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Homework answers / question archive / Respond to the following discussion post as a peer
Respond to the following discussion post as a peer. The US healthcare system is not an easy concept to describe in a straightforward way. Many developed countries fall into one of many categories of systems, such as single-payer, multiple-payer, or a national health service. The US, however, takes aspects of each of these systems in different ways building a patchwork hybrid system that as both public and private payors (Klassen, 2020). Because the system is so heterogeneous it is burdened with problems of inefficiency, inconsistent quality, low accessibility, and high administrative costs. US health care expenditures per capita are multiples higher than similarly developed countries, while lagging in key indicators of quality like life expectancy and infant mortality (Klassen, 2020). Much of this increase in costs is attributable to administrative costs that account for nearly a third of health care spending within the US (Dewar, 2017).
Throughout the political history of the 20th and 21st centuries these inefficiencies have been addressed in various ways with varying amounts of success. Employer-based health care insurance and public programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) have been implemented to attempt to increase coverage and access to health care for US citizens (Klassen, 2020). Most recently, the Patient Protection and Affordable Care Act has provided the greatest overhaul of the US health care system since Medicare, though not without much political strife and technological difficulties (Klassen, 2020). The ACA has specifically identified the importance of preventative health, for example, by requiring coverage for preventive care procedures due to the increased costs associated with chronic illnesses. Overall, the US healthcare system occupies a crossroads of affordability, accessibility, economic incentives, and technological innovation.
I have had the benefit of never being without health insurance or access to care. As a young adult I benefited from the ACA because I was able to stay on my parents plan until I turned 26, long after I started working for a company that provided medical, dental, and vision benefits. I have also been acutely aware of the importance of preventative health care habits. My worldview could bias me towards not understanding how difficult it can be for people in disadvantaged populations to gain access to quality health care. As a pharmacist in an inpatient setting, my focus is often on balancing the quality of care with the increasing costs of medications through intense formulary management. Removing low use, high cost medications may save the hospital money but if a patient needs a specific medication this can reduce their quality of care through long waiting periods or denial of order which could be another bias on my perspective of the health care system. I try to keep these concepts in mind when making cost savings recommendations and when writing policy for my department.
Discussion
In many industries, consumers have the freedom to decide on the best service or product supplier. However, the healthcare industry seems to be quite different from other sectors. For instance, the healthcare sector has limited service providers for specific services. Patients have been able to benefit from health insurance coverage. At times patients fail to cater for out-of-pocket medical expenses due to the emergency of the health disorders. However, even without financial stability, a patient can access medical services because of an existing third-party payer. The third-party payers exist in various categories. For instance, there are payers in government agencies, employer-based health insurance, insurance organizations, and government agencies (Lambert et al., 2017). The state government uses Medicare and Medicaid programs to ensure health coverage for the people with disabilities, from low-income levels, and for the vulnerable young (Kruger et al., 2019). The US has an Act promoting accessibility to quality care, namely the Patient Protection and Affordable Care Act. Initially, most individuals suffered poor health or access to inadequate health facilities because of age, discrimination, and limited resources to access better services in more established healthcare facilities. Hence, the government and other private sectors decided to sign contracts with willing individuals regarding their medical expenses on given terms and conditions.
Even though many people benefit from third-party payers, there are challenges that patients face before receiving the care. For instance, some hospitals may compromise the care quality since the patients are not making direct payments for the received services. At times healthcare facilities may receive too much congestion from people under health coverage. Hence, it may take patients a longer time to receive medical services. Congestion may also affect the nature and quality of services. Nevertheless, patients can access medical services without economic restriction, primarily when government agencies are third-party payers.
