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Affordable Care Act's Impact On The Health Care Industry If you've lived in the United States, there is no way the topic of Affordable Care Act(ACA) could be evaded. Its on the news, its on the streets, its everywhere! For the general public the ACA stands for complete health coverage and cheaper insurance premiums. For the healthcare Industry however, whether Hospitals, Health care delivery models, Insurance Companies, Pharmaceutical and Biotech Industries, the ACA poises a huge reform in the delivery of services and products. The ACA or commonly known as Obamacare or the Patient Protection and Affordable Care Act(PPACA) hopes to improve accessibility and quality while reducing costs. Value Based Purchasing The existing reimbursement models in healthcare has failed in many different ways. The pay for service had negatively incentivised physicians to prescribe unneeded tests and procedures. The per diem or the pay per day reimbursement system had encouraged hospitals to keep the patients for longer periods. The DRGs or the Diagnostics Related Groups which pays for each diagnosis(disease) had resulted in physicians choosing the cheapest way of treating patients and turned out to be the least effective. Affordable Care Act brings in a new system of reimbursement model called the value based purchasing (VBP). To address the threats of lesser quality, lesser accessibility and higher cost which constitutes the focus of the ‘Triple Aim,’ VBP brings in a solution by financially incentivising hospitals to provide better care. The hospitals are reimbursed based on patient satisfaction and quality performance. While most countries break even through volume rather than cost, the US uses big bucks to break even. To give an example, while... ... middle of paper ... ... say that the accountable care organisations and value based purchasing will financially impact the industry. The shift from fee for service to a value based model will increase the sales of evidence based medicines and decrease the sales for new drugs. General Public One of the major stakeholders of the healthcare industry is the general public as everyone would need healthcare at some point of their time. The ACA concentrates on making it easier for the public. ACA promises to increase the insured by A global survey from Deloitte has found out that 7% of the surveyed population agreed that they spent lesser than the previous year for healthcare products and services in the United States.The 7% in the USA was much higher than the other countries that were surveyed. The study which was done right after the implementation of ACA summarises the effect on the public.
It is generally accepted that the method of payment to physicians affect their professional attitude and behaviour. Consequently, health policy makers manipulate payment system in an attempt to achieve optimal health care for their citizens such as improve accessibility, quality of care, patient’s satisfaction and cost containment. In Ontario, there are a wide range of mechanisms that are used to pay physicians for their services that are funded by both federal and provincial government. According to Canada Health Act annual report (2013), the majority of primary healthcare physicians are funded using the fee for service payment arrangement but of that majority, only less than 30% are compensated exclusively according the fee for service plan. The remaining physicians are funded using one of the following mixed compensation models:
The aim of affordable care act (ACA) was to extend health insurance coverage to around 15% of US population who lack it. These include people with no coverage from their employers and don’t have coverage by US health programs like Medicaid (Retrieved from, https://www.healthcare.gov/glossary/affordable-care-act/). To achieve this, the law required all Americans to have health insurance which is a reason of controversy because, it was inappropriate intrusion of government into the massive health care industry and insult to personal liberty. To make health care more affordable subsidies are offered and the cost of the insurance was supposed to be reduced by bringing younger, healthier people to the health insurance system. This could be controversial, if older, sicker people who need the coverage most enter the market but younger group decline to do so. The insurance pool will be unbalanced and the cost of coverage will rise correspondingly.
Miller, H. D. (2009). From volume to value: better ways to pay for health care. Health Affairs
On a global scale, the United States is a relatively wealthy country of advanced industrialization. Unfortunately, the healthcare system is among the costliest, spending close to 18% of gross domestic product (GDP) towards funding healthcare (2011). No universal healthcare coverage is currently available. United States healthcare is currently funded through private, federal, state, and local sources. Coverage is provided privately and through the government and military. Nearly 85% of the U.S. population is covered to some extent, leaving a population of close to 48 million without any type of health insurance. Cost is the primary reason for lack of insurance and individuals foregoing medical care and use of prescription medications.
