage and Cost-Sharing - Essay Example

? Healthcare coverage and cost-sharing Table of Contents Introduction 3 Identified Problem 3 Literature review 5 Discussion 7 Population coverage for healthcare under public programs 8 Lack of direct health coverage to people 8 Lack of Healthcare Utilization and Health Status 8 Gaps in healthcare baskets 9 Solution and recommendations to health coverage and cost sharing barriers 10 Health insurance covers for entire population 10 Conclusion 10 Introduction America’s healthcare system allows a considerable number of its population to access high-quality healthcare without long waits even though it is available at high costs. However, the uninsured and increasing population of underinsured, the minority groups, as well as the poor have limited or insufficient access to healthcare resulting to poor health outcomes, at times inferior to those available in developing country. As such, provision of affordable, easily accessible, and quality healthcare to the entire American population still remains a challenging encounter. It is apparent that ensuring healthcare access to all American citizens, while maintaining high-quality health as well as managing overall expenses is an overwhelming challenge. Furthermore, the issue of health insurance coverage and cost-sharing has raised alarm with different individuals putting forth conflicting interests as well as views on how these elements should be incorporated in healthcare system. The United States health sector is currently experiencing serious problems resulting from these elements, and it is important that appropriate measure be implemented to prevent further inconveniences. The non-real American system should sanction universal healthcare access for its overall population through adequate healthcare covering and cost-sharing Program. This paper will address healthcare coverage and cost-sharing as one of the problems associated with current US healthcare system by examining various aspects influencing access to healthcare services, financing and costs of healthcare, as well as quality. In addition, it will discuss the pros and cons of healthcare coverage and cost-sharing, and provide recommendations of appropriate ways that are likely to improve healthcare delivery in healthcare institutions. Identified Problem One of the objectives of implementing an effective healthcare system is to improve accessibility and quality of care while at the same time regulating costs. The implementation of an appropriate healthcare provision system will facilitate healthcare coverage and cost-sharing in various healthcare activities such as financing disease diagnosis, treatment as well as doctor consultation. Healthcare coverage is an essential means of enhancing access to healthcare among the American citizens. It is obvious that health insurance in an appropriate measure that the government can use to promote equality and availability of healthcare drugs as well as services. Through a well-developed health insurance strategy and system, it is possible to offer an all-inclusive healthcare system in both private and public health sectors. Nevertheless, the US government fails to establish efficient, effectual, and reliable structures or programs for providing healthcare coverage to its populace. Available healthcare coverage plans constitutes several limitations, including high premiums, minimal employers contribution to health coverage, and limited funds among others. This has caused a high number of uninsured and underinsured individuals in America. Consequently, it has heightened healthcare cost, influenced healthcare quality negatively, and rendered healthcare inaccessible to the poor as well as minority groups. The US government has the responsibility of providing affordable, quality and accessible healthcare regardless of the associated financial burden (Harris, 2011). Furthermore, cost-sharing initiatives can be implemented in the form of revolving drug funds and charges for healthcare services in the attempts to elevate care provision in times of economic crises as well as decline in government revenue. As a result, it improves quality and availability of significant healthcare services. Moreover, a carefully designed cost-sharing system can augment access to healthcare, enhance community participation and equity. It is argued that community participation in financing-related strategies can considerably improve healthcare coverage and quality. However, cost-sharing policies are considered to impact access to healthcare by increasing out-of pocket payments or premiums. In this sense, healthcare coverage and cost-sharing policies or measures in the United States are associated with multiple controversies, which account for under-exploitation of these approaches in healthcare provision (Al Serouri, Balabanova, & Al Hibshi, 2002). Literature review Several researchers have addressed the issue of healthcare coverage and cost-sharing. Haren and McConnell (2009) observed the relationship between employers and healthcare insurers, which has significant effects in making decisions concerning cost-sharing, benefit design as well as coverage of services and products. In conformity to the research carried out by Zitter Group, a comprehensive outlook of the relationship between employer and insurer was found to influence several aspects of healthcare coverage as well as cost-sharing. Their web-based survey constituting key decision makers in commercial-oriented care plans. Furthermore, research findings indicated that cost-shifting is the common cost-containment strategy employed by employers and insurers. Insurers as well as employers perceive further cost-shifting to have negligible effects on healthcare outcomes with respect to accessibility, cost and quality. Following Haren and McConnell’s research, it is apparent that insurers and employers prefer cost-shifting to healthcare coverage as a cost-containment strategy regardless the undesirable cost and health outcomes associated with cost-shifting (Haren & McConnell, 2009). Shields, McGinn-Shapiro and Fronstin (2008), analyzed public and private health coverage trends along with health disparities as well as outcomes experienced by vulnerable populations. According to their research, health benefits accruing from employment are inexistence, and the proportion of employees with coverage as