Analysis Report-Quality vs. Access

Introduction

The introduction of the Affordable Care Act in America was highly beneficial since it increased the number of low-income covered by Medicaid. It ensures that they are able to acquire medical coverage and access to healthcare services. Essentially, they have an opportunity to increase their eligibility despite their poverty level state. The Act has been able to improve the quality of Medicaid in the country to the same level as Medicare. Currently, people who fall between ages 19 to 64 and below the federal poverty level of 133% can be covered under Medicaid.3 Before the introduction of ACA, such patients would not be eligible.

Stakeholders

The Medicaid program affects different groups of people in the country. Millions of people have a direct stake in the program, meaning any changes will directly affect their decisions on health care coverage. They include low-income earners, the federal government, private insurance companies, and healthcare providers.

Overview

The Affordable Care Act certainly affected the number of people covered under Medicaid. Moreover, the amount of healthcare coverage in the county had a direct correlation with the availability of the Act in the United Sates. Currently, questions have been circulating as to whether the Act should be revised. However, the pertinent issue that arises from such questions is the manner in which any changes in the Federal Law might affect the Medicaid program. The program covers approximately 50 million Americans from low-earning families.1 Medicaid involves a partnership between the Federal and local governments over funding. It is optional for states to participate in the program, but all local governments are currently involved in the partnership. For a state to participate, it has to meet federal requirements. One of the requirements is that the state cover a particular group of people and offer certain benefits.

However, most of the eligibility in the program is dependent upon a person's income and the category in which he or she belongs. Many young adults with no children previously lacked coverage because they did not fall under the categories provided for by the program.

However, the Federal poverty guidelines would help to solve this problem since it lists a cut-off point for young adults with low income. The program now has a component that facilitates reporting of quality through patient measurements. An example is patient satisfaction and adherence to treatment, which has reportedly dropped by 40%.2 The challenge is that the program may fail to be beneficial for patients who need it since they may be turned away by healthcare providers. The component entails utilizing the measurements to determine choices of reimbursement. There is a risk that providers might begin turning away patients from low-income backgrounds

Analysis

The program has come a long way since it was first enacted, but there is the risk that such a measure might lock out large sections of the public from healthcare coverage. Very few healthcare providers want to be involved in a process that takes more of their time and effort. As a result, they may end up turning away patients without administering any treatment.

Recommendations

The most suitable solution for this challenge would be to reduce the risks of patient non-adherence by fostering mutual physician-patient relationships. This solution means that physicians should make an effort to assess the patients' understanding of the treatment regimen. Additionally, patients should be allowed to give a thorough story of their experiences with unique illnesses. Mutual collaboration between physicians and patients results in higher adherence levels.2

Conclusion

Balancing the quality of healthcare with access can be an uphill task if no strategies are applied. Moreover, it can be a counterproductive process against the Medicaid program and what it was introduced to achieve. As clearly elaborated, physician-patient collaboration should be prioritized if both goals are to be achieved.

References

1. Baicker K, Taubman SL, Allen HL, et al. The Oregon Experiment — Effects of Medicaid on Clinical Outcomes. New England Journal of Medicine. 2013;368(18):1713-1722. doi:10.1056/nejmsa1212321.

2. Martin LR. The challenge of patient adherence. Ther Clin Risk Manag . http://www.academia.edu/581889/The_challenge_of_patient_adherence. Accessed January 30, 2018.

3. Wherry, L. R., & Miller, S. “Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid expansions: a quasi-experimental study.” Annals of internal medicine 164.12 (2016):795-803

3

Carissa Lee