Future trends in the United States Healthcare system Title: Future trends in the United States Healthcare system Class HCA421: Health Care Planning & Evaluation Instructor Jennine Kinsey Name Crystal Batts Date October 29, 2012 Future trends in the United States Healthcare system For this paper I have chosen to write about the future trends in the United States healthcare system regarding Financial and Insurance issues, and access to health care including the uninsured and those in the poverty levels.
Health care financing is affected by many things and affects the society in many ways. The costs of health care can be kept affordable for both individuals and society. It is not really the costs of health insurance that is the main problem in the country’s health system; it is the cost of healthcare itself. The cost of healthcare in this country is ridiculously high and skyrocketing. If medical insurance fees are also astronomical it is only a reflection of the actual high costs of healthcare.
People that have private insurance not only struggle to pay their health insurance premiums but then whatever the insurance does not pay they struggle to pay there coinsurance and or copayments. It is so costly that 15 percent of the population lacks health insurance. I believe that the only way that the costs of health care are kept affordable for both individuals and society is for the government to step in and actually say that the doctors and hospital can only charge so much for procedures.
I think that in order for the prices to lower the government would have to step in and actually create and fees schedule for the providers to go by. I am not saying for it to be completely set in stone but for the government to set the prices. For example I think that they should go through all the diagnosis codes and set prices from one range to the other. For example it a child is going in for surgery to have their tonsils removed the provider should have to pull out the fee schedule and see that he can only charge between one amount and the other but can’t go over the maximum chargeable amount.
I also think that providers should be monitored and make sure that they are not doing unessacary testing and or procedures. I just had a recent experience with my primary care physician. My PCP wanted me to go to another specialist to have a very expense test done when I had already had that same test done two years before hand. My PCP said he just wanted to confirm the diagnosis which in some cases I can understand this. My PCP had the test results in his hand and I asked him why do you want me to get this done again when you are only going to get the same results that you already have in your hand now.
To say the least he was not pleased with my statement so I went to the specialist and he told me he would not do that particular test on me again because it was medically unnecessary, and that I was too high of a risk to develop complications after the procedure. So my overall wish with this new healthcare reform is that they start to regulate the cost of procedures and this in turn will start to lower the cost of health insurance premiums.
I am also a strong believer in people being their own patient advocate and to make sure they know what their options are along with the outcome so they can make the best choice for themselves. How societies pay for health care, and how many resources they devote to health, affects both the care people can get and its quality. In most developed countries, health care is paid for largely by the government or an organization associated with it, using taxes collected from citizens.
The United Kingdom, for example, has a “single-payer” system in which the government pays directly for care; in France and Germany, the government collects taxes to fund part of the government health care system, and employers and individuals pay for the remainder of the costs directly. In other countries, such as the United States, a portion of the health care system is market-based, that is, paid for by private entities such as employers and individuals. Even in market-based systems, the government may provide health care to vulnerable people.
For instance, in the United States, federal funds support Medicare, which covers the elderly and disabled, and state and federal funds support Medicaid, which covers low-income people. I believe that the costs of health care can be kept affordable for both individuals and society by operating the same as other devolved countries. For example Canada’s health care system is a group of socialized health insurance plans that provides coverage to all Canadian citizens.
It is publicly funded and administered on a provincial or territorial basis, within guidelines set by the federal government. Under Canada’s health care system, individual citizens are provided preventative care and medical treatments from primary care physicians as well as access to hospitals, dental surgery and additional medical services. With a few exceptions, all citizens qualify for health coverage regardless of medical history, personal income, or standard of living. I believe that this type of system would work well for the United States.
I know that it would mean higher taxes but I think that the wealthy should be taxed just as much as the middle class. I understand the more taxes that the wealthy experiences may cause a problem as to moving their business out of the country. The wealthy and business owners are taxed more and they don’t make a profit they will more their business and jobs overseas in order to make a profit. I consider myself as middle class, however I could be wrong. I just feel that this health care reform is only going to really work is if they start taxing the upper class just a bit more.
Since significant reductions are likely in the federally supported health care programs that today account for about forty percent of US personal health care expenditures, those who rely on programs like Medicaid may expect more reduction in coverage and eligibility. The Patient Protection and Affordable Care Act will require states to expand Medicaid eligibility to all individuals whose income is less than one hundred and thirty three percent of the federal poverty level. States that fail to meet this requirement will no longer receive federal Medicaid grants.
Once this happens the states can either chose to follow the federal regulations to receive the grants or choose against expansion and find the money elsewhere. With Medicaid constituting one of the largest parts of every state budget, states do not have a realistic choice. A lot of people now that may not qualify for Medicaid may qualify for it after the healthcare reform is started and will be forced to either pay for private insurance and or be forced to join Medicaid. The cost for these individuals will not be covered by the federal government and will have to be covered by the states.
All of this means states will experience significant cost increases for a Medicaid system that has already proven financially unsustainable. I can only hope that as the time nears for people to be required to have healthcare insurance that the federal government will have worked out a better system the Medicaid services. I believe the people that are already eligible for the state Medicaid program will continue to be eligible. My thought is with those people that are right on the edge where they make just a penny over the eligible income rate and they are required to purchase private healthcare insurance or find a job that offers benefits.
