The development of any nation is dependent on the actions of various individuals in places of authority. These individuals develop policies and other regulations which seek to govern the activities within the land. The will of the people is held supreme in any land, and it is the responsibility of such individuals to ensure that the people’s needs are met. These are the needs for food, shelter, and clothing. However, a major need that the governing body within any nation has to ensure is met, is the need for a functional healthcare system. Every individual can contract a given ailment in their lives; it is up to the government of a nation to provide healthcare facilities which an individual can access and can afford the finances involved in attaining the services. Every healthcare facility has its financing policies. In this paper, an assessment of the economics of healthcare delivery in the United States (US), taking a keen look on how the industry finances itself and the various advantages and disadvantages that are experienced by the current healthcare policies will be made.
The Healthcare System in the US has undergone numerous changes since its enactment in the 1920s. The system, at the time, comprised of hospitals giving individuals services on a pre-paid basis, many. Since this time, the healthcare policies generated have incorporated the use of insurance premiums to access healthcare services. The ultimate objective or goal of such policies is to ensure individuals can access healthcare services that are of quality standing and also stabilize or reduce the costs that are involved. Due to these factors, the healthcare industry has ensured that it is constantly advancing its technologies to guarantee the provision of quality healthcare services. The use of technology has given rise to efficiency, cost-effectiveness, quality and safety (Kalem & Turhan, 2015). However, the increasing use of technology to provide quality services has been argued to be a factor leading to the rise in the cost of healthcare within the US. Many individuals have been unable to meet the necessary regulations and conditions that allow them to access the services.
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In a research conducted by Johnae Snell (2013), she identified that several reasons have attributed to the development of costs in healthcare. As a result, many people have been unable to access the services. Technology, she stated, is directly correlated to the rise of costs within the healthcare industry. It is, however, not the major factor that affects the price increases (Snell, 2013). More scholars are arguing that technology within the healthcare industry has outweighed the associated costs, this is viewed in response to the number of people who can access quality healthcare in today’s economy. Most of the people are unable to attain insured healthcare. These policies are too expensive or have conditions which make the majority of the population unable to attain the services. Additionally, the employment of technology within the industry has allowed for benchmarking and performance increases in the delivery of health services. Many health practitioners are now reliant on technology to perform previously unaccomplished tasks. For instance, surgery that could not previously be handled with bare hands is now available through the use of robotics (Camarillo, Krummel, & Salisbury, 2004).
Entitlement programs have been the subject of controversy as they are also viewed as cost increasing factors. Medicaid and Medicare, for instance, are insurance packages which cater to the access and delivery of several healthcare services, depending on which package a person is subscribed to. However, the financing of these insurance programs is also a factor that has to be considered. The packages allow citizens to pay fewer amounts when they visit a healthcare facility. However, the costs are regained in other areas, or paid by other persons. Various components are issued when delivering healthcare, and each has to be covered (Kaiser Family Foundation, 2012). The US spends far much more on healthcare than in any other country elsewhere. However, the expenditure only covers 5% of the population who can afford Medicare or Medicaid. The expenditure of the programs has slowly risen and with it, increased the costs of the healthcare industry. The programs are financed by the government partially, and private pockets. In 2010, the percentage for which the government financed the healthcare Insurance programs was 45% while private pockets paid for 55% (Snell, 2013). The government pays for such services through taxes that are collected from organizations and individuals (Kemble, 2010).
