Health Science - Research Paper Example

? Health Science Table of Contents: Serial No. Topic Page No Introduction 3 2. Issues to Healthcare Delivery Associated withHealth Insurance Coverage 4 2.1. Problem 1 4 2.2. Problem 2 4 2.3. Problem 3 4 2.4. Problem 4 4 2.5. Problem 5 4 2.6. Problem 6 4 3. Governmental Involvement in Health Insurance Coverage Plans and Issues 5 4. Literature: A Brief Review 6 5. Current Policy Position in the Country 8 6. Current Bill Associated with Health Insurance in the US 10 7. Conclusion 11 References 12 1. Introduction: Issues related to health care are undoubtedly significant for understanding such that the delivery of healthcare may be improved in any country. The present study considers the issue of health insurance coverage that proves to be an essential factor in the present day treatment necessities. The primary issue in countries like America in relation to health insurances is the gaps in the health insurance coverage that has been persisting as a problem in the country. This mostly affects the families that have low incomes, thereby making the problem an “all-American problem” (Collins et al, 2006). The United States has an extremely intricate and complicated structure for funding and delivering health care. Individuals in the country acquire coverage in the course of their jobs, the federal government, and the military, state programs or sometimes on their own. Simultaneously, they compensate for the coverage through planning with their employers, the state and federal taxes, and also from their own funding (Health Care Coverage in America: Understanding the Issues and Proposed Solutions, 2007, p.3). In a country like the US, the health care spending has been found to have increased drastically over the years that at times proving to increase the economic growth of the country by certain margins. However, in spite of such circumstances there are several individuals who are not health insured, even when the economic growth of the country is high. “This combination of eroding health insurance coverage and rapidly rising health care costs raises concerns about the ability of U.S. families to obtain timely medical care, protect their finances from catastrophic health care costs, and save for retirement” (Collins et al, 2006). This particular hence discusses about this particular issue and determines the current situation considering the USA. 2. Issues to Healthcare Delivery Associated with Health Insurance Coverage: Owing to the rising costs and the fixes not been improved by the healthcare delivery in the country, the US healthcare system was proclaimed to have been out of order, leading to problems for the patients and physicians across the country (Garson, 2000, pp.2015-2016). 2.1. Problem 1: First is the problem that every individual in the country is not insured. Hence basic health plans should focus and make the health insurance compulsory for all individuals (Garson, 2000, pp.2015-2016). 2.2. Problem 2: Problem arises with a purely governmental system instead of which public-private mix of activities could be linked (Garson, 2000, pp.2015-2016). 2.3. Problem 3: The insurance system is employer-based and limits the choice of insurance, and get stuck with jobs in apprehension of losing coverage (Garson, 2000, pp.2015-2016). 2.4. Problem 4: The healthcare system is complicated creating problems for the administrators, patients, and physicians (Garson, 2000, pp.2015-2016). 2.5. Problem 5: The quality of healthcare delivery is not constantly considered, accounted, realized, or employed in decision-making (Garson, 2000, pp.2015-2016). 2.6. Problem 6: Financing is not considered effectively in the present times that would require sincere focus in the near future (Garson, 2000, pp.2015-2016). 3. Governmental Involvement in Health Insurance Coverage Plans and Issues: The US National Government is known to have a significant role in the financing, systematizing, supervising, as well as in delivering health care. In several cases the role of the government is concerned with providing care to people who would otherwise not receive such healthcare. These include the poor, the disabled, and the elderly since these people may not be able to have the funds for insurance or might be returned back by the insurance companies if they plan to buy it. Not only this, the role of the government in health and delivery of health care also includes reaching into the area of developing new discoveries, regulating activities of the private-markets, and several other such actions (Health Policy Brief, 2009). The United States has a number of widely financed health insurance plans. The government does not provide health care directly through these initiatives. It works as a financial medium, and accumulates funds from taxpayers and directs it through the federal government to compensate generally health care providers in the private sector for health care delivery. Medicare is a leading program that involves federal expenditures. It is funded by the federal government and personal donations from recipients for premiums, fixed-dollar payments referred as copayments, and a percentage of charges made by providers referred as coinsurance. “Federal spending currently devoted to Medicare and Medicaid is equal to about 4 percent of GDP and is projected to rise to nearly 6 percent by 2019 and 12 percent by 2050. In addition to Medicare and Medicaid, there is also the Children’s Health Insurance Program (CHIP), which began in 1997 and is paid for jointly by the federal and state governments” (Health Policy Brief, 2009). Thus the government can be understood to have an important role as far as the healthcare delivery and health insurances are concerned. 