I know right now I am not eligible for Medicaid but I barely make enough money to pay for my healthcare insurance through my job. So I am still basically in the poverty level but are still required to pay for my healthcare insurance and if I don’t I’ll get fined for not having coverage. When I look at the plans that the government has set up for this healthcare reform I just can’t help but think that a lot more people will be filing for bankruptcy do to not being able to pay their copayments and coinsurance along with all the other bills for daily living.
The main reasons behind the Patient Protection and Affordable Care Act is the individual mandate to require most individuals to purchase health care coverage or pay a penalty, beginning in 2014. I agree that the health care reform act has a lot of good ideas that are being implemented, such as children can now remain on their parent’s health insurance coverage until they reach age 26. I can remember when I turn nineteen and I was no longer covered under my parent’s healthcare coverage and I could not afford my own coverage.
Another good reason is people that have not been able to get healthcare coverage will now be able to get it and not be turned down for a preexisting condition. Another requirement is employers that have fifty or more employees will be required to offer benefits to their workers. I think the people that will be most affected by this will be the ones that work for small employers and they don’t have to provide benefits and the employee does not make enough money to purchase private healthcare coverage and does not qualify for the state Medicaid program.
The other good thing is that the federal government is providing small business with a tax break in order to be able to afford to offer their employees benefits. My favorite change that the health care reform act has put into motion is all new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. The health care reform act has also cracked down on the insurance companies which I would really like to see more of.
I work an insurance company so I can see all the ins and outs of why claims denied and sometimes I can’t believe it. Also under the new law, insurance companies are prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays. Also sixty eight percent of medically underserved communities across the nation are in rural areas, and these communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities.
Another way the government is cracking down on the insurance companies is new plans sold to individuals and small employers, at least eighty percent of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates to consumers. So I can see all the good things that the healthcare reform act is doing but I do still not understand exactly how all of this is going to be paid for.
I can see now the federal government has cut back on their state funding for healthcare programs. The United States has created tax increase to pay for the health care reform one of these taxes is the Excise Tax on Indoor Tanning Services. The Excise Tax on Indoor Tanning Services is a ten percent excise tax on indoor UV tanning services went into effect on July 1, 2010. The tax doesn’t apply to phototherapy services performed by a licensed medical professional on his or her premises.
There’s also an exception for certain physical fitness facilities that offer tanning as an incidental service to members without a separately identifiable fee. There are a number of other tax increase to help finance the new healthcare reform I just thought that the tanning taxes was the best one, and it might kill two birds with one stone raise the taxes for indoor tanning and reduce the number of people diagnosed with skin cancer. I do believe that it would be beneficial for the United States to offer a two tiered plan that way they are at least giving a more of a choice to the people to choose their overage. I think that if someone thinks that all they need is basic preventive care then they should have the choice to purchase what they think they need, and not be forced to purchase something that they don’t think they will get use out of. To force some to buy something they won’t really get use of is unconditional to me. I think that it would be smarter for them to purchase the full coverage plan because things happen and it is better to have it then not too.
I just think that the government can still make the people feel they have a choice to choose the type of coverage they feel is right for them. I feel that the people who will benefit the most from the healthcare reform are mainly the people who are uninsured or could not obtain insurance do to a preexisting condition. I feel that the healthcare reform all over all is a really good idea and something needed to happen in order to change the way our healthcare system was evolving. With all the new laws people who didn’t have health care insurance will now.
More people will have access to affordable healthcare insurance and quality health care insurance. Even when I believe that the direction in healthcare is heading is a good thing, I do however believe that there will be challenges. I believe the most of the problems will come from Information technology advancements including the electronic medical, or health, record, and Economics, including third party payers, future funding, rising costs, the Medicare and Medicaid programs. The first challenge I see is the electronic medical or healthcare record.
Though a law has not been passed to require the use of an EMR, the word “mandate” has been used quite often. The Federal Government has made incentives-and penalties-for using an EMR/EHR system. They will also be requiring certain reporting by all physicians and will keep a central database. Although these reports can be filled out manually it would be more cumbersome. EMRs are a near future reality in an industry that has stayed the least technological than most any other industry.
A lot of this has to do with the cost and then transferring paper records to electronic and a lot of the older practioners or private offices don’t want to do this. It is very costly and time consuming and some feel unnecessary. I think in the long run it is over better for the office of healthcare facility to do so in the long run. I think it will free up space and time and most offices I go to no do this but I know that the offices that have done this did it a year ago and are still working on imputing some patient into the system and transferring them from paper charts to electronic.
I know that the first few years of the reform will be a little rough but I believe that change is good and this will also open doors to improving the healthcare system in the United States in the long run. Resources www. ppaca. com/ http://ushealthpolicygateway. wordpress. com/payer-trade-groups/p-health-reform/patient-protection-and-affordable-care-act-ppaca/ Sultz, H. & Young, K. (2011). Health care USA: Understanding its organization and delivery (7th Ed. ). Sudbury, MA: Jones & Bartlett. http://www. healthcare. gov/