Insurance companies have made considerable improvements in the delivery of healthcare services. It is now possible to visit healthcare institutions and receive treatment without necessarily carrying cash but just an insurance card where doctors provide their services and get reimbursed by health insurance companies. Health service provision is composed of physical capital, human resources, and consumables as the inputs, with its objective being to better peoples health. Many changes have occurred in these two areas for the last several years. This paper examines the trends which have been identified as the contributors of these changes and their impacts on the health sector.
The PP & Affordable Care Act (Obamacare/ACA) & HCER Act of 2010
This Act was signed by President Obama of the United States of America on the 23rd of March 2010. This Act aimed at reforming the health services that were offered by health insurance companies, making consumers take full charge of their health maintenance. This Act has proved useful, benefiting both the insured and the uninsured that were not previously covered by the insurance companies, the rich alike the poor. These benefits include improved quality and low cost health care, consumer protections and increased access to health maintenance. According to US Department of Health and Human Services (2015), the Act has really been a great tool for betterment of the health of citizens within the United States of America. The Health Care and Education Reconciliation Act of 2010 also aims at ensuring access to affordable and quality insurance covers.
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Bundled Payment structure and fee-for service payment structure
The Fee-For Service payment structure has remained the dominant healthcare scheme in the United States for a number of years. It is a system whereby providers of medical services are reimbursed depending on the number of patients they attend to. This means that services rendered may not always be efficient and effective, and this increases the cost of medical care thus affecting the economy of the United States as well as increasing morbidity. This system has been criticized as it has a negative impact. More services provided in this system means more resources are used to pay the providers, who only focus on quantity and not quality services (Orszag, 2010)
Bundled Payment is a system in which the service providers are paid in a lump sum and required to provide services to patients. The reimbursement includes all costs oncurred on the performance of medical procedures, as opposed to the FFS system where the insurer has to pay for every single operation thats performed. Burns (2013), notes that this scheme is better compared to FFS as high quality services are offered while costs are kept low. Another group argues that this is risky as the providers may turn away patients who are at high risk in order to make profits (Burns 2013). Note that, if the sum reimbursed is less than the cost incurred in providing the services the provider makes a profit and the opposite is true in the event costs are higher.
Accountable Care Organizations (ACOs)
This system is taking shape within the U.S. It involves a group of health care providers coming together and accepting the responsibility of taking care of a determined population by managing reimbursed finances and the health of that select population. This system aims at reducing high costs of treatment such as those observed in FFS schemes and offer high quality services by restructuring the payment and service delivery schemes. The flexibility of this mode of service delivery has seen the ACOs increase tremendously from less than 100 to 700, operating in all 50 states and providing services to over 23 million citizens (Glied, 2015).
Technology and Telemedicine
This is a system which enables health care providers to offer medical services in remote locations through the use of telecommunications technology. Patients access medical services efficiently and faster without necessarily travelling.
Medicare Advantage Plans
In this type of health service delivery, federal governments contract the MAPs where they are paid a specific fixed sum per person to offer Medicare benefits. These plans include Private Fee-For Service, Health Maintenance Organizations, and Preferred Provider Organization.
Population health management strategies
These are strategies that are aimed at preventing the spread of diseases, lengthen life and improve health organized efforts of all members of a given society through their collective choices. These have not been fully embraced in the United States.
Of the discussed trends, ACA has proved to have a huge impact in many hospitals, for example, the operations of Ascension Heath, which is found in District of Columbia and 23 states have been affected. There has been increased demand for patient care although the revenues of patients have been shown to increase. This act has further increased the shortage of health care workers and lack of motivation among health care professionals leading to poor service delivery. Patients looking for services are increasing due to affordability, yet institutional medical staffing remains inadequate. Other trends that impact public healthcare negatively are the FFS systems. They lead to poor service delivery and wastage of state resources. ACOs have impacted positively on health care organizations. Medicare ACOs have made profits through the cultivation of a savings culture. This advantages them. The number of ACOs is projected to increase since ACOs have attained the goal of providing quality health services at low cost and yet make profits. These trends are impacting in health care organizations overall.
Bundled payment structures affect public healthcare in general and more specifically, also affect my field of professional medicine. This is because some lose is at times realized . This has reduced my incentive to professional practice of medicine. One motivation to work is income from whatever service one provides. There is a need for a better compensation scheme to be included under this system in order for job satisfaction to be attained.
ACA is likely to impact on both the organization I work for as well as my alien health care sector. Increased patients looking for treatment in the yet to be expanded health care institutions leads to congestion. Congestion means poor working conditions as well as increased work load since I have to attend to many patients.
ACO is likely to impact positively in alien healthcare, which I practice. These offers a lot of benefits such as profits. I am also motivated to offer my services by virtue of the incentivization. Fee-For Service trend will negatively impact the alien health sector to some extent. Reimbursement is based on the work done. This means that when few patients patronize the health care institutions, then little earnings are realized.
In Fee-For Service settings, the high cost incurred in paying services in spite of their quality, further complicates the states capacity to make changes to or expand health facilities. Poor service delivery may also mean risking the lives of the patients. ACOs will go a long way in ensuring any emerging issues are addressed since finances are always available.
The trends in the provision and reimbursement of health care services have both negative and positive impacts both on the economy of nations and patients as well as the medical health professionals. The pros and cons of each trend should be examined keenly so as to maintain sanity within the healthcare sector.
References
Burns, J. (2013). Bundled payment: hospitals see the advantages, but face big challenges too. Hospitals & health networks/AHA , 87 (4), 26-31.
Glied, S., & Ma, S. (2015). How will the Affordable Care Act affect the use of health care services? . Commonwealth Fund.
Orszag, P. R., & Emanuel, E. J. (2010). Health care reform and cost control. New England Journal of Medicine , 363 (7), 601-603.