4. Literature: A Brief Review: Studies considered by Faden et al (2011, p.2) focus on the role of health insurance systems in cost effective use of medicines in healthcare delivery. All-inclusive coverage of medicines is many times not included in the health insurance benefits. Several insurance systems had been developed with the principal attention on reduction of appalling health expenditures, particularly those related to hospitalization. “However, given high out-of pocket spending on pharmaceuticals, an insurance scheme with no or limited medicines coverage may not prevent cost-induced poverty from medicine expenditures” (Faden et al, 2011, p.2). According to the study, there are four broad categories of policies and management strategies that health insurance policies can utilize to bring equilibrium in the challenging goals of improvement. These include selection, purchasing, contracting, and utilization management (Faden et al, 2011, p.3). Savage (2011, pp.193-194) in his studies reflected on three major reasons owing to which several Americans are not covered under health insurance plans. These include: (1) people being healthy are reluctant to pay the price for the insurances; (2) insurance underwriting practices or rigidities in the labor market do not allow people to obtain health insurances with ease; and (3) people want insurances but are incapable of affording the coverage. Moreover, the socio economic status of the country, the demographics, and the definite and perceived status of health, the perceived value, and the perceived needs are other factors that determine the purchase of health insurance plans by individuals in the country. These factors may significantly affect the young adults from obtaining health insurances, along with the rising costs of the insurance products. Dicken & Dicken (2011, p.1) conducted studies on health insurance coverage issues and highlighted on the data gathered by the GAO. Data reveal that several Americans that cover around 64 percent of the individuals are dependent on the health insurance plans. The Patient Protection and Affordable Care Act were enacted in March 2010. With this enactment, private health insurances enrollment was able to develop appreciably, mainly for individuals and families that are not provided with group coverage by their employers. There are some federal requirements that defend against the rejection of claims for enrollment for individuals entitled for group coverage. However until PPACA is completely put into practice, such protections cannot be applied to some customers who are in search of individual coverage from private health insurers. The flow of technology within the delivery of health care system has been put under inspection as its role in the present times has significantly increased, particularly in terms of expenditure. Medical innovations have been obtained to explain for a considerable percentage of the increase in medical expenditure. As far as the health insurance coverage is concerned, studies focus on the fact that the type of insurance coverage planned and implemented may be capable of determining the use of new drug. A relation has been obtained in between the health insurance coverage and the prescription of drugs where the “more generous insurance coverage increased consumption of prescription drugs” (Costa-Font, Courbage & McGuire, 2009, p.111). Research has also taken into consideration the effects of different reimbursement plans on the acceptance and transmission of new medical technologies. In spite of the new technologies, there are barriers for the utilization of new drugs. However, it is still believed that the type of coverage may actually predict the demand for newer technologies (Costa-Font, Courbage & McGuire, 2009, p.112). According to studies by Chesnay (2005, pp.420-421), a significant development in the rate of Americans who are not insured is the decline of employer-provided health coverage, the chief cause of insurance for practically two of three Americans. Based on data provided by National Federation of Independent Business, in the year 1993, 65 percent of employers provided individuals with insurance coverage that in the present times have reduced to only 47 percent. Studies have also associated the lack of insurance with the incapability to get hold of services with undesirable health effects. Poverty also has been related to the lack of insurances, and it has been observed that several individuals without the health insurances experience major impediments to health care services. 5. Current Policy Position in the Country: Expenditure on health care delivery in the United States has amplified from “$75 billion (7% of Gross Domestic Product [GDP]) in 1970 to more than $2 trillion (16% of GDP)” (American Association of Orthopaedic Surgeons, 2009). This has been obtained to be two times the pace of expenditure of other developed countries. Nevertheless Americans follow behind other nations for several health effects. Although the level of spending in the country is so high, yet tens of millions of Americans are found to lack insurance. There are different factors leading to augmented and ineffective health care costs are that include high administrative costs, an out of order accountability system, an enhancement in occurrence of chronic disease, a movement in cost from the uninsured to the insured, a principal third-party payer system, and needless care for patients (American Association of Orthopaedic Surgeons, 2009). The prevailing system of health care in the country is employer based posing distinctive problems with respect to convenience and the ease of use of health care for every patient and physicians. The current system of health insurance and health care delivery cannot be carried on with success. There is an immeasurable demand that needs to be checked by a different ways. Individuals in America obtain their health care coverage by means of a wide range of public and private arrangements. The Congress has been known to reflect on a variety of schemes to alter the currently prevailing system of health care. It is significant in this regard that policy makers stay away from constructing new high-priced programs that reiterate the earlier mistakes. “Existing government programs – Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP) – face long-term sustainability challenges due to trillions of dollars in unfunded liabilities” (American Association of Orthopaedic Surgeons, 2009). According to American Association of Orthopaedic Surgeons (AAOS), in any deliberation of modifications to the financing of health care and system of delivery in the United States, “the well-being of the patient must be the highest priority” (American Association of Orthopaedic Surgeons, 2009). The reform measures and principles are strongly supported by the AAOS providing individuals with constant rights of entry to “patient centered, timely, unencumbered, affordable and appropriate health care and universal coverage while maintaining physicians as an integral component to providing the highest quality treatment” (American Association of Orthopaedic Surgeons, 2009). According to the AAOS the policymakers “should make certain that patients are empowered to control and decide how their own health care dollars are spent, ensure unencumbered access to specialty care make health care coverage more affordable, improve the quality of care, extend both coverage and access for the uninsured and under-insured, and avoid establishing new unsustainable programs” (American Association of Orthopaedic Surgeons, 2009). 6. Current Bill Associated with Health Insurance in the US: Under this section of the study, the Affordable Care Act may be considered that has recently come into place. “The Affordable Care Act is a health care law that aims to improve our current health care system by increasing access to health coverage for Americans and introducing new protections for people who have health insurance” (What is the Affordable Care Act?, 2012). Depending on this law (1) young adults can now settle on the health plan of their parent till they are 26 years old, (2) Some small businesses that have less than 25 employees can get assistance for payment of the cost of providing health insurance, (3) Insurance companies cannot reject health coverage to children who have pre-existing conditions, (4) Adults who have been uninsured for a minimum of 6 months and have been denied coverage owing to any pre-existing condition are now capable of receiving coverage, (5) Insurance companies can no more place dollar limits on the health care delivery that they cover in one’s lifetime, (6) Those in Medicare can get precautionary services and screenings, such as mammograms and colonoscopies, at no cost, and (7) New health plans must offer preventive and screening services like mammograms and colonoscopies, at no cost to the patient (What is the Affordable Care Act?, 2012). Thus small businesses are assisted by this law through payments for health insurance for their employees. It also supports plans that will facilitate boosting the number of primary care physicians, nurses, physician assistants and other health care professionals. “The law now offers health plans for people with pre-existing conditions who have had trouble finding care. And it will increase access to coverage for more Americans in 2014” (What is the Affordable Care Act?, 2012). 7. Conclusion: As far as the study is concerned, it can be said that in terms of the health insurance coverage, there is a significant association of the healthcare delivery and the government. The study considered US as the country for understanding this issue. It can be concluded from the study that with the passing years, not much improvement has been obtained as far as people’s obtaining health insurances is concerned. Although there are several new insurance products being initiated, yet the rising costs as well as the reluctant attitude of the customers are creating concerns for the insurance coverage plans. This in turn is affecting the effective delivery of healthcare to several individuals particularly those who cannot afford the insurances. In regard to this, it can be said that the government of the US needs to immediately take concern of the matter and plan of creating such innovative health insurance coverage plans that can be made compulsory on the consumers with easy to afford facility. This might require the government to increase its funding however being effective and not wasting the funds as mere healthcare expenditure. The government needs to understand the significance of the heal insurance plans for the delivery of healthcare and consider measures accordingly towards successful achievement of healthcare in the country irrespective of the condition of the consumers. References 1) American Association of Orthopaedic Surgeons (2009). Position Statement, aaos, Retrieved on August 30, 2012 from: http://www.aaos.org/about/papers/position/1176.asp 2) Chesnay, M.D. (2005). Caring For The Vulnerable: Perspectives In Nursing Theory, Practice, And Research, Massachusetts: Jones & Bartlett Learning 3) Collins, S.R. (2006). Gaps in Health Insurance: An All-American Problem, commonwealthfund, Retrieved on August 27, 2012 from: http://www.commonwealthfund.org/Publications/Fund-Reports/2006/Apr/Gaps-in-Health-Insurance--An-All-American-Problem.aspx 4) Costa-Font, J., Courbage, C. & A. McGuire (2009). The Economics of New Health Technologies: Incentives, organization, and financing, Oxford: Oxford University Press 5) Dicken, J.E. & J.E. Dicken (2011). Private Health Insurance: Data on Applications and Coverage Denials, Darby: DIANE Publishing 6) Faden, L. et al (2011). The Role of Health Insurance in the Cost-Effective Use of Medicines, haiweb, Retrieved on August 29, 2012 from: http://www.haiweb.org/medicineprices/24072012/HealthinsurancefinalMay2011.pdf 7) Garson, A. (2000). The US Healthcare System 2010, Circulation, 101, pp.2015-2016, Retrieved on August 28, 2012 from: http://circ.ahajournals.org/content/101/16/2015.full 8) Health Care Coverage in America: Understanding the Issues and Proposed Solutions (2007), allhealth, Retrieved on August 27, 2012 from: http://www.allhealth.org/publications/uninsured/health_care_coverage_in_america_2007_54.pdf 9) Health Policy Brief (2009), rwjf, Retrieved on August 29, 2012 from: http://www.rwjf.org/files/research/82409healthaffairs7.pdf 10) Savage, G. (2011). Biennial Review of Health Care Management, England: Emerald Group Publishing 11) What is the Affordable Care Act? (2012), healthcareandyou, Retrieved on August 31, 2012 from: http://www.healthcareandyou.org/what-is/ Read More