well as employers providing coverage has declined. Besides, individuals with coverage encounter increased cost sharing with the decline in benefits. In the public sector, there has been a decline in Medicaid, with ever-increasing restriction of coverage benefits. It is notable that health coverage must be provided to all America’s citizens in order to satisfy their healthcare needs as well as minimize health disparities. In addition, adequate fullness of benefits in public and private programs is essential so that healthcare needs of enrollees can be attained. Shields’, McGinn-Shapiro’s and Fronstin’s research findings confirm that America has failed to meet healthcare needs of her citizens with regard to health coverage (Shields, McGinn-Shapiro, & Fronstin, 2008). According to Kinney (2011), amendments made by the Healthcare and Education Reconciliation Act of 2010 on Patient Protection and Affordable Care Act instigated an all-inclusive change in the United States’ healthcare sector. As a result, PPACA incorporated strategies for enhancing effectiveness as well as efficiency of American healthcare sector. Through the research plan on comparative effectiveness of the healthcare sector initiated by PPACA, increasing healthcare costs are addressed with the federal commitment to ensuring healthcare expenditures’ value. This indicates that healthcare policies in the United States are dedicated to promote availability of quality and affordable healthcare to all American. In so doing, they focus on healthcare coverage plans in addition to cost-sharing programs. However, there are controversies concerning the governance capabilities of the institute monitoring these initiatives. It is apparent that the government plays a significant role in ensuring appropriate utilization of funds in publicly financed healthcare plans in its effort to ensure comparative effectiveness of healthcare-related plans such as health coverage. Moreover, findings obtained from various healthcare research initiatives are used to minimize costs resulting from medical practices, as well as increase effectiveness, quality and efficiency of healthcare (Kinney, 2011). The survey carried out by Commonwealth Fund Healthcare Opinion Leaders indicated that the US Congress views increasing coverage for uninsured individuals as one of the key healthcare priorities. Findings revealed that most members considered providing health coverage to all as an avenue of offsetting the increasing cost of healthcare. One of the strategies identified for increase coverage was authorizing all people to purchase health coverage as well as subsidies so that the uninsured can affordable coverage. The provision of matching funds to states for extended Medicaid coverage to aid low-income adults as well as children was identified as a feasible way of increasing coverage of the uninsured. Other alternatives included establishing an insurance system based on single-payer plan, and extending Medicare coverage to all Americans. In addition to healthcare coverage, congress laid emphasis on reforming Medicare, regulating healthcare costs, and enhancing healthcare quality through information technology (Commonwealth Fund Healthcare Opinion Leaders, 2007). Discussion Healthcare coverage and cost sharing initiatives are forms of fees to health services and revolution of drug funds. The two initiatives have been implemented in various countries across the world to respond to the current severe economic crises that has declined government revenue leading to low funding of healthcare systems. Health coverage and cost sharing have been associated with numerous advantages. This is because they have enhanced improvement of quality and availability of essential health and medical services (Guy & Gery, 2010). Many healthcare participants and communities across the world have identified health coverage and cost sharing as the major problem in healthcare systems. The major theme of these communities concern poor coverage of health services despite their high cost. According to research from healthQuest, these barriers are interrelated and render people into a risk of social exclusion. In addition, the study also identified that, most vulnerable groups at risk of poverty lack health cost leading to delay or lack of healthcare services. This indicates that most poor people in societies have reduced access to healthcare basket (Hoffman & Paradise, 2008). Population coverage for healthcare under public programs Most European Union member states around the world have mandatory systems that offer universal health coverage. They offer universal coverage against health risk to all people with documented resident status under public programs. This is because making health insurance payment a personal responsibility will pose problems of accessing healthcare among many people. In various countries such as Netherlands and Germany, everyone is obligated to registering for health insurance. Failure to comply with the requirement results into a fine or high payment of health services. Insurance payment as the main instrument of healthcare coverage is spreading among EU states in order to reduce risks of health exclusion (Rowland & Garfield, 2000). Lack of direct health coverage to people Although healthcare services vary among different countries, coverage gap appears between illegal immigrants and other health seekers without residency permit. Lack of proper health coverage is not only a barrier toward health services but it is also connected to other barriers. According to world health organization, access to healthcare should be operationalized in relation to the proportion of the population in a country (Guy & Gery, 2010). This is in order to reduce risk of the patients’ health. Patients’ safety should, therefore, be parallel to the quality of healthcare initiatives. Due to the rising healthcare, various states should consider policies that ensure low-income earners are the beneficiaries for the health services. This is because higher health cost sharing makes it unaffordable to poor families, people with disabilities and seniors (Hoffman & Paradise, 2008). Lack of Healthcare Utilization and Health Status Some of the substantial researches in various states have demonstrated that low income people are vulnerable to effects of cost sharing in health services. This is because cost sharing policies