Some of the significant healthcare reforms in the past decade include the introduction of pay-for-performance programs and the Patient Protection and Affordable Care Act (ACA). The changes aimed at improving the quality of healthcare and reducing the cost. The program has enjoyed mixed success, thus driving opinion among policymakers. Some see the programs as beneficial while others argue that they should be repealed, or at least revised. The expansion of Medicaid and the implementation of ACA are credited with the reduction of the uninsured rate (Talbert, Martin, Frazier, & Byas, 2018) . For example, between 2013 and 2016, the uninsured rate fell from 18 percent in 2013 to 8.6 percent in 2016 (Talbert et al., 2018). Today, there are more than 115 pay-for-performances in the US, serving over 50 million people (Sullivan & Soumerai, 2018) . Despite the improvement, there are challenges in the planning and implementation of the programs that are preventing them from achieving their full potential.
Implementation of the ACA affects the operations of many stakeholders, from insurance companies to medics to patients. With that, it is expected that the program would make promoting health literacy one of its top priorities. That entails training the workforce as well as providing infrastructure that supports clear communication on the healthcare reforms (Wizemann, 2011). It also involves sponsoring campaigns to educate even the most remote populations on the healthcare reforms introduced under the ACA and their implications. The planning and implementation of ACA ignored the critical role that health literacy plays in the success of any healthcare reforms (Wizemann, 2011). Further, there was a problem in the design of the ACA program that makes it hard for it to attract millennials (Talbert et al., 2018). One provision of the ACA allows young adults to continue using their parent’s insurance plans, and taxes penalties for lack of health insurance have been removed. According to Talbert et al., that has lead to “lack of people in the risk pool who are young, healthy and whose parents will pay their premiums” (2019). The inability of the program to attract young adults pushes up the insurance premiums
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Regarding pay-for-performance programs such as Medicare, research has shown that they do not achieve their goals of improving the quality and reducing the cost of healthcare (The Commonwealth Fund, n.d.). Their planning and implementation ignored the effect they would have on the doctors since they are too patient-centered. For example, Medicare pay-per-performance programs punish doctors who attend to very sick patients by reducing their quality scores (Sullivan & Soumerai, 2018) . Finally, pay-per-performance programs focus on populations who already have standardized quality measures; they are not suitable for high-cost populations such as the elderly and disabled(The Commonwealth Fund, n.d.). There is, therefore, need to revise them to make them ideal for all populations.
References
Sullivan, K., & Soumerai, S. (2018, January 30). Pay for performance: a dangerous health policy fad that won’t die. Retrieved August 15, 2019, from Stat News: https://www.statnews.com/2018/01/30/pay-for-performance-doctors-hospitals/
Talbert, P. Y., Martin, L. F., Frazier, M., & Byas, D. (2018, July 20). Benefits and Challenges of the Affordable Care Act: What should be the Future of the ACA in 2018? Retrieved August 15, 2019, from ACTA Scientific Medical Sciences: https://www.actascientific.com/ASMS/pdf/ASMS-02-0076.pdf
The Commonwealth Fund. (n.d.). Medicaid Pay-for-Performance: Ongoing Challenges, New Opportunities. Retrieved August 15, 2019, from The Commonwealth Fund: https://www.commonwealthfund.org/publications/newsletter-article/medicaid-pay-performance-ongoing-challenges-new-opportunities
Wizemann, T. (Ed.). (2011). Health Literacy Implications for Health Care Reform: Workshop Summary . National Academies Press
