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Running head: HEALTH CARE COSTS IN AMERICA 1

HEALTH CARE COSTS IN AMERICA 4

Health Care Costs in America

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The current state of the healthcare system in America is part of the economy. More private entities operate the health care system as compared to the government health services. In the U.S there are two categories of healthcare systems. The first category is for profit health care service while the second category is a not for profit health category. There are equal numbers of for profit and not for profit health care services provider of which the for profit services providers are dominant because they also a profitability advantage to investors, who in turn invest more money to these facilities (Swayne, Duncan, & Ginter, 2012).

The strengths of managed health care is that this entities was devised to improve the economics of healthcare services provision. The economics mechanism was devised with the purpose of increasing utilization while reducing the cost of services, (Berwick, Nolan, & Whittington, 2008). For example, managed health care services will offer high quality services at reduced cost to health care consumers as compared entities that rely on fee for service. Managed care pool resources to enhanced member facilities.

On the other hand, the weaknesses of managed care has been associated with interest of keeping the cost of providing healthcare services low at the expense of compromising with consumer members. To some extent, HMOs dictate the type of treatment patients receive and they do not approve costly treatment to patients even though such treatment is required and may improve the health outcome of patients (Berwick, Nolan, & Whittington, 2008). In other words, HMOs restrict treatment options.

The priority of HMOs has been considered as trying to reduce the cost of health care services provision to consumers. This priority is based on pooling resources and utilizing the mechanism some sort of economies of scale. Also, HMOs have been cited to favor preventive medicine. Preventive medicine is the type of medicine that encourage prevention of diseases as compared to treating diseases, (Berwick, Nolan, & Whittington, 2008). Through preventive medicine, patients are less likely to go treatment hence saving on the cost of treatment.

The priorities of healthcare providers is to provide adequate and effective treatment to patient customers. Adequate and effective treatment for consumers means that health care providers require adequate and modern facilities and equipment (Berwick, Nolan, & Whittington, 2008). HMOs seem to provide these facilities as compared to other systems of payment.

The priorities of consumers in the modern revolved health care systems is access to adequate and effective health care services. HMOs provide adequate health care services to consumers. However, it does so to members only suggesting that health care services consumers who are not recognized by HMOs are not entitled to any medical or health care services within the health facilities that are managed by HMOs (Berwick, Nolan, & Whittington, 2008).

Health care regulation in the U.S. is complex. However, HMOs regulate the quality of healthcare services among member services providers. Complying with HMO standards require compliance of rules that government membership and qualification (Scott, 2000). Also, healthcare services providers need licensure and accreditation from the government and professional organizations for individual services providers to operate.

The health care reforms are constant changes in America. However, the cause of raising cost of health care services has been directly linked to health care reforms that are progressing towards installing an economic model of health services delivery. Today, citizens who are members of a private health insurance receive or are entitled to adequate health care services as compared to citizens who are not members of any health insurance program, (Scott, 2000). Also, the health care reforms dictate that health care services providers belong to a HMOs if they are going to get paid for the services they provide. This means that doctors and physicians who are not part of the HMOs will not get reimbursed for the services they provide to the public. This also means that doctors are not going to attend to members of the public who do not have health insurance. It is uncommon in America to see people without health insurance getting a difficult time finding a primary physician.

Reference

Scott, W. R. (2000). Institutional change and healthcare organizations: From professional dominance to managed care. University of Chicago Press.

Swayne, L. E., Duncan, W. J., & Ginter, P. M. (2012). Strategic management of health care organizations. John Wiley & Sons.

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: care, health, and cost. Health affairs, 27(3), 759-769.