leads to the reduction of healthcare services among the poor. Reduction of these services results into adverse health consequences especially to people suffering from chronic diseases. Moreover, higher payment of drugs and medical services make poor people in societies to use non-essential and less effective medical services. According to an experiment conducted by RAND health insurance, about 44 percent of low-income earners reduce their use of essential and effective medical services when forced to make payment (Rowland & Garfield, 2000). Existence of cost sharing and lack of health coverage will also encourage people to have cost consciousness and make better healthcare decisions. This is by avoiding unnecessary medical care that lead to excessive use of money. Patients can choose not to get medical services for coughs or any another discomforts that might be signs of common cold. In addition, they can also decline from seeking treatment for chest pains that in some situations can be signals of heart related diseases (Hoffman & Paradise, 2008). Gaps in healthcare baskets Health coverage and cost sharing barriers have a great impact on primary health services and medications. This is because most of these services are offered free of charge to all eligible population in a country. There are various coverage gaps that are evidenced in healthcare such as prescription of drugs and surgeries (Guy & Gery, 2010). This indicates that there is a very strong relationship between how health basket regulations interact with the cost sharing and health coverage to determine accessibility of health services. This is because cost sharing can result to restriction of access to health services and medication to vulnerable people in societies despite health coverage offering extensive prescription of medical care to all. Solution and recommendations to health coverage and cost sharing barriers Every individual in various countries across the world has the right to access healthcare according to chapter of fundamental rights from European Union (Rowland & Garfield, 2000). In addition, every person has the right to benefit from medical services as depicted by conditions that were established by International laws and policies. Healthcare and access projects have examined six hurdles to make it possible for all people to access healthcare within different counties. The six hurdles include health insurance covers for entire population in a country, medical benefit covers, utilization of accessible health services and arrangement for cost sharing. The six helps in alleviating barriers that prevent people from accessing better health services and medication. Health insurance covers for entire population Governments from different countries across the world should ensure health services and medications are extended to the entire population. This is in an effort to issues of health access barriers among less vulnerable people in societies. Health coverage should comprise of entire basic packages of health services and medications which should be free of charge to all. In addition, to enhance better and high quality services, public health services in different states should have compulsory health insurance and National health services financed through tax. In order to enhance equality of all people in terms of receiving prevalent medical services, the healthcare should embrace reforms designed to address cost and quality of health services. This can be achieved through introducing private health insurance markets with service providers to ensure medications are readily available (Guy & Gery, 2010). Conclusion Healthcare services and medications should be made universal and available to every person in the world. Health coverage and cost sharing should, therefore, be embraced to reduce risk of social exclusion among vulnerable people. This is because although health basket is comprehensive to all, poor people in societies suffer from shortage of medical and health services due to financial constrains. Research indicates that existence of public budget variation among people has a great impact on utilization of health services. This leads to restriction of quality health services to those groups under risks of social exclusion. In addition, low level of health literacy is another factor that poses a barrier to the access of better healthcare services. This is because most people avoid taking health insurance coverage in order to lower their economics of scale. They believe that it is unnecessary to get medical services for some health conditions such as coughs. It is, therefore, important for health services administration to impose policies that will enhance accessibility of effective medical services to all people irrespective of their financial status. This is because vulnerable groups in societies are at risk of cost sharing and healthcare coverage barriers. References Al Serouri, A. W., Balabanova, D., & Al Hibshi, S. (2002). Cost Sharing for Primary Healthcare: Lessons from Yemen. Oxford, UK: Oxfam. Commonwealth Fund Healthcare Opinion Leaders. (2007). Focus on Covering the Uninsured, Reducing Health Costs, Say Healthcare Leaders. Healthcare Financial Management , 61 (3), 13-16. Guy, J., & Gery, P. (2010). The Effects of Cost Sharing on Access to Care among Childless Adults Effects of Cost Sharing on Access to Care. Health Services Research , 45 (6), 1720-1739. Haren, M., & McConnell, K. (2009). Patient cost-sharing on the rise: results from the Benefit Design Index. American Health & Drug Benefits , 2 (2), 70-77. Harris, T. F. (2011). Healthcare coverage and financing in the United States. Winsted, CT: ACTEX Publications. Hoffman, C., & Paradise, J. (2008). Health Insurance and Access to Healthcare in the United States. Annals of the New York , 1136, 149-160. Kinney, E. D. (2011). Comparative Effectiveness Research Under the Patient Protection and Affordable Care Act: Can New Bottles Accommodate Old Wine? American Journal of Law & Medicine , 37 (4), 522-566. Rowland, D., & Garfield, R. (2000). Healthcare for the Poor: Medicaid at 35. Healthcare Financing Review , 22 (1), 23-31. Shields, A. E., McGinn-Shapiro, M., & Fronstin, P. (2008). Trends in Private Insurance, Medicaid/State Children's Health Insurance Program, and the Healthcare Safety Net. Annals of the New York Academy of Sciences , 1136, 137-148. Read More