By definition, health care policy denotes rules, regulations as well as guidelines that are in existence for operating, financing and molding the delivery of health care. More of an assortment than a single actual policy, health care policy covers a variety of issues related to health. These include public health, financing of the health care, chronic illness and disability, preventive health care, mental health, and long-term care (Laszewski, 2012). The policy was mooted by the President Barrack Obama during his campaigns in 2008. What was primarily an election promise by the president, was later introduced in the House of Representatives and the Senate and eventually passed as Patient Protection and Affordable Care Act (PPACA) which became a law by March 2010. The lawmakers revised Obama’s initial healthcare plan through a series of amendments until the policy became practicable.
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Inefficient measures in the US healthcare system led to the drafting of the healthcare policy. In the United State of America under the current health care system there are notably many health care organizations and billing agencies. As a result of these different health care fees, the system has been characterized by a huge amount of administrative wastage (Maltessich, 2011). Besides, the system of health care in the US has been faced with the problems of the ever expanding ranks of the uninsured individuals. It is for such reasons that the PPACA avails the single payer model. In the single payer model, the government is the one to which taxes are paid and thereafter takes the initiative of paying the health care providers including nurses, doctors as well as dentists to avail this vital health care to individuals. In a single-payer health care system all doctors, hospitals, and other health care providers will be obliged with billing of their services to a sole entity. Through this, the earlier mentioned administrative costs are greatly reduced thus saving money which can be utilized to avail insurance and care to those in the society who are not receiving such services (Laszewski, 2012).
The principal objective of this model is to ensure that each and every American is in a position to access comprehensive medical benefits through the single payer. This is because care will be based on the need of the individual rather than the ability of the individual to pay for the same. Thus, all services that are medically vital will be covered including home care, rehabilitative care, long-term care, prescription drugs, mental care, medical supplies and public and preventive health measures (Hezekiah, 1989). It is this method, which has seen through the elimination of hospital billing. Now hospitals will be receiving a yearly lump-sum payment from the federal government for the covering of operating expenses. This could be termed as a global budget. Besides, a separate budget would be put in place to cover such expenses as the purchase of technology, marketing, and hospital expansion. In this health care policy system, medical practitioners have a three-fold payment option: salaried positions in hospitals, salaried positions within group practices, and/or HMOs or fee-for-service. Notably, negotiations of the fees are between a state payment board and a representative of the fee-for-service practitioners, who may be the state medical society. More often than not, the government serves not as the employer but as the administrator (Nilsen et al, 2006).
On the issue of financing, a single-payer health care system is supposed to be financed and at the same time overseen by a single public insurer at the regional or state level. Copayments, premiums, and deductibles would be done away with. While the employer is expected to pay up to 7% of the payroll tax, the employees pay 2%, thus making a conversion of the premium payments to a health care payroll tax (Garson, 2000). On the other hand, administrative savings are projected at 10% by the General Accounting Office. This is done through the eradication of private insurance bills as well as the administrative waste. The administrative savings are then utilized to avail medical care to those individuals who are underserved. According to the Congressional Budget Office, a single payer is likely to cut down on the overall health costs by a considerable amount even in an era when expansion of the comprehensive care is expected to be availed to all Americans (Hezekiah, 1989).
This single payer model of health care has made available a number of benefits to various stakeholders including patients, medical practitioners, the Congress, hospitals, business, and insurance industry. To begin with, each and every individual regardless of his/her paying capability, is positioned at receiving comprehensive, high-quality medical care as well as has a free choice of hospitals and doctors. Besides not receiving bills, the individual’s deductibles and copayments are eliminated. There is also a high possibility that majority of the people will be paying relatively smaller prices than what they have been paying for the overall health care (Laszewski, 2012). On the side of the doctors, their incomes are likely to change a bit although the inequality in the income between specialists is likely to shrink. Additionally, doctors and other medical practitioners will not be asking for payment before they attend to a patient. Besides, time that was earlier being wasted on various administrative responsibilities is redirected to providing care. Further, clinical decisions get out of the hands of the policy of the insurance company. Hospitals also benefit from this system since there is no longer any need to hire numerous members of administrative personnel earlier obliged with the handling of itemizing billing. Moreover, operating expenses will now be swallowed in the global budget. Closure of hospitals as a result of unpaid bills will no longer be a problem since budgets will be separately allocated on the basis of health care priorities. The Congress will also benefit in the sense that it will be easier for it to implement the most efficient health care system (Naidoo & Wills, 2008).
In the social insurance system, on the other hand, nationals are necessitated to make a purchase of health insurance from non-profit insurance companies. Thereafter, they utilize this health insurance in the payment of services made available to them by health care providers. In the United States, these two systems have been used in a combination. Primarily, health care is financed via insurance companies which are privately owned with the individuals accessing them through their employers. However, it is not a must that individuals carry out insurance. This has been substantiated by the fact that those uninsured in the US are numerous (Mahon, Walshe & Chmabers, 2009).
PPACA has been implemented through the sponsorship of three main health care programs in the United States. These included the Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP). Medicare refers to a government health care program that is obliged with the provision of health insurance to Americans of sixty five years of age and over and a portion of people with disabilities. Medicare is made up of two principal parts for medical and hospital insurance (Maltessich, 2011). The first part is the hospital insurance and the second is the supplementary medical insurance. But there is also the Medicare advantage and prescript drug coverage. Medicaid, on the other hand, refers to a government health program which avails health insurance to the poor in the society. It is restricted to specific categories of individuals who may be receiving welfare payments as well as those with disabilities. This program’s chief oversight is dealt with at the federal level. However, each and every state is obliged with the establishment of its own standards of eligibility, determination of the type, duration, scope and amount of service, setting the payment rate for the services and administration of its own Medicaid program (Nilsen et al, 2006). Despite the fact that the state is obligated with making the very final decision as to what Medicaid plans ought to provide, there is a number of compulsory prerequisites that these states need to meet for them to be in a position to receive the matching federal funds. These include such as inpatient and outpatient hospital services, prenatal care, physician services, vaccines for children, rural health clinics, family planning services and supplies, nursing facility services for 21 old and above persons, x-ray and laboratory services, nurse-midwifery services, pediatric and family nurse practitioner services, federal qualified health-center services and ambulatory services. The State Children’s Health Insurance Program (SCHIP), on its part, provides health insurance to the uninsured in the society and the low income children (Laszewski, 2012).
Besides funding of health care, health care policy also entails the prioritization of a number of health care problems as well as other special funds provided for increasing research. Likewise, throughout the history of other issues regarding health, special attention has been given to specific issues such as smallpox, smoking of cigarettes, HIV/AIDS, substance abuse, and suicide prevention (Mahon, Walshe & Chambers, 2009). Ordinarily, issues garner importance in the event that those who are directly affected by them organize themselves and thereafter lobby their designated officials for resources. Alternatively, they may insist on the release of reports that display a despairing need to take action. For funding further studies, these public health initiatives ought to include programs geared towards transforming the behaviors that lead health risks, or in a case of a disease (as the ones listed in an earlier paragraph), make available easy access to vaccinations aimed at preventing the disease (Naidoo & Wills, 2008). Such behavior-changing programs may include public advertising directed towards promoting the use of condoms in helping prevent the rapid spread of HIV and AIDS or availing relevant information about health risk brought about by smoking. Moreover, in order to change behavior it is important to focus on the relationship between the doctor and the patients as well as the kind of advice dispensed in the course of routine visits. Support systems, such as suicide prevention hotlines, should also be provided to assist those predisposed to certain risks and health problems.
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