For a long time, health care reforms in the United States are often proposed, with most of them not being implemented. The Affordable Care Act is among the little legislation that has made a significant impact on the American health system. The Affordable Care Act has increased access to care among all citizens in the United States. Millions of Americans previously uninsured can now afford healthcare services. However, this progress has resulted to higher spending on health care, making the US health care system the most expensive among all the developed nations.
The Patient Protection and Affordable Care Act is designed to improve accessibility, affordability, and quality of care to all citizens. Besides, the legislation also proposed a shared responsibility between employers, individuals and the government (Niles, 2019). The percentage of individuals who are insured by public health insurance has greatly increased, with nearly 26 percent accessing basic health care services.
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With the introduction of affordable care though the ACA; the federal government has expanded health insurance using Medicare and Medicaid. America spends approximately $ 3.2 trillion amounting to $ 10, 000 per person as Medicare services provides health insurance to approximately 13 percent of the entire American population (Burns, Alexander & Andersen, 2020). Medicare has two options, the first being, compulsory insurance coverage offering inpatient services and specific care services for individuals in limited nursing home. The second part is voluntary or more of a supplementary plan that includes physician services, outpatient laboratory, radiology and home services (Burns, Alexander & Andersen, 2020). On the other hand, Medicaid focuses on individuals with low income groups. The program runs jointly by the state and federal government (Burns, Alexander & Andersen, 2020). Medicare and Medicaid are the two major national public health insurance programs the US utilize to increase accessibility to care.
In the US, Medicaid and Medicare services vary with each program having specific eligibility criteria. Additionally, the federal government provides specific care benefits to hospitals, physician and nursing services depending on each state (Liao, Navathe & Werner, 2020). The ACA reforms expanded coverage using both Medicaid and Medicare, which operates differently and have faced different barriers in implementing these services. The US health system is fragmented as compared to other nations. The country relies on multiple systems run by both government and private entities. For instance, insurance covers are purchased from different service providers authorized by the government (Liao, Navathe & Werner, 2020). This is different from Canada and Germany who uses a single-payer system.
Canada has a well-structured health system whereby everyone is insured .Payments for health services are conducted by one authorized third party (Qureshi, Nagai & Bennett, 2019). Similarly, Germany's health care system operates under the principle of social benefit and solidarity, thus, the government has the obligation to provide all the social benefits to every citizen including medical services (Qureshi, Nagai & Bennett, 2019). Canada and Germany have a well-structured health system compared to the US.
The fragmented nature of health care services in the US is a result of a multiplayer system, which makes the system complex. The health system comprises of commercial health insurance companies, private health care organizations, both the state and federal government, all these players are involved in direct reimbursement of care services (Niles, 2019). Reimbursements takes place in different forms, thus, the prices vary greatly from provider to provider. The third-party payer covers apportion of what patients own the medical service provider and the payment comes with different sets of rules which the clinicians and the facility have to fulfill to get paid Niles, 2019). As a result, what the provider charges and what the insurance pays depend on several factors. Such complexities make the US health care most expensive among all the developed nations.
The US should adopt a single payer model used by Canada and Germany to eliminate wastage of resources. The government can convert Medicaid and Medicare into a single and efficient health finance system. A single payer platform will streamline health care services saving the countries millions of dollars.
References
Burns, L. R., Alexander, J. A., & Andersen, R. M. (2020). How different governance models may impact physician–hospital alignment. Health care management review , 45 (2), 173-184.
Liao, J. M., Navathe, A. S., & Werner, R. M. (2020). The Impact of Medicare's Alternative Payment Models on the Value of Care. Annual Review of Public Health , 41 , 551-565.
Niles, N. J. (2019). Basics of the US health care system . Jones & Bartlett Learning.
Qureshi, Z. P., Nagai, S., & Bennett, C. L. (2019). Biosimilar filgrastim use in the United States vs the European Union and Japan—why does it lag behind and what can be done. JAMA oncology , 5 (3), 297-298.
