Access to Healthcare Services based on Type of Insurance Coverage in the US - Research Paper Example

Access to Healthcare Services based on Type of Insurance Coverage in the US Summary The healthcare service sector and the insurance sector of the US, operating through alliances, contribute substantially to the country’s overall socio-economic development. With due consideration to the increasing demand for healthcare insurance activities and the corresponding coverage schemes, this report intends to briefly discuss the issues relevant to the present healthcare insurance groups and companies. Moreover, the discussion also focuses on illustrating the operational functionalities of various healthcare insurance companies and describing their roles in providing sufficient coverage of health-related risks through insurance plans. Introduction Healthcare insurance is considered one of the booming sectors in the US, which has been creating a strong impact on the citizens’ lifestyle choices, irrespective of their age groups or income capacities. The US insurance sector can be further divided into two dimensions, i.e. the government-owned insurance providers and the privately-owned insurance providers. The governance system in the US has an exceedingly intricate and a long-winded system for delivering healthcare benefits that helps preserve justness and transparency in the entire process. However, special relaxations are provided to specific professionals associated with military services, federal government, and various state programs. In the present day context, US citizens have become increasingly involved with procuring various types of healthcare insurance and coverage plans offered by both the government and private healthcare agencies (U.S. Department of Health and Human Service, 2004). Importance of Health Coverage US citizens tend to use healthcare insurance services for various reasons, such as preventing future healthcare risks, satisfying the financial requirements of future healthcare treatments, and reducing the possibilities of monetary insecurity for their families after their death. It is in this context that healthcare insurance helps provide financial benefits to an individual to mitigate health-related hazards, compensating majority of the expenses incurred while availing of compulsory medical facilities (Lewit & Baker, 1995). The development of healthcare policies in the country has been based on these key interests, which can be further considered as either convenient or inconvenient on the basis of quality and value of healthcare services rendered by the governmental and non-governmental institutions. In the current day context of the US healthcare sector, it has been identified that remarkable changes regarding the insurance plans have occurred during the past few decades. The fact that advanced and innovative technologies have changed the model of providing healthcare services significantly impacts the way people select insurance plans (U.S. Department of Health and Human Service, 2004). Facts about US Healthcare Service From an overall perspective, the health insurance programs currently available in the US can be considered as forming one of the most developed insurance service mechanisms effectively covering a wide range of health-related risks. The national health insurance programs are principally implemented by the governmental bodies which intend to provide financial support to the citizens through the general taxes collected from across the country. Correspondingly, the healthcare system of the US has been voluntarily involved in response to the considerations regarding the accessibility, quality, and the cost of the health insurance services (Shi & Singh, 2009). During the year 2006, the US Census Bureau has declared that more than 45 million of the US citizens were yet to be covered by health insurance schemes. It was further revealed by the Census Bureau that more than 36% of US households living below poverty line were not insured, which indicated the partial failure of the program to benefit a large proportion of the US population. However, with reference to the total spending on healthcare and its insurance beneficiaries, the nation has been recorded to spend approximately USD 2 trillion every year, and this can be apparently affirmed as a sum higher than in other countries of the world (Wilper, Woolhandler, Lasser, McCormick, Bor, & Himmelstein, 2009). This huge spending accounts for almost 31% as administrative costs and 13.3% as average overhead costs to commence Medicare and essential healthcare programs periodically (Sicko, n.d.). Nevertheless, from a positive perspective, it was revealed by the Census Bureau that the number of people adopting health insurance policies had increased to 260.2 million during the year 2011, which covered approximately 84.3% of the total population in the country (American Health Lawyers Association, 2012). Moreover, the rates of the uninsured in the US were also found to decrease substantially with the growth of the household income (Stewart, 2012). In addition to the health insurance institutions, private agencies operating in the US have also been achieving significant growth by rendering various innovative health insurance services targeting people belonging to various age-groups and income ranges. According to the observations of Census Bureau, a growth rate of 63.9% in the year 2011 was recorded by private insurance companies. The employment-based health insurance policies of the country have also been observed in a stable position covering approximately 55.1% of people until the year 2011. Most significantly, by the year 2011, 32.2% of the total population was recorded as covered by the government-owned health insurance service providers, whereas 16.5% of the insured citizens were covered by Medicaid services and 15.2% by Medicare services (Stewart, 2012). Evaluative Summary In the context of providing healthcare insurance facilities, there are three major players that control the overall healthcare system in the US, which fundamentally consists of the governmental bodies (federal, state or local), employers rendering health insurance services, and consumers themselves, who incur the required healthcare expenses. It has been observed in this regard that primary services covered by health insurance and payment programs are likely to be more frequently utilized than the services paid directly by the consumers in the healthcare sector of the