The development of digital medicine has come with various challenges and advantages regarding healthcare provision by providers. Essentially, digital healthcare involves the provision of services without having to visit the hospital. The technology involves online prescription without the need to visit the physician. Essentially, there has been the development of ingestible medical sensors and part of digital medicine technology. The ingestible sensors were allowed by the foods and drugs administration in 2012. In essence, this digital technology monitors the ingestion of medicine as prescribed by the doctor ( Antonisse et al., 2018 ). With the enacting of the Obama care or the affordable care act in 2014, there have been various occurrences, including inclination towards hospitals' closure.
Significantly, digital medicine has had various effects on healthcare improvement in the past few years. For instance, the ingestible sensor's development has improved inclination towards prescription and discipline in taking medicine as prescribed by the doctor. In essence, this fact illustrates that there has been an improvement in patient's attitudes to treatment as a result of the technology. Through the sensors, the technology records drug ingestion time, ensuring the follow-up of the patient's progress. This one could be one reason for the increase in recovery cases and the reducing mortality rates, especially in 2012 ( Emanuel, 2014 ). Notably, one of the significant benefits of digital medicine is the manageability of minor illnesses. This is due to the ease in self-diagnosis through tips provided through online sites by the health providers.
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The digital medicine ensures affordability and has improved access to healthcare services as opposed to instances where physical appearance in healthcare facilities is necessary. The reason is since patients can communicate with their health providers despite being way from the facilities. Accessibility of healthcare services is one of the significant healthcare challenges as most patients are in communities where there are no facilities. In essence, hospitals differ inability to respond to various health needs due to efficiency in medical technology and the availability of enough health workers. In such cases, digital health ensures that patients can access health advice from specialists, even without setting appointments. In most cases, long-term patients, especially those suffering from terminal illnesses, require constant care, which has been made accessible by digital medicine technology. The reduction of queues in hospitals is the primary advantage of this technology.
The digital health technology has had various financial effects on the healthcare industry. The patients have cheaper access to services as the provision of information creates long-term patients' ability to take care of themselves at home without necessarily paying home care nurses. Access to data by hospitals is less costly as well as online engagement to ensure the collection of patient information.
However, it is essential to understand that digital medicine does not, in all instances, prate adherence to medicine intake and treatment. It is more comfortable to monitor the health of the patient physically by conducting tests and physical observations to follow up on the adherence to prescribed treatment. This observation is not possible in the use of digital medicine technology. The provision of urgent care, especially for the aged and patients with long-term illnesses, is problematic as the patient is far from the hospital, making it challenging to observe possible indicators of deterioration of the patient's health ( Antonisse et al., 2018 ). Significantly, the hospitals have to put up measures and acquire equipment to ensure the digital health technology is functional. This fact indicates the great challenge of institutions spending too much on delivering health services that are not entirely effective and whose results cannot be observed immediately.
More than 100 hospitals have closed in the United States of America, especially in rural areas since 2010. In total, 150 rural hospitals have closed since 2005, indicating an unmanageability of facilities. Even with hospitals closing in both the urban and rural areas in the USA, the most significant impact has been felt in rural communities. In essence, the closure in rural communities has caused a rise in mortality rates by 5.9% ( Emanuel, 2014 ). These hospital closure has mainly been caused by financial strains experienced by most institutions, causing a low supply of medical equipment and drugs and the inability to pay the health workers. These events have dismembered the patient access to health care, especially since most health practitioners, especially nurses, have relocated from rural areas due to the facilities' closure and consequently increasing travel time and distance for patients in search of medical care.
Access to healthcare also includes access to ambulance services, which are difficult to access in America's rural areas due to the closure of hospitals. This fact suggests that there is a lower response to emergencies such as those caused by accidents since the ambulances have to travel from urban areas or nearby states to respond to the emergencies. There is an excellent connection between the closure of hospitals and the lack of resources. For instance, the Hahnemann university hospital, which is considered a large facility due to its 496-bed capacity, closed down due to losses amounting to $ 3 to 5 million ( Antonisse et al., 2018 ).
