Access to Healthcare in the United States - Essay Example

Access to Healthcare in the United s of Outline Introduction Hypothesis The policies in place The current systemstructure Outcome of the current system Health outcome indicators Patient satisfaction under the HCAHPS measures The improved system and impact Access to Healthcare in the United States Introduction Access to quality healthcare is the question that most Americans want answered. Commentators would say that if ordinary healthcare is not readily available, what more if quality healthcare is in question. The Patient Protection and Affordable Care Act of 2010 (ACA) has been implemented by the current administration to correct the mistakes of the previous system of providing quality healthcare. The question is: is this the system that Americans have long been waiting of? The purpose of the law is to provide healthcare for all citizens regardless of their socio-economic status in life. Moreover, it is also implementing a system that will provide quality healthcare and ensure that patients are satisfied with their experience in the hospital. This is known as the VBP, or value-based purchasing program. While the program is still on its pilot stage, it is a good step towards the direction of quality healthcare. A continuous survey is also conducted to provide data on patients’ views about care. The VBP motivates hospitals to provide quality healthcare to patients. Hypothesis The present law, the Affordable Care Act (ACA), aims to provide quality healthcare for American citizens regardless of socio-economic status, but the law is still in its pilot stage and there are still numerous challenges regarding the question of quality healthcare. The policies in place Americans have access to healthcare, provided in the Patient Protection and Affordable Care Act (ACA) of 2010, also known as the Obama Care. Public and private insurance agencies are authorized to provide health care services. The Obama Care was enacted in lieu of the past healthcare policies, like the Medicare, which left millions of Americans, particularly senior citizens, without health insurance due to the high cost of insurance premiums. The administration of President Obama wanted to correct this policy and make available low-cost drugs for ordinary Americans. The ACA was enacted to provide healthcare access, especially on preventive services, reduce financial costs for treatment of chronic disease, and eliminate discrimination among different ethnic groups in the United States (Davis, 2011 as cited in Mason et al., 2011, p. 2211). In short, the law was enacted to expand the Medicaid and make available healthcare to all Americans by eliminating obstacles and providing federal budget to Medicaid enrollees. The estimated budget was around $98 billion annually (Sommers, Swarts, & Epstein, 2011, p. 2186). The Centers for Medicare and Medicaid Services (CMS) study found that there would be about eighteen million new enrollees in 2019. The number of enrollees in Medicaid affects government provision of healthcare. But the primary aim of the law was to provide healthcare to even the uninsured Americans. One problem is that there are many health providers which have low reimbursement. Insured individuals have to find providers if they see that their present providers cannot give them the necessary healthcare. The current system structure The US healthcare system is dependent on employer-based private insurance, while public coverage is for some groups such as children and the elderly. Private insurance also adds to the coverage. Unemployed individuals do not have insurance as they cannot afford the premium; or those who previously have insurance lose the coverage if they become unemployed, plus they are ineligible for public programs (Roydhouse, 2009, p. 304). The ACA was designed to correct the old system wherein millions of Americans did not have access to healthcare. Although the current structure is regarded as a perfect system, it is believed one of the most expensive systems in the world. It was found in a study that in the old system there were 43 million individuals that did not have access to healthcare, or did not have health insurance. Families USA, a government agency under the Department of Health and Human Services, reported that individuals, mostly seniors, did not have health insurance. (Benson et al., 2011) Outcome of the current system Medicare has long been a government program which insures the elderly (65 years and above) and the physically challenged. Funds for Medicare come from federal taxes and the payroll tax of employers and employees. Benefits include hospital services, doctor’s services, and prescription drug benefits. Studies by a major national health advisory body reported the problems and costs of the health care situation in the United States. The uninsured have had worse health outcomes. Cost was the main reason why there was a big percentage of the uninsured who could not buy prescription drugs. There is a current projection that by 2030, there will be 25% spending increase in healthcare. (Roydhouse, 2009) In 2006, some states experimented on various methods to achieve healthcare for their population. Two reform projects became significant and these were the Massachusetts plan and the San Francisco plan. The Massachusetts plan became of note because it implemented a mandatory individual insurance purchasing requirement. The San Francisco plan emphasized access to healthcare, rather than insurance. Mayor Gavin Newsom’s spokeswoman said that the system had “everything from primary care to pharmaceuticals” (Lin, 2006 as cited in Roydhouse, 2009, p. 304). The ObamaCare requires citizens and legal residents to have health insurance starting in four years. There would be penalty of US$95 to individuals who do not have insurance starting this 2014. By 2016, this will be increased to $695, and for families who will not have insurance coverage, the penalty will be US $2250. (Roydhouse, 2009) Health outcome indicators A question may be asked with regards to health outcome indicators: does the indicator measure the actual health outcome? There are assumptions that indicators are related to positive health outcomes. Health is not just about being free from disease and disability, it also encompasses psychological and social well being, quality of life, life satisfaction and happiness. Health outcome indicators provide the state of health of individuals or the situation wherein mortality is avoided. (Pastrana et al., 2010, p. 859) Quality assurance should be provided by public and private healthcare providers in order to ensure positive health outcomes. Quality assurance refers to a systematic approach to ensure that a specified standard or level of care is met. Healthcare providers should provide services that are appropriate to the needs of the people. The public health system must ensure that community health unit provides services which are of professional standards. Strategies that can lead to positive health outcomes include methods “to prevent diseases, to alleviate disability, and to restore function” (Jenkins, Mellsop, & Singh, 2010, p. 314). Patient satisfaction under the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures Patient satisfaction is significant measure in the delivery of healthcare of healthcare associations from both public and private sectors. Satisfied patients would usually have a consistent relationship with the healthcare provider and they would also promote the system that provides them satisfaction. When the customers return to the service provider for more services, the reason is that they are satisfied with how they were treated. System weaknesses, particularly on the contents of the ACA, can also be detected and addressed if patients are not satisfied with the quality of healthcare in the current delivery system. Quality healthcare is related with customer retention and will also backfire on the law that implements the system. (Yeddula, 2012) The new system under the Obama administration, through the ACA, is trying to implement (or currently implementing) the Centers for Medicare & Medicaid Services’ value-based purchasing (VBP) program. Through this system, payments correspond with patient satisfaction; meaning, if patients are not satisfied, they may not pay or pay only a part of the afforded services. The quality measures are calculated through the Inpatient Prospective payment System. Hospital executives will have to qualify for incentive payouts wherein the scores or assessments are measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). This survey was designed to provide data on ‘patients’ views about the care that allow objective, meaningful comparisons of hospitals in areas of importance to customers’ (Cliff, 2012, p. 157). The VBP motivates hospitals to pay attention to patient satisfaction and their experience in the hospital. This program will trigger more debates on patient-centered approaches to care. Patient-centered hospitals have to ask patients to define a positive and satisfying patient experience. HCAHPS scores will show how hospitals are meeting the needs of the patients and provide more avenues for improvement (Frampton et al., 2008 as cited in Cliff, 2012, p. 158). Levels of achievement in patient-centered care are based on evidence and experience of patients. A program known as Planetree Designated Patient-Centered Hospitals (as cited in Cliff, p. 158) is the sole program that recognizes excellence in patient-centered care in the subject of healthcare. Hospitals recognized by this system consistently exceed national HCAHPS performance measures for patient satisfaction. Their achievements have been used as benchmarks for other hospitals on the matter of patient satisfaction. The improved system with the impact We have discussed in this essay the good and bad sides of the Affordable Care Act (ACA) also known as the Obama Care. While we claim that the system may not be perfect, it has advanced to that state wherein every American will have access to quality healthcare, regardless of their socio-economic status. The ACA also aims for patient satisfaction and benchmarks have been provided under the Planetree Designated Patient-Centered Hospitals program. This may be the step for the right direction where citizens can rest assured that they are given quality healthcare and a prolonged quality of life. References Benson, A., Mendelsohn, N., Gervits, M., Adeshuko, F., Garcia, C., & Smoller, S. (2011). Medical student views of healthcare reform in the United States, 2009. The Einstein Journal of Biology and Medicine, 17(20), 28-33. Jenkins, R., Mellsop, G., & Singh, B. (2010). Measuring outcomes in mental health: Implications for policy. In G. Thornicroft & M. Tansella (Eds.), Mental Health Outcome Measures (3rd ed.) (pp. 313-318). London: RCPsych Publications. Mason, T., Wilkinson, G., Nannini, A., Martin, C., Fox, J., & Hirsch, G. (2011). Winning policy change to promote community health workers: Lessons from Massachusetts in the health reform era. 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