Each insurance program has a specific service which it covers. The plans also have a minimum and maximum amount for which they cover. In the case of Medicaid and Medicare, there are various payments which have to be made prior when subscribing to the plan. These payments aid the government in financing the health care programs across various regions. Individuals have to ensure that they select a viable insurance plan which will guarantee they can attain some benefits from their subscription. The same plans have to be within the individual’s payment capacity. This payment, as healthcare costs increase, also change depending on the model of healthcare (Calsyn & Lee, 2012). As a result, many persons are unable to attain health insurance due to such payment. Health insurance deductibles, for instance, are costs which an individual has to pay before the insurance starts covering costs. Depending on the type of insurance plan selected, the deductibles pricing range is made between hundreds to thousands of dollars. After a person has completed the payments for deductibles, then they have to pay co-insurance until they have attained their out-of-pocket maximum. After meeting these costs, then the insurer pays for the services, as agreed in the insurance package. Other costs that have to be considered are a fee for service. For instance, where a healthcare facility charges a particular fee before offering the care services to the individuals. These services are not held together or catered for as a whole, rather, they are unbundled, and payment is issued for specific services offered (Calsyn & Lee, 2012). Also, those that are under the exclusions within the insurance package. Every insurance package lists the services that are covered under it, however, there are also those services that are excluded from the coverage. Before 2014, some insurance policies would not cover specific types of diseases if they were already pre-existing. For instance asthma, diabetes or cancer. Also, an individual also had to consider the types of healthcare organizations which allowed for insurance. Before the expansion of PPACA, many individuals were unable to access the plans as they were not offered in the hospitals or clinics which they visited (Calsyn & Lee, 2012).
As healthcare costs continue increasing, then such costs continue to rise, and more people are unable to meet the prices or afford insurance plans. I many areas, these costs have been curbed or obliterated when delivering healthcare. However, there are still those who apply. Additionally, the US is made up of immigrants (Zimmermann, Carnahan, Paulsey, & Molina, 2016). Each of these immigrants is unable to attain such services due to their nature. These immigrants have to rely on other forms of healthcare. However, the introduction of the Patient Protection and Affordable Care Act (PPACA) has allowed these individuals to have access to emergency Medicaid services where they are required. However, eligibility remains to be a valid barrier to the access of such healthcare programs (Edward, 2014).
A major disadvantage to the access of such programs would be the legality of an individual within the country. It wasn’t until the introduction of the Patient Protection and Affordable Care Act (PPACA) that the uninsured rate in the US reduced (Wharton University, 2013). Before 2009 46% of the US population was uninsured (Rosenbaum, 2011). The number of persons who are uninsured continues to grow in seasons where the country faces an economic downturn. The enactment of the Act has allowed for more citizens to be able to afford healthcare policies. PPACA, through the use of Healthcare models such Medicare and Medicaid, has expanded the affordability and availability of public health care by providing conditions which take into account incomes that are below 138% of poverty (Rosenbaum, 2011). These are in line with the growing healthcare rates within the industry. Additionally, it allows for people who are unable to afford such premiums to purchase healthcare through the marketplace using tax credits. Hence, through the use of healthcare models, the government has been able to costs that outweigh technology use in the industry. Medicaid and Medicare as health care models have, however, been attributed to other rising costs within the industry (Kaiser Family Foundation, 2012).
The existence of entitlement programs continues to allow for the access to healthcare services to various individuals within the country. The implementation of PPACA has allowed the Advanced Practice of Registered Nurses (APRNs) to expound the industry by opening or providing independent Nursing Care clinics to assist in maintaining a steady flow of professionalism to address the increased number of patients accessing medical health care services (Erickson, 2016). More funding is being poured into Advanced Nursing Programs which allow for more professional and able service providers to enter the Healthcare Industry. However, the finances required to ensure the continuity of the industry has given rise to the rise in healthcare costs (Edward, 2014). As a result, price increases and other costs continue being barriers to the ability of individuals to attain such services. Additionally, the eligibility and availability criteria placed on such programs have continued being barriers for the vast number of immigrants that are within the country.
In conclusion, the Healthcare industry has a lot of factors which have to be considered. The financing of the industry is dependent on the government. The industry also relies on other private organizations to aid in the financing of the various services that are undertaken within the industry. These sources of financing are highly relied upon as factors such as technological advancements, development of new entitlement programs that seek to meet the needs of various groups of individuals, the development of new services which seek to cater to previously uncovered ailments or diseases, continue to increase the costs of healthcare within the industry. Also, the industry does not cater to the majority of the persons within the United States who are immigrants. There is need to develop solutions that will curb the financing problems that are being experienced in the industry currently (Kemble, 2010). The Industry can concentrate on developing policies which will cater to all the individuals in the country. Currently the policies are hindering the access of healthcare to various individuals. Hence the need to enact new reforms that meet the needs of various persons such as immigrants is important, that is, amending the eligibility and availability criteria of the entitlement programs.
References
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