The US health care system has been criticized by many people over the years for several of its characteristics compared to other developed nations around the world. While the criticism may not be taken to imply a failed health system, it signals the need for strategic reforms to the sector that would improve the quality of products and services rendered to the public, improve health care coverage, lower the costs of obtaining health care, improve the methods of reimbursement, and reduce the disparities in the access to healthcare for the public. This paper describes the five areas that are need of reforms, including the issues with the current healthcare system of the country.
Health Insurance
The current health insurance system of the US has been criticized for two primary reasons. First, the country does not have a universal health coverage for its populace. According to (), about forty-four million Americans do not have health insurance and another thirty-eight million do not have an adequate cover, which implies that approximately one third of the entire populace do not have an access to the required level of health insurance. Another most cited issue with the American health care insurance is the fact that the government has not adopted an effective regulatory framework that controls the amount of premiums that the public pays and providers of such services. The health insurance market of the country is dominated by private providers, which suggests that they most likely exploit the public for profit (Obama, 2016). For example, in 2017, the public spent close to $3.2 trillion on healthcare, a significant figure that was allocated to health insurance (Woolhandler, Campbell, & Himmelstein, 2018). The two issues call for reforms, first to increase the number of insured persons, and second to regulate the health insurance market and eliminate the exploitation of the public. The current Affordable Care Act has already been subjected to significant levels of scrutiny, which has already repealed some of its clauses, such as the individual mandate (Saltman & Figueras, 2018). Amending the Affordable Care Act could be one of the most useful approaches to attaining universal health insurance for Americans.
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The Quality of Healthcare in America
America enjoys high standards of health care that only a few countries around the world can match and surpass, and some people could be taking the quality outcomes for granted. Most people are often satisfied with individual medical care and personal physicians although they could express general dissatisfaction with some elements of the health care system, which may include the access to timely care. Quality issues have been identified with ambulatory and inpatient care. For example, studies find excessive and inappropriate surgery procedures, variable results of the surgical procedures done on patients, issues with the use of laboratory tests, such as lack of effective follow-up on the results, underuse, and overuse, nosocomial infections, inappropriate diagnoses and subsequent treatment of acute cases as well as inappropriate or excessive use of prescription drugs (Lohr, Yordy, & Their, 2018). Further appraisal of literature notes high variations in population-based levels of utilization of specific medical procedures, inappropriate discharge procedures that reduce the potential benefits of hospital stays among the elderly and other related issues.
Reforming the quality aspect of healthcare in America, therefore, could lead to better quality outcomes for the public, which would be one of the ways that would help in compensating the high costs of health care that are associated with the system as described subsequently.
The Cost of Healthcare
That the US has the most expensive healthcare system of the developed world is now common sense. The cost of health care in the country has been subject to significant attention from policymakers and the public. For example, by 2013, close to fifty-six million Americans struggled with their health care related bills (Berwick & Hackbarth, 2014). The primary reason is the fact that health care and health insurance in the country are too expensive for all people to handle them comfortably. It has been mentioned the public spent close to $3.2 trillion on health care in 2017, which is a significant proportion of the country’s GDP. On average, a person spends between $5000 and $10000 on healthcare in the US, which makes the system very expensive (Woolhandler, Campbell, & Himmelstein, 2018).
High costs of healthcare have associated negative implications in elements, such as the access to services and products and the expected quality of care. In this case, the high costs of health care reduce the number of people with access to high standards of care and causes them to expect that they would receive the highest quality standards. Any reforms that would reduce the cost of care would be highly welcome by Americans, and it would have positive accessibility outcomes for the populace.
Healthcare Reimbursement
The country may already be moving towards the novel value-based payment method, but significant changes need to be attained if the widely adopted fee-for-service approach to payment is to be phased out. Traditionally, the US has favored the fee-for-service method of reimbursing for health care services and products, which ties the payments that individuals make to the volume of services that health care practitioners offer to their clients (Robert Wood Johnson Foundation, 2019). As it has been experience, the fee-for-service model of payment is associated with poor health outcomes and inefficiencies.
The novel value-based approach to paying for health care services and products associated the payments that the public makes with the quality that they receive from health care professionals (Robert Wood Johnson Foundation, 2019). The country needs to adopt a policy framework that would drive the healthcare sector towards this new approach to payments that has potential quality and cost outcomes for the patients.
Access Disparities
Much as it is founded on principles of equality, the healthcare system of the country is marked by disparities, which stem from the social determinants of access to health care. The social health determinants, according to Bergmark and Sedaghat (2017) include insurance status, ethnicity, race, educational status, poverty, and other social and demographic factors influencing health and health care outcomes, the capacity to utilize health care, and the development of illness. In the US, some social groups of people, which are mostly people from minority backgrounds, especially African Americans and Latinos, have been disadvantaged in their access to health care services and products compared to the majority Whites (Lasser, Himmelstein, & Woolhandler, 2016). Furthermore, the incidence of some diseases has been associated with people from specific backgrounds, and most of them from low socioeconomic backgrounds have been on the losing end in matters health care accessibility.
The social determinants of access to healthcare have affected the way different groups of people from different geographies around the country access health care, which is why reforming the health care system with the objective of increasing the levels of accessibility by the disadvantaged groups—reducing access disparities—is one of the most important health care reforms that the country needs now.
References
Bergmark, R. W., & Sedaghat, A. R. (2017). Disparities in health in the United States: An overview of the social determinants of health for otolaryngologists. Laryngoscope investigative otolaryngology , 2 (4), 187-193.
Berwick, D. M., & Hackbarth, A. D. (2014). Eliminating waste in US health care. Jama , 307 (14), 1513-1516.
Lasser, K. E., Himmelstein, D. U., & Woolhandler, S. (2016). Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey. American journal of public health , 96 (7), 1300-1307.
Lohr, K. N., Yordy, K. D., & Thier, S. O. (2018). Current issues in quality of care. Health Affairs , 7 (1), 5-18.
Obama, B. (2016). United States health care reform: progress to date and next steps. Jama , 316 (5), 525-532.
References
Robert Wood Johnson Foundation (2019). Value-Based Payment Reform. RWJF . Retrieved 5 March 2019, from https://www.rwjf.org/en/library/collections/health-care-payment-reform.html
Saltman, R. B., & Figueras, J. (2018). Analyzing The Evidence On European Health Care Reforms: Experience in western European health care systems suggests lessons for reform in the United States, according to a major international comparison by the World Health Organization. Health affairs , 17 (2), 85-108.
Woolhandler, S., Campbell, T., & Himmelstein, D. U. (2018). Costs of health care administration in the United States and Canada. New England Journal of Medicine , 349 (8), 768-775.
