The delivery of healthcare faces efficiency as a gap due to the rising costs of pharmaceuticals, which mostly affects the aging population. Efficiency gap is where clinicians will look into using treatments that are less expensive in order to avoid wasting resources. Health care systems are judged using efficiency as the third criterion and is considered to be IHI’s sixth improvement aims of health care systems. In the health care environment, efficiency is defined as avoiding waste due to its productive or allocative nature.
The debate over efficiency gap in access to healthcare started way back in the 1960s for the elderly population. Especially with regard to prescription drugs and amendments were later made in 1972, but legislation was never attained. The national health insurance benefit package was later introduced in the same year and this shifted people’s focus (Kesselheim, Avorn, & Sarpatwari, 2016). In 1988 a limited prescription drug benefit was passed, but it was repealed even before it was implemented. Years later Medicare Part B became effective in meeting the needs of the elderly people with regard to prescription drugs. The history presented shows that this has been an historical issue and is now present in modern times.
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The socioeconomic background of the aging population has negatively impacted their access to healthcare. Many have experienced worse self-report health, have lower life expectancy, and face more chronic conditions. The diagnostic tests they receive are few plus the medications they are given does not correlate with their chronic disease. Such limited access to health care service is because of coverage and cost. Physicians of these populations are bound to receive low reimbursement rates and this has translated down to the service accorded to their patients. As such, these patients will be given more generic medications and their diagnostic testing will be delayed. Furthermore, their physicians will not refer them to special medical personnel for observation due to their social background.
The healthcare delivered to the aging population is affected by the efficiency gap in access due to the financial burden associated mostly with the costs of services. The major concern for the aging population is affordability and many elderly people will forgo or delay their care (Yamada et al., 2015). This results in the health care system not meeting their intended vision, mission and goal due to the lack of enough resources. It is the sole responsibility of health care provider to restore people’s health in an efficient way because it is their way of serving the community.
The potential implications of not meeting this efficiency gap with regard to access of healthcare for the elderly population is disastrous because many of them will live a painful life. The population is in dire need of their prescriptions and the “out-of-pocket” strategy of payments is not something they can afford. Therefore, they will resort to being dependent on other people in their society such as family members and this results in straining of available resources. They will live in a very deplorable state both physically and mentally.
II. Existing Initiatives
Affordable Care Act (ACA) is the existing healthcare initiative put in place to address the efficiency gap in access ( Joshi et al., 2016 ). The provisions under the ACA are numerous in promoting a shift towards reimbursement that is value-based. Accountable care organizations are created through these new models and medical homes become patient-centered. The existing healthcare initiative intends to address issues such as escalating costs, poor quality, and increasing numbers of people in America without health insurance coverage.
The specific goal of the ACA is to expand health insurance coverage. Secondly, it intends to shift its focus of delivery of health care system to that of preventive from treatment. This is possible through provision of incentives and funds to public health agencies and communities like the Community Transformation Grants. Lastly, ACA looks at reducing costs and improve efficiency of health care (Hellerstedt, 2013).
The rising costs associated to health care in 2010 resulted in the development of the ACA. The passing into law of this bill by President Obama necessitated the accommodation of health care needs for people from low-income families, which included the aging population. Rosenbaum asserts that the ACA has managed to establish the basic legal protections of a near-universal guarantee of access that is intended to be an affordable coverage of health insurance (2011). It is meant to start from birth through retirement, which is geared to be a shared responsibility for government, employers, and individuals. ACA also looks at improving the quality, fairness, and affordability of coverage with regard to health insurance. It also looks at improving health care quality, value, and efficiency and at the same time, reducing wasteful spending. By so doing, the health care systems will be made more accountable to diverse populations of patients (Rosenbaum, 2011).
The resources required to fund the ACA are medical personnel who are ready and willing to restore the health of American people with the low reimbursement offered. Having such a group of people makes the work of ACA easier because they will be able to reach a big number of American people especially the aging population that require their prescriptions in order to live longer. It is also essential for the existing initiative to have agencies that will fund their programs by providing for them medical equipment, resources, and ideas that will help propel their goals to reach maximum numbers of Americans. Other resources include volunteers from the medical arena who help in reaching out to the aging population still living in the rural area.
The ACA is seen to be leaving out substantial number of Americans without insurance yet their goal is that of universal health coverage. This has forced people to move to high-deductible health insurance policies due to their affordability. Moreover, the deductibles are also found under the Affordable Care Act and thus, healthcare spending is put under control meaning that efficiency gap is addressed fully.
III. Regulation
The ability for small businesses and self-employed individuals by the Trump administrations has finalized the new rule that enables them band together in purchasing health insurance, which is less expensive ( Vogenberg & Smart, 2018 ). Furthermore, the insurance does not necessarily need to be fully compliant with the ACA. The aim of the regulation was to make it easier for health insurance to be sold across state lines with the help of association health plans (AHPs). The Department of Labor concurs with the new rule because it provides more choices and health insurance is made more affordable. The regulation is important because price negotiation has been enabled. By so doing, more AHPs are allowed into the equation, which results in the expansion of access to health coverage. Small businesses experienced health coverage that was expensive and the regulation intends to help working Americans, plus their families, to purchase health coverage that is affordable and of high quality.
The regulatory level of the ACA being addressed at is the presidential level where it has created an agency that is charged with overseeing insurance agency. It is called the Center for Consumer Information and Insurance Oversight (CCIIO), which is also part of the Centers for Medicare and Medicaid Services. The CCIIO is known to work closely with state insurance commissioners, stakeholders, and consumers in ensuring that the new law has served the American people in the best possible way. The provisions CCIIO oversees include compiling data for governmental organizations like healthcare; overseeing new rules associated to Medical Loss Ratio; and Early Retiree Reinsurance Program among many others.
IV. Conclusion:
The ACA is portrayed to be an effective initiative and the associated regulation put in place by Trump’s administration has facilitated for the expansion of health insurance coverage for the American people. By so doing, efficiency gap is being addressed in access to the delivery of healthcare to the aging population. Indeed, the ACA aligns itself with the initiative that gives support to the stated efficiency gap as it reframes the financial relationship existing between Americans and the health care system. In addition, it realigns the health care system for changes that are long-term with regard to quality, design and organization of practice in the health care system and transparency of health information. All this is made possible through introducing changes to Medicaid and Medicare that empowers certain agencies to test new payment models and service delivery. By so doing, it has managed to stem the crisis of the health insurance, which seems to envelop families, individuals, the health care system, communities, and the national economy.
The conflicts that are evident with regard to the existing initiative are in line with how to secure principles laid down by Obama’s work. This is in regard to reshaping the health care system of America to enable it endure broad public support. Today, the issues at hand is inclined to guaranteeing the health insurance coverage of American people.
References
Hellerstedt, W. L. (2013). The Affordable Care Act: What are its goals and do we need it?.
Retrieved from http://www.epi.umn.edu/mch/wp-content/uploads/2013/09/ACA-
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Joshi, M., Erb, N., Zhang, S., & Sikka, R. (2016). Leading health care transformation: A primer
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Kesselheim, A. S., Avorn, J., & Sarpatwari, A. (2016). The high cost of prescription drugs in the
United States: Origins and prospects for reform. Jama , 316(8), 858-871.
Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for public
health policy and practice. Public Health Reports , 126(1), 130-135.
Vogenberg, F. R., & Smart, M. (2018). Regulatory change versus legislation impacting health
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Yamada, T., Chen, C. C., Murata, C., Hirai, H., Ojima, T., & Kondo, K. (2015). Access disparity
and health inequality of the elderly: Unmet needs and delayed healthcare. International
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