The closure of hospitals has affected smaller hospitals more since 1990 due to their inability to adjust to policies and economic changes. Arguably, the more prominent hospitals, especially in urban areas, have lower chances of closing down, and hence most have only cut down expenditure through the relieving staff of duties. However, states that have been able to expand their Medicaid have decreased closure rate, while the opposite is true for hospitals that have been able to adjust through the expansion of Medicaid ( Emanuel, 2014 ). It is possible to use the community's wealth where hospitals exist to predict the amount of money earned by hospitals. This fact indicates that economic strains of households within the community significantly affect the health institutions' financial stability.
Impact of ACA
The affordable care act of 2014 was a move by the federal government to improve healthcare service delivery in an attempt to ensure equality in healthcare. Notably, the act's intension was to ensure that a more significant population was insured, making it possible to access affordable healthcare services. This act sought to introduce higher taxation of the 1% of the American population considered to be rich to cater to the health of the 40% of the low population.
As a result of the ACA of 2014, the uninsured population decreased by half within two years of its implementation. This fact means that an additional 24 million people were insured by 2016, with the uninsured population falling from 16% to 8.9%. This change negatively affected smaller hospitals and private facilities that did not create partnerships with insurance companies to accept patients who were now covered ( Kwon, 2016 ). This fact caused massive inclination of insured patients towards public hospitals, hence cutting the revenue sources for the smaller hospitals in America.
It's vital to consider that previously, people with preexisting conditions like cancer were denied insurance cover. However, in the post ACA, these patients have been insured, which is advantageous to the patient but a disadvantage to the health providers. Essentially, hospitals benefited from expensive cancer treatment services, which are now claimed by the insurance companies. Without banking on the extra charges for treatment and with the interference of the insurance companies' terms, most hospitals have had to move towards closure of their facilities.
The ACA allowed states to the eligibility of Medicaid to nonelderly adults who earn 138% of the poverty level, ensuring reduction in the low uninsured population. This fact has led to an increase in the number of individuals reporting to hospitals, resulting from the affordability of services ( Soni et al., 2020 ). In essence, this change has positive outcomes since it has reduced hospitals' high rate of closure in states such as California that expanded Medicaid. Improvement in the communities' financial status in these states due to the affordability of such essential services such as healthcare has directly affected the urban hospitals in these states, ensuring higher turnovers hence the ability to reduce the accumulation of debts.
As a result of the implementation of the ACA of 2014, there has been an increment in taxes. For instance, the cost of medical devices and pharmaceutical supplies have increased over the years due to ACA related taxes. These increments have caused the hospitals' inability to stock drugs and equipment, causing most of them to become financially unstable ( Antonisse et al., 2018 ). This fact illustrates that the implementation of the act is partly bad for business.
Further, the ACA set the American healthcare system on the pathway for the revitalization of digital technology. The health information technology economic and clinical health provisions under the ACA ensured hospitals' funding to set up IT systems as approved by the federal government. These electronic healthcare record systems set the most substantial platform for digital health innovation, which has seen digital health development through the collection and utilization of patient information to improve healthcare quality.
Through data collected through EHRs and by the insurance companies, patients can receive healthcare services from any part of the country without going to their usual hospitals. This fact means that patients with preexisting health conditions such as cancer can report at any facility and get accurate medical assistance. In this way, it becomes clear that the continued acceptance of digital systems such as EHR by over 96% of the hospitals results from the aim of the ACA ( Lee et al., 2020 ), which was to ensure more fluidity, hence accessibility, affordability, availability and quality services.
Despite the closure of many hospitals, it is also crucial to consider that `there have been positive ACA effects. For example, the increase in the number of screenings of diseases such as culture and inclination towards preventive services has increased the well-equipped government and private hospitals' revenue. This fact indicates that there has been a reduction in the rate of closure. A total of 21 hospitals were closed in 2018, while in 2019, the number decreased to 18 hospitals. This fact indicates that despite a continued downwards trajectory, there is a situation may go back to fewer closures as more states embrace Medicaid.
