NRS 428 Describe the effect of health care reform on the U.S. health care system and its respective stakeholders

NRS 428 Describe the effect of health care reform on the U.S. health care system and its respective stakeholders

NRS 428 Describe the effect of health care reform on the U.S. health care system and its respective stakeholders

A health care delivery system incorporates four functional components, financing, insurance, delivery, and payment, (the quad-function model). Health care delivery systems differ depending on the arrangement of these components. There are three main finance sources for health care in the United States: the government, private health insurers, and the individuals. Between Medicaid, Medicare and the other health care programs it runs, the federal government covers just about half of all medical spending (Havaei et al., 2019). The current US delivery system and financing structures are unsustainable. Inequitable distribution of resources continues, and an increasing number of American families do not have access to adequate care. The U.S. health care delivery system is complex and massive. I honestly feel unqualified to judge the effectiