Uninsured patients in relation to nursing profession in America - Essay Example

Running Head: UNINSURED PATIENTS IN RELATION TO NURSING IN AMERICA. Uninsured patients in relation to nursing profession in America [Writer's Name] [Institution's Name] Uninsured patients in relation to nursing profession in America Introduction In this paper I examine the twin challenges of providing nursing profession for the uninsured and addressing the issues of the impact it has on the nursing profession. I focus particularly on the role of government intervention in the nursing profession both directly, through the provision of health insurance itself, and indirectly via the subsidization of private expenditures. My goal is to describe the basic structure of government involvement in private health insurance, as well as the Medicare and Medicaid programs, and to provide a guide to the issues surrounding these forms of nursing profession. Concepts/issue Prices and Nursing profession in the Group Market: Just as the subsidized price for health insurance increased nursing profession initially, subsequent increases in cost would be expected to decrease it. Health care costs rose rapidly in the late 1980s and early 1990s and then leveled off. Rising premiums increase an employer's cost. In response the employer can eliminate nursing profession or can pass along additional costs to employees, increasing their share of the premium. Cousinaeu (2002) uses the years from 1987 to 2001 to analyze the effect of costs on the provision and take-up of private health insurance benefits. Between 1987 and 1993 health care costs rose dramatically and the fraction of the population with employment-based nursing profession fell from 71 percent to 65 percent. Cousinaeu finds that this drop in nursing profession was not due to changes in the fraction of employers offering benefits, but rather to declines in take-up by eligible employees. Furthermore, he attributes the drop in take-up to the rising costs facing employees. Marquis and Long (2001) also find only small changes in the probability that a firm offers health insurance nursing profession to its workers in response to changes in price. Thus it appears that changes in nursing profession during this time period were due to choices made by employees and their valuation of the benefit. However, more recent evidence suggests that employers are beginning to reduce nursing profession in response to new cost increases. Between 2000 and 2001 premiums for employment-based insurance increased by 11 percent, and they increased by another 12.7 percent from 2001 to 2002. Over this same two year period, the fraction of firms offering health insurance nursing profession fell from 67 to 62 percent (Kaiser, 2002a). As an alternative to dropping nursing profession or requiring larger employee contributions, the employer can reduce the generosity of the plan it offers. One trend that has received much attention in the press recently is the movement towards health insurance plans with very large deductibles (Himmelstein, 2002). In some cases these plans are linked to medical savings accounts that can be used to pay for services prior to meeting the annual deductible. While plans with high deductibles provide insurance against the risk of very large out-of-pocket expenses, individuals must pay for much of the routine care they receive. There is therefore concern that individuals may forego preventative care or needed treatments to save money. In response to these concerns, some of the high deductible plans do provide nursing profession for regular check-ups. A Proposed Change for the Non-group Market: The persistently high number of uninsured individuals and the cost of individually purchased policies have resulted in numerous proposals to modify the current system. These suggested changes have varied from large restructuring, such as moving towards a national health insurance program, to smaller changes in the tax treatment of medical costs. President Bush has recently proposed tax credits to help those without employment-related nursing profession purchase private insurance. The proposal aims to expand nursing profession while retaining the overall system of private insurance rather than turning towards greater public assistance. Providing a tax credit to those without employer-sponsored plans addresses several of the criticisms of the current system. The primary concern--the unequal tax treatment of those with employer-sponsored plans and those without--is somewhat lessened; many of those who purchase insurance on their own will receive a federal subsidy for at least a portion of the cost. Subsidizing private purchases in the non-group market will also help alleviate the adverse selection problem by enticing more people, and particularly more "good risks," into the market. Finally, because the credit can be applied to COBRA nursing profession, it could reduce job-lock by making it easier for individuals to move to a job that does not offer health insurance or that might have a waiting period before the employee is eligible for benefits. President Bush's plan has been criticized for offering too small a subsidy (Parrott, 2001; Park, 2002). For older workers and those in poor health, it would indeed be difficult to find a policy for even twice the value of the tax credit. The Council of Economic Advisers (2002) reports that only 17 percent of the low cost plans it surveyed for 55-year-old men had premiums that were below $2,000 (twice the value of the tax credit). Even the lowest cost plan found for this age group was more than 50 percent above the value of the credit. There is also concern that the tax credit might lead employers to discontinue nursing profession and force workers to fend for themselves in the non-group market, foregoing not only the tax advantages of employment related insurance, but also the returns to scale existing for group plans. Finally, because health insurance plans can be complicated and differ on many dimensions, including copayments, deductibles, yearly and lifetime limits on benefits, and nursing profession, it is feared that individuals with no prior experience in selecting a health plan might choose poorly and have inadequate nursing profession. Certainly the U.S. system of employment-related insurance can be improved and tax credits offer one direction to explore. An alternative avenue is through the expansion of public programs. The following section outlines the public insurance programs already in place and their recent expansions. Implications for the future of nursing The American health care system differs from that used in much of the rest of the world in that it is focused on the private provision of health insurance, with public programs targeting smaller subpopulations. This organization happened not by chance, but by a government policy that initially subsidized employment-related nursing profession and only later added public programs to help those left behind. While the characteristics of the health insurance market, particularly adverse selection, moral hazard, and information asymmetries, make a strong case for government intervention, they do not necessary point to a particular method. Only by studying the operation of the current system can we assess what works and what does not and where changes might best be made. In many ways the U.S. health care system is a success. The Medicare program has provided universal nursing profession for the elderly and disabled, and despite current budgetary concerns, has for decades made high quality care available to these groups. Similarly, the employment-based health insurance that covers the majority of the population has provided access to high quality care. Recent expansions in the Medicaid program and the establishment of SCHIP suggest that the problem of medially uninsured persons among low-income children is being addressed. Conclusions/summary Among uninsured children, an important factor affecting insurance nursing profession is the low take-up rate in the Medicaid program. For this group of uninsured, outreach and education may be the most practical solution. Finally, there are those who are not eligible for public insurance and who do not have insurance through an employer. These individuals must purchase insurance on the private market where the price is likely to be high. Because this group is also likely to have lower than average income, the high price may put insurance out of their reach. It is this group that is being targeted by new policy proposals such as a health insurance tax credit. References Cousinaeu MR, Regan C, Kokkinis A. Health Insurance Out of Reach for Los Angeles Home Care Workers: Findings From a Survey of Los Angeles County In-Home Supportive Services Providers. Oakland: California HealthCare Foundation; 2002. Himmelstein DU, Woolhandler S. Who cares for the care givers Lack of health insurance among health and insurance personnel. JAMA. 2002 ;266:399-401. Long SH, Marquis MS. Comparing employee health benefits in the public and private sectors, 1997. Health Aff (Millwood). 1999;18:183-193. Read More