Health insurance still remains to be the most sought out insurance package by most if not all mankind. Various schemes have been devised to try and improve patient’s medical cover as well as sustain the insurance company to continue to provide these schemes. These plans have been done with different motives, some having the patients’ best interest at heart while others for personal gains and wealth boost. This called upon the government to step in and regulate these insurance companies so as to standardize the kind of insurance covers that will be for the greater good of the nation. A good example is the “Affordable Care Act” also known as “Obamacare” which was a landmark healthcare law that brought about the long-awaited reforms and saw the percentage of uncovered persons drop to less than 10% over the years. This reform did not come easy as striking a balance between the various stakeholders was not an easy task. Due to the various arguments from both parties the Affordable Care Act was to be abolished and a new system assimilated, but later on amendments were done to the healthcare bill to encompass everyone.
Stakeholders Compare and Contrast
Taking into consideration the Affordable Care Act which is considered one of the greatest overhauls the healthcare system in the United States of America has had, since it provided medical cover for a huge portion of the population with the key additions that were distinct from other healthcare bills. The additions include the coverage for pre-existing conditions, and coverage of young adults under their guardians which was non-existent before then (Glied & Jackson, 2017). For any reforms to take place such as the Affordable Care Act (ACA), there was so much back and forth on the most feasible way to tackle the reforms since some stakeholders wished to overhaul the whole system and replace it with a “better one” while some suggested amendments to the ACA so as to accommodate everyone.
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Looking at the amendment from the patient’s point of view, the most dominant question remained to be if the cover is to be trusted to cater for all their needs as well as the affordability of the whole package. From Insurers, they were under the magnifying lens as they would be attacked from left right and center since it meant their current system wasn’t favorable, but on the other hand it meant that if the whole process is carried out right then, they might make great financial gains since it would see new members and market opportunities that would come as a result of the law (Politi et al., 2018). This implementation would be worst felt by hospitals since there was reduction in federal reimbursements due to operation consequences of carrying out reforms in tough economic times. This was mostly felt by the nonprofit hospitals who needed reassurance. The physicians on the other hand, also referred to as grassroots stakeholders, were not included when the policy was being formulated and this brought about a huge disconnect between the patients and the healthcare they need (Housten et al., 2016).
Once effective amendments had been attained, the details, which are the most important part of the policy, had to be taught to the public masses, who had started feeling frustrated by the high costs and complex calculations for asserting assets costs. This brought about doubt since making the wrong decision would see one tied to the plan for not less than a year. The proposed solution to this predicament was that the language to be used is supposed to be simple for ease of implementation. This brought the need to customize the various aspects on the whole policy, to suit the various consumer needs.
Evidence-based practices (EBP) was put in place to ensure a value-based healthcare was adopted contrary to the traditional volume based which would see quality of healthcare improve since it would be designed to be both cost effective and effective (Lang et al., 2017). This was accepted by all stakeholders since it ensures testing the EBP in the various states before implementing them. This approach benefited all stakeholders in the health care sector since it standardized the care for all patients based on the best outcome attained at after the trial is carried out. Generally, the statistics showed that the patient outcome improved since most citizen enrolled to the health insurance policy while the whole process was more cost effective, which was desirable by employers and insurers since it is key for facility and provider reimbursement.
To add on this, patients gained confidence since it was elucidated that they are getting what works rather than what has been in existence. This leads to a more informed end user since they understand better what works and what doesn’t, hence the kind of care they choose will be based on knowledge instead of what the insurers wow them with. This on the other hand made the providers accountable for their services since they are rated based on how they perform in terms of reimbursements. The health practitioners were also tasked with the role of creating awareness as a result providing confidence that the solution is at the patient’s best interest, as well as providing the best healthcare to them.
Repeal of the ACA would have caused more harm than good since millions of Americans would have lost their cover, and the promise of a better plan would have taken enough time for the country to suffer tremendously. Since not all systems are perfect, amendments were made to tighten the plan and the benefits are in effect to date.
References
Lang, J. M., & Connell, C. M. (2017). Measuring costs to community-based agencies for implementation of an evidence-based practice. The journal of behavioral health services & research , 44 (1), 122-134.
Glied, S., & Jackson, A. (2017). The future of the Affordable Care Act and insurance coverage. American journal of public health , 107 (4), 538-540.
Spruce, L. (2015). Back to Basics: Implementing Evidence ‐ Based Practice. AORN journal , 101 (1), 106-114.
Politi, M. C., Shacham, E., Barker, A. R., George, N., Mir, N., Philpott, S., ... & Peters, E. (2018). A Comparison Between Subjective and Objective Methods of Predicting Health Care Expenses to Support Consumers’ Health Insurance Plan Choice. MDM policy & practice , 3 (1), 2381468318781093.
Housten, A. J., Furtado, K., Kaphingst, K. A., Kebodeaux, C., McBride, T., Cusanno, B., & Politi, M. C. (2016). Stakeholders’ perceptions of ways to support decisions about health insurance marketplace enrollment: a qualitative study. BMC health services research , 16 (1), 634.
Cafasso, E. (2011). How health-reform stakeholders will be affected by recent changes. Retrieved from http://apps.prsa.org/Intelligence/TheStrategist/Articles/view/9071/1028/How_health_reform_stakeholders_will_be_affected_by#.XHxYTsZRWvA
Rice, T., Unruh, L. Y., van Ginneken, E., Rosenau, P., & Barnes, A. J. (2018). Universal coverage reforms in the USA: From Obamacare through Trump. Health Policy , 122 (7), 698-702.
Marcozzi, D., Carr, B., Liferidge, A., Baehr, N., & Browne, B. (2018). Trends in the contribution of emergency departments to the provision of hospital-associated health care in the USA. International Journal of Health Services , 48 (2), 267-288.
