HP 1 RESP 3

RUBRIC: 20 pts

Exceptional

One post written in response to fellow learners’ post each between 100-150 words. Response is substantive insightful and contain at least one reference.

STUDENT’S POST

What are the key functional components of the US healthcare system? 

There are four functional components of the US healthcare system termed quad-function model. They include namely financing, insurance, delivery, and payment. Financing is the most important aspect which involves payment of the health care services provided. It is either employment based, as for most private insured Americans, or government-ran for publicly insured individuals under Medicare, Medicaid, and state employees’ group (Shi &Singh, 2019).  Insurance serves to protect the individual insured from catastrophic health issues while the insurance company serves as claim processors and fund disburser to the providers of care (Shi &Singh, 2019). Delivery is the healthcare services provided by physicians, dentists, nurses, therapists and etc. (Shi &Singh, 2019). Finally Payment describes reimbursement made to the providers that provided care through the managed care organization (MCO) or insurance company (Shi &Singh, 2019). 

 Choose one other first world country and compare/contrast their healthcare system to that of the US. 

 The US health care system is one of the most complex and fragmented health care systems (Shi &Singh, 2019; Porche, 2019). Its healthcare system has the key functional components, however it is coordinated loosely. The system is most controlled by private and government-ran programs. US health care is not universal for all citizens nor controlled by any central agent like most developed nations. The bulk of the heath care finance, insurance, payment and delivery remain in the hands of the private insurance companies and many working-class poor are left uninsured (Shi &Singh, 2019). According to Shi and Singh (2019) the two primary objectives of any health care delivery system are 1) to grant all citizens with health delivery services; and 2) to ensure that the services are cost-effective and meet standard quality; yet, the US health care system has fallen short of these objectives (Shi &Singh, 2019).  Furthermore, because of the market oriented economy, the system has attracted many individual entrepreneurs who pursue profits and find ways to monetize services to benefit their quest. In the market-oriented arena, there are the purchasers of health care services such as the employers, government and private entities. In spite of this imperfection with the US healthcare services, they still offer the most sophisticated institutions, products and processes of health care delivery (Shi &Singh, 2019). However, due to the imperfection in the health care system with many working poor uninsured, health care reforms such as Affordable Care Act of 2010 was introduced to provide access and affordable care.

            Germany is one of those nations that practice Socialized Health Insurance (SHI) system which mandates employers and employees contribution into the healthcare financing since 2009  (Shi &Singh, 2019).   German health care system is based on SHI with an option for voluntary substitutive private health insurance if desired. Government exercises overall control of the system and disbursement of payment to the providers. According to Blumel and Busse (2016), there are some fractions of citizens that obtain care through special programs but the bulk portion of the citizens is dependent on the SHI or substitutive private health insurance (PHI).  Just like US, Germany health care system is undergoing reforms due to high cost of healthcare for paying aging populations, fewer people in workforce and stagnant wage growth during recessions (Shi & Singh, 2019).  In addition, the challenges encountered between the SHI and the substitutive PHI in risk pools, financing structure, access and provisions of care increase inequalities in care, calls for reformation of care initiatives (Shi &Singh, 2019).  In June 2015, the Germany had a reformation of health care system by the introduction of the Act of Strengthen SHI Health Care Provision which gave right to the municipalities to establish medical treatment centers, right for patients to see specialists within 4 weeks and promotion of innovative care. Furthermore, in 2016, Hospital Care Structural Reform Act was initiated to regulate hospital volume and payment (Shi &Singh, 2019).  

Summarize current reform efforts taking place at a national and global level. In what ways could these efforts improve healthcare outcomes? 

At the national level, the Affordable Care Act (ACA) of 2010 is the latest health care reform in United States history (Shi & Singh 2019; Porche, 2019). ACA is a health care reform that provides health insurance accessibility and affordability to Americans.  Its expanse coverage and lower health care costs ensures more choice and enhances the quality of care for all. ACA requires all individuals without private or public insurance coverage to obtain one through web-based, government-run exchanges otherwise pay fine (Shi & Singh 2019), Benjamin et al, 2017 highlights in their studies the effort and improvement this health care reform has brought to the states that embarked  on it. According to their studies, the ACA was linked to statistically significant and clinically relevant improvements for low-income adults’ access to care, use of preventive services, and self-reported health care services. Also, among those with chronic conditions, coverage expansion was connected to improved medication adherence, more regular communication with physicians, and improved perceived health status.

With the gap in health care and health care status, policy makers are lunching healthcare reforms to benefit the uninsured; and many of the low and middle-income countries are moving towards universal health coverage which will ultimately contribute to positive health outcomes globally (Shi &Singh, 2019).

In what ways does/does not current healthcare reform address population need, social justice, ethics, and technology in our current system (pick one)? 

In addressing population need, most of the health care reforms stressed the importance of affordability, access and quality health care for all. With national and global initiatives and the WHO pressure for health care reforms, there have been changes in the right direction. In the United States, the Affordable Care Act of 2010 provides care to uninsured working class Americans; an estimated of 20 million nonelderly adults (ages 18-64) Americans gained healthcare insurance coverage under ACA initiative (Uberoi et al., 2016). Furthermore, other developed nations like Germany, are going through health care reformation or rather have gone through it for better health care outcomes for the citizens. With the ongoing health care transformation around the world today, there is great hope and future for healthier national and global health care system. 

 

References

Blumel, M., & Busse, R. (2016). The German health care system. The commonwealth fund. Retrieved 10/29/2021 from http://international.commonwealthfund.org/countries/germany/.

Porche, D. J. (2019). Health policy: Application for nurses and other healthcare professionals. 2n (Ed). Burlington, MA: Jones & Bartlett Learning

Shi, L.  & Singh,  D.A. (2019). Delivering Health Care in America. 7 th (Ed). Burlington, MA: Jones &Bartlett Learning

Sommers, B. D.,  Maylone, B., Blendon, R. J., Orav, E.J., &Epstein, A.M (2017). Three-year impacts of the affordable care act: Improved Medical care and health among low-income adults. Retrieved 10/31/2021 from https://www.healthaffairs.org/doi/citedby/10.1377/hlthaff.2017.0293

Uberoi, N., Finegold, K., and Gee, E. (2016). Health insurance coverage and the affordable care act, 2010-1016.  Retrieved 11/3/2021 from https://aspe.hhs.gov/sites/default/files/private/pdf/187551/ACA2010-2016.pdf

 

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