Effect of AHCA
The proposed bill was meant to make changes to the existing ACA enacted in 2014. One of the changes was to cut down federal government spending on Medicaid. This change would have seen a reduction of government spending by $ 834 billion in 10 years after its implementation. This move would have caused a decline in states' funds to cater to insurance of millions of low-income earners. In essence, this effect would have led to an increase in the cost of healthcare services hence causing a decline in the rate of reporting to hospitals by patients.
Further, the act would have placed caps on amounts remitted to hospitals, causing further financial strain on the already affected hospitals. As opposed to the ACA, which affected hospitals in states that failed to embrace Medicaid expansion, the AHCA would have affected hospitals in all states. Hospitals in 31 states that expanded Medicaid were expected to experience a 78% increase in uncompensated b care cost, causing a financial crisis for most of them that already have debts ( Blumenthal, D., & Collins, 2017 ). This effect would have resulted in the closure of more hospitals in all states despite the expansion of Medicaid.
Another provision of the AHCA was to create per capita limits on Medicaid funding to states by the federal governments. This would have caused the return of expensive services dependent on the income earned in various states. This fact indicates that people living in rural areas and in urban areas but with low incomes would have to pay more for services compared to states with higher populations of high-income earners ( Hirsch et al., 2017 ). Significantly, this move would have overturned provisions hence favoring the wealthy states and disadvantaging poor states. The financial strain caused by an increase in uncompensated care services would have resulted in most hospitals' inability to improve digital technology meant to improve quality due to the inability to sustain additional expenses such as maintenance of sites for online consultancy by patients.
However, the provision of the AHCA to fund safety-net hospitals of states that had earlier failed to expand Medicaid would have affected the private hospitals, especially in rural areas of states that did not expand positively. The funding of these facilities would have seen the development of more safety-net hospitals in the states that are currently disadvantaged due to the lack of expansion of Medicaid ( Dynan & Smith, 2020 ). However, this provision would have benefited private hospitals that provide all services while draining public hospitals further. This fact suggests that the provision would have led to the development of more private facilities than public ones.
In conclusion, there have been considerable improvements in digital healthcare technology due to the affordable care act in 2014. Similarly, various numerous health facilities have been closed due to the reduction in profit-making due to the act. However, the enactment and implementation of the AHCA, which was meant to counter changes caused by ACA, would have led to a massive closure of hospitals across the USA regarding the safety net healthcare centers in states that did not expand Medicaid.
References
Antonisse, L., Garfield, R., Rudowitz, R., & Artiga, S. (2018). The effects of Medicaid expansion under the ACA: updated findings from a literature review. Published March .
Blumenthal, D., & Collins, S. (2017). Where both the ACA and AHCA fall short, and what the health insurance market really needs. Harvard Business Review [serial on the Internet] .
Dynan, L., & Smith, R. B. (2020). Hospital Quality-Review Spending and Patient Safety: A Longitudinal Analysis Using Instrumental Variables. Available at SSRN 3596948 .
Emanuel, E. (2014). Reinventing American health care: how the affordable care act will improve our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system . Public Affairs.
Hirsch, J. A., Rosenkrantz, A. B., Nicola, G. N., Harvey, H. B., Duszak, R., Silva, E., ... & Manchikanti, L. (2017). Contextualizing the first-round failure of the AHCA: down but not out. Journal of NeuroInterventional Surgery , 9 (6), 595-600.
Kwon, J. H. (2016). Review of Ezekiel Emanuel, Reinventing American Health Care.
Lee, L. K., Chien, A., Stewart, A., Truschel, L., Hoffmann, J., Portillo, E., & Galbraith, A. A. (2020). Women’s Coverage, Utilization, Affordability, and And Health after the ACA: A Review of the Literature: A literature review of evidence relating to the Affordable Care Act’s impact on women’s health care and health. Health Affairs , 39 (3), 387-394.
Soni, A., Wherry, L. R., & Simon, K. I. (2020). How Have ACA Insurance Expansions Affected Health Outcomes? Findings From The Literature: A literature review of the Affordable Care Act's effects on health outcomes for non-elderly adults. Health Affairs , 39 (3), 371-378.
