Delivering quality healthcare system has been the focus of the American government and changes have been made in the healthcare system with an objective of improving the healthcare approach in the country. The programs have been implemented by healthcare systems in other countries but it has been challenging for the government to achieve the intended purpose because of the increased inefficiency in the operation (Shi & Singh, 2014). The process focused on relinquishing the existing tighter controls but they failed to achieve an intended purpose with the set objectives. The focus to deliver comprehensive care system resulted in the integration of several services such as insurance, integration finances, delivery and payment which resulted in healthcare inefficient as well as failure for achieving the intended purpose for delivering healthcare services. Quality of care has been improved through the Long-Term care services that serve the interests of all patients in the healthcare system. The inefficiency has led to the emergence of the cost control process designed to improve the care management approach.
Cost savings
The existing process for healthcare providers is based on services such as those designed to meet the needs of people as well as those of the providers. Insurance companies and integrated programs have challenges originating from moral hazards where the insured do not access the quality of services to determine the effectiveness of the process. As a result, there is a lot of inefficiencies that calls for a need for developing a change in the treatment process to implement the cost-saving plan (Shi & Singh, 2014). Efficiency in the healthcare system can only be achieved through the establishment of a mechanism designed to give the patients a chance to negotiate with care providers and make payments which can later be compensated by the insurer. Through this approach, it will be possible to evaluate the quality of care that the patients and making payments that are worthy of the care. Cost saving approach should also be achieved by restricting the freedom of choice that insured patients usually have regarding the kind of treatment they need to access (Elliott et al., 2016). Improved healthcare accompanied free requirement for patients to seek treatment anywhere they want increases the costs of healthcare provision. A restriction will reduce or minimize this kind of treatment. In effect, cost savings will be achieved by creating a program such as providing a variety of providers across to improve service improvement rather than increased hospitalization that increases the cost of operations. As a result, people will find it easy to access improved healthcare at a lower cost.
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Provider Reimbursement
Healthcare administrators need to increase hospital profitability and reinvestment of surplus while community-based approaches remain worried about the closure of community hospitals. There is a need for changing the healthcare reimbursement to shape the payment prescribed to the individual for services received from doctors, diagnostic facility, and healthcare providers. The reimbursement approach requires that people focus on ensuring that people receive effective treatment and they make payment for the services they receive. Government and insurance companies should be able to pay for the services that patients receive while the people emphasize on ensuring that there is a continuous provision of healthcare in the society (Elliott et al., 2016). As a result, patients should be required to add the extra payment to hospitals for healthcare services they receive but they are not covered by government or insurance companies. The payment received should be in a position to offer community-based hospitals profits. However, there is a need for implementing programs that focus on monitoring and evaluating the efficiency and worthiness of the service and value of payment requested. There should a reimbursement program that enables patients to understand the portion of their pay and the part of the payment covered by the insurer. Understanding medical bills become the first approach to avoiding inconveniences in understanding the payment program.
Quality of Care
It is evident that there is a challenge facing the provision of successful treatment approach because people with complex diseases such as heart diseases, diabetes, and hypertension do not receive effective treatment approaches. Patients who are under regular treatment do not always receive successful treatment process thus calling for a need of reforming the system. The establishments of treatment services such as treatment care for the adults, aged, and adolescents become a viable approach for addressing these challenges. Continuing care at home need to be achieved through the establishment of people acquire developed an approach for providing care to the people. There is also a need for establishing more community centers in the United States capable of providing healthcare services that serve the interests of all patients. Adult day care and home care community-based approaches should be conducted by specialized physicians who are capable of offering quality services to the patients (Shi & Singh, 2014). The existing legislation should also be able to provide improved healthcare service to the people with an objective of achieving the rights of people in society. Healthcare provision gives an opportunity for people to acquire developed and services. The program should also be shaped to ensure that there is a provision of healthcare services in a way that protects the rights of the patients.
Conclusion
Based on the analysis of the chapters, it is evident that management care goes beyond efficiency in offering healthcare services. Insurance companies and government involvement in meeting some part or the whole medical operations come in with different forms of inefficiencies in the healthcare system thus preventing the success of the treatment process. This information indicates that there is a need for making some changes in the insurance of healthcare treatment to ensure that the services that quality services match the required payment for that particular treatment. Cost saving need to begin by restricting the areas and services that patients need. Provider reimbursement requires should be in a position to balance between the part of payment received from the insurance companies, the part of payment received from the patient, and the cost that the patient has to pay. Patients need to be aware of their bills as well as increasing an opportunity for patients to receive quality services from specialized staff and community-based treatment programs.
References
Elliott, M. N., Beckett, M. K., Lehrman, W. G., Cleary, P., Cohea, C. W., Giordano, L. A., ... & Damberg, C. L. (2016). Understanding the role played by Medicare’s patient experience points system in hospital reimbursement. Health Affairs , 35 (9), 1673-1680.
Shi, L., & Singh, D. A. (2014). Delivering health care in America . Jones & Bartlett Learning.