Healthcare has been a topic of discussion with the majority of the country. Issues with insurance coverage, rising costs, limited options to gain coverage, and the quality of healthcare have become concerns for law makers, healthcare providers and the general public. Some of those concerns were alleviated with the passing of the Affordable Care Act, but new concerns have developed with problems that have occurred in the implementation of the new law. The main concerns of the country are if the Affordable Care Act will be able to overcome the issues that plagued the old healthcare system, the cost of the program, and how will the new law affect the quality of the health delivery system.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
The United States (U.S.) has a health care system that is much different than any other health care system in the world (Nies & McEwen, 2015). It is frequently recognized as one with most recent technological inventions, but at the same time is often criticized for being overly expensive (Nies & McEwen, 2015). In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) (U. S. Department of Health & Human Services, n.d.) This plan was implemented in an attempt to make preventative care more affordable and accessible for all uninsured Americans (U.S. Department of Health & Human Services, n.d.). Under the law, the new Patient’s Bill of Rights gives consumers the power to be in charge of their health care choices. (U.S. Department of Health & Human Services, n.d.).
The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS).
If the United States had unlimited funds, the appropriate response to such a high number of mentally ill Americans should naturally be to provide universal coverage that doesn’t discriminate between healthcare and mental healthcare. The United States doesn’t have unlimited funds to provide universal healthcare at this point, but the country does have the ability to stop coverage discrimination. A quarter of the 15.7 million Americans who received mental health care listed themselves as the main payer for the services, according to one survey that looked at those services from 2005 to 2009. 3 Separate research from the same agency found 45 percent of those not receiving mental health care listing cost as a barrier.3 President Obama and the advisors who helped construct The Affordable Care Act recognized the problem that confronts the mentally ill. Mental healthcare had to be more affordable and different measures had to be taken to help patients recover. Although The Affordable Care Act doesn’t provide mentally ill patients will universal coverage, the act has made substantial changes to the options available to them.
The Affordable Care Act, more commonly known as Obamacare, is a new health policy created by the American federal government. Its purpose is to make healthcare more affordable and friendly for the people. Unfortunately in some way that does not prove to be the case. It is becoming apparent that Obama may have made some misleading statements to help get the ACA put into action. The ACA is sprinkled with many flaws that call for a reform such as people’s current plans being terminated, high costs, and at minimum some people’s hours being cut by their employers.
...lthcare system is slowly shifting from volume to value based care for quality purposes. By allowing physicians to receive payments on value over volume, patients receive quality of care and overall healthcare costs are lowered. The patients’ healthcare experience will be measured in terms of quality instead of how many appointments a physician has. Also, Medicare and Medicaid reimbursements are prompting hospitals, physicians and other healthcare organizations to make the value shifts. In response to the evolving healthcare cost, ways to reduce health care cost will be examined. When we lead towards a patient centered system organized around what patients need, everyone has better outcomes. The patient is involved in their healthcare choices and more driven in the health care arena. A value based approach can help significantly in achieving patient-centered care.
Health insurance, too many American citizens, is not an option. However, some citizens find it unnecessary. Working in the health care field, I witness the effects of uninsured patients on medical offices. Too often, I see a “self-pay” patient receive care from their doctor and then fail to pay for it. Altogether, their refusal to pay leaves the office at a loss of money and calls for patients to pay extra in covering for the cost of the care the uninsured patient received. One office visit does not seem like too big of an expense, but multiple patients failing to pay for the care they receive adds up. Imagine the hospital bills that patients fail to pay; health services in a hospital are double, sometimes triple, in price at a hospital. It is unfair that paying patients are responsible for covering these unpaid services. Luckily, the Affordable Care Act was passed on March 23, 2010, otherwise known as Obamacare. Obamacare is necessary in America because it calls for all citizens to be health insured, no worrying about pre-existing conditions, and free benefits for men and women’s health.
The U.S. expends far more on healthcare than any other country in the world, yet we get fewer benefits, less than ideal health outcomes, and a lot of dissatisfaction manifested by unequal access, the significant numbers of uninsured and underinsured Americans, uneven quality, and unconstrained wastes. The financing of healthcare is also complicated, as there is no single payer system and payment schemes vary across payors and providers.
Over the last few decades, various laws have been established with the main purpose of making the system equal and more efficient for all. The U.S. hospital system has become more complex and less efficient due to significant political and monetary interference along with the passage of these laws. The most recent amongst those laws is the Affordable Care Act (ACA), which was signed into legislation by President Obama in 2010. Various provisions in the ACA includes universal health insurance coverage, significant changes in the payment for health services and changes in the health care organization delivery and workforce policy. Thus, ACA has a significant influence on the current U.S. healthcare system.
The United States health care system is one of the most expensive systems in the world yet it is known as being unorganized and chaotic in comparison to other countries (Barton, 2010). This factor is attributed to numerous characteristics that define what the U.S. system is comprised of. Two of the major indications are imperfect market conditions and the demand for new technology (Barton, 2010). The health care system has been described as a free market in