Health Care Reform: Delivery and Financing

Although there is widespread agreement among Americans that the healthcare system in the country needs reforming, little agreement exists on how the reforms should be attained. Among the most common proposals by experts include reforming healthcare delivery, reforming the healthcare financing system, and ensuring that the healthcare system provides quality care to all people.

Healthcare delivery

Universal health coverage is not common among most Americans who argue that it is a socialist idea which will only end in congestion and decreased healthcare quality. It is for this reason that experts such as Lancaster et al (490) and Wells Fargo (1) suggest a delivery system that grants patients the choice between universal and private healthcare provision. Universal provision would act as a safety net to ensure that no citizen ever misses quality treatment just because they cannot afford it. According to Lancaster et al., (490) healthcare should be provided under a three tier system that includes the base level tier 1(universal coverage), tier 2 would be administered by the private sector for extended care services, while tier 3 would be medical and surgical services considered luxury or cosmetic in nature.

The proposed new law meets the proposals by the experts in this sector by making insurance affordable to a significant percentage of the middle income earners through tax cuts and reduction of premium costs. Consequently, the law gives the more than 30 million Americans access to affordable healthcare. Under the new law, the white house estimates that at least 95 percent of Americans will have health insurance cover (White House 1)

HealthCare financing

Arrow et al. recommends three approaches to financial reform in the healthcare sector: i) identifying revenues sources that would enable the government and other players in the industry to subsidize healthcare coverage in such a way that all Americans would be insured; ii) creation of insurance exchanges that would be used to pool risk. This would in turn ensure that people with employer-based coverage obtain standard benefits from the exchanges; iii) creation of a health-coverage board that would determine and update the standard-benefit package to be availed to the general population through regional or state insurance exchanges (Arrow et al. 495). Fuschs and Emmanuel on the other hand proposed that healthcare financing should be reformed through increasing employer mandate, increasing subsidies to the uninsured population, expanding Medicare and Medicaid or the introduction of health-savings accounts that would be subsidized by the government (1402).

Arrow et al. further proposes that payments in the reformed healthcare system should be pegged on increased service efficiency and patient outcomes as opposed to the current system where payments are pegged on services and the appropriateness of health outcomes (475). More to this, the writers propose that the fee-for –service payment method should be replaced with a system that is keen or rewarding innovation that ensures that there is provision of quality care in the health sector.

According to information provided in the White House website, the new law will “set up a new competitive private health insurance market; hold insurance companies accountable; and cut government overspending in healthcare by reining the fraud, abuse and waste in the current system” (White House 1). More to this, the law would ensure that insurance company abuses are banned, and the populace is given more coverage options that would ensure that most people locked out of the current insurance market receive cover. To this end, it is apparent that the law has covered most of the proposals presented by the experts as analyzed above.

Provision of quality care

Although the phrase ‘quality care’ can take several definitions, this research paper will define it as the unbiased, competitive, realistic and efficient provision of healthcare services. Wells Fargo defines competitive healthcare as one that will allow people the freedom to choose between different providers and insurers (1). Unbiased healthcare system on the other hand would treat patients and insurance cover in the same manner regardless of whether the employer is large or small. Efficient healthcare system would on the other hand mean that the regulations, insurance covers and relevant laws would all be geared towards maximizing health among Americans.

The issue of quality of care is comprehensively addressed under part 3 of the new law, which seeks to encourage the development of “new Patient care models” (Office of the Legislative Counsel 306). Here, the law proposes the development of low-cost, but high-quality healthcare institutions. This would be attained through the development, documentation and dissemination of best practices in the healthcare sector, the implementation of proven care methods and best practices within healthcare institutions, the provision of assistance to healthcare institutions that are yet to embrace good practices as well as proven healthcare methods. More to this, the law proposes that inpatient care (including intensive care) for all applicable patients to be facilitated at their local hospitals. Outpatient services on the other hand are to be more timely and efficient (Office of the Legislative Counsel 309).

The experts and the government seem to agree that reforming the healthcare system in the country requires more than financial reform. Initially, the biggest complaint among Americans was that the country continues to spend more than other developed countries in healthcare provision, yet the system compared poorly to countries like Canada and the UK, which spend much less money on their respective healthcare systems.

Observations and conclusion

Since the problems facing the healthcare system in the United States have been identified as cost, quality and coverage, the law should be able to comprehensively address all the three concerns. To this end, this study has found out that the law has succeeded and has even gone further to address the delivery of care in addition to the core issue of financing the healthcare system. This approach acknowledges that both financing and the delivery system have been responsible for the problems facing the healthcare system presently. The government therefore through the proposed law acknowledges that in addition to high cost undermining the access of the majority population to healthcare, poor quality has also been an issue in the US healthcare system.

For the reforms to work however, they will need to be comprehensive because patchwork which is evident through Medicaid and Medicare has only addressed part of the problems in the past. Overall, the proposed law from this research paper’s perspective looks like a systematic and goal-oriented proposal, which has policies that reinforce each other. As such, one would expected that when enacted, the law will improve the overall health outcomes in the country through providing accessible, quality healthcare to all Americans. Seeing that an efficient healthcare system is essential for development, all players in the industry would have to strike a compromise between the capitalist ideals of the American economy, and the need for accessible healthcare for everyone regardless of their economic capabilities.

Works cited

Arrow, Kenneth, Et al. Towards a 21st century healthcare system: recommendation for health care reform, Medicine and public issues, 150.7 (2009):493-495.

Fuschs, Victor & Emanuel, Ezekiel. Health Care reform: Why? What? When? Health Affairs, 24.6 (2005): 1399-1414.

Lancaster, Gilead Et al. The expanding Medical and Behavioral resources with Access to Care for Everyone Health Plan. Annals of Internal medicine, 150.7 (2009): 490-492.

Office of the Legislative Counsel. Compilation of Patient Protection and Affordable Care Act. 11th Congress 2d session, 2010. Web.

Wells Fargo. Reforming Health Care reform. Wells Fargo Small Business Roundup®. 2008. Web.

White House. Health Care: health reform. 2010. Web.

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