US. Correspondingly, private service providers including Medicaid and Medicare tend to make cost control efforts such as Prospective Payment System (PPS) compensating hospital expenses and Resource Based Relative Value Scale (RBRVS) covering the physicians’ payment. Alteration in payment policies also encourages the healthcare system to offer services in different innovative ways (Hahn, Payne, & Lucas, 2008). Moreover, there are certain major policies that can be identified to affect the healthcare services in the US by a considerable extent. In the year 1985, as a part of Consolidated Omnibus Reconciliation Act (COBRA), Emergency Medical Treatment and Labor Act (EMTALA) evolved, which principally deals with the issues of ‘patient dumping’ from emergency section of the US hospitals. Federal Nursing Home Reform Act (FNHRA), which is also a part of COBRA, developed a set of minimum national standards of healthcare and rights for communities, which have further been certified with nursing amenities to cover a larger area of healthcare services (U.S. Department of Health and Human Service, 2004). According to the present developing measures of the healthcare insurance facilities, both the governmental and non-governmental insurance agencies are examined as highly focused on developing their offerings in order to accomplish a significant growth for their institutions. Over the past few decades, both governmental and private institutions have made increasing progress in order to identify causes of illness and disability, rendering advanced treatments and deploying various technological influences to inform people about the prevalence of major diseases. Moreover, the emerging growth of managed care and various advantageous payment modes employed by the insurance companies can be identified as quite beneficial for the US citizens in terms of acquiring any health insurance service. In order to enhance the measure of care enrollment and increase the value of Medicaid and Medicare services, the employers of health insurance institutions have also decided to reallocate sites in accordance to the need of the residents in various economic regions (U.S. Department of Health and Human Service, 2004). In the modern day context, there are various reasons that can be identified with regard to the growing interest of acquiring healthcare coverage by the people of the US. The people and the employers in the present scenario have made significant increase concerning the rising costs and benefits of the healthcare and health insurance services. However, a majority of the Americans also seemed to be anxious regarding the coverage of healthcare costs due to some uncertainties and complex guidelines specified in healthcare insurance policies (Alliance for Health Reform, 2007). Recommendations It has been observed that the rising costs in healthcare sector and various insurance policies have been significantly increasing the value of the labor market in addition to the productivity of the workforce. However, it can be evidently identified that growing healthcare expenditures have also led to decrease in the number of insured people within the US households. It has further been observed that a significant proportion of the US consumers, especially the uninsured persons, are troubled and cannot receive medical benefits due to the increasing medical bills (U.S. Department of Health & Human Services, n.d.). Therefore, it can be recommended in relation to the above discussion that the health insurance service sector of the US should highly focus on motivating and providing healthcare services and other benefits to the citizens, especially the uninsured individuals of the country. Moreover, the healthcare organizations of the country would also need to concentrate on the possibilities of reducing the cost of healthcare services, particularly for the low income group within the US population. Conclusion Healthcare services in the US can be considered among the major elements contributing to the country’s overall socio-economic growth acting as an efficient source of employment for the citizens. Moreover, the healthcare insurance institutions, both the governmental and private, are also considered significantly focusing on adopting various innovative measures to provide more effective and beneficial services to each of the insured people in the nation. Furthermore, the employers in the field of health insurance have also been observed to encourage an increasing percentage of employed population to acquire healthcare services that help shield against the huge costs of catastrophic diseases. In relation to the insured and the uninsured people of the US, it can be affirmed that they will be likely to acquire recommended examining processes and the care for prevailing conditions, which will reduce the number of Americans suffering from undiagnosed chronic conditions in the near future. References Alliance for Health Reform. (2007). Health care coverage in America: Understanding the issues and proposed solutions. Retrieved from http://www.allhealth.org/publications/uninsured/health_care_coverage_in_america_2007_54.pdf American Health Lawyers Association. (2012). Census Bureau reports decline in number of uninsured. Health Lawyers Weekly, 10(37). Hahn, D., Payne, W., & Lucas, E. (2008) Focus on health, 11/e. New York City: The McGraw-Hill companies. Lewit, E. M., & Baker, L. S. (1995). Health insurance coverage. Retrieved from http://futureofchildren.org/futureofchildren/publications/docs/05_03_Indicators.pdf Shi, L., & Singh, D. A. (2010). Essentials of the U.S. health care system. United States: Jones & Bartlett Publishers. Sicko. (n.d.). Facts about healthcare in America. Retrieved from http://sickothemovie.com/_media/SiCKO_sickofactoids.pdf Stewart, D. (2012). Medicare News: Health insurance coverage in the US. Retrieved from http://www.scribd.com/doc/105738429/Medicare-News-Health-Insurance-Coverage-in-the-US U.S. Department of Health and Human Service. (2004). Healthcare and America trends in utilization. Retrieved from http://www.cdc.gov/nchs/data/misc/healthcare.pd U.S. Department of Health & Human Services. (n.d.). The effect of health care cost growth on the US economy. Retrieved from http://aspe.hhs.gov/health/reports/08/healthcarecost/report.pdf Wilper, A. P., Woolhandler, S., Lasser, K. E., McCormick, D., Bor, D. H., & Himmelstein, D. U. (2009). Health insurance and mortality in US adults. American Journal of Public Health 99(12), pp. 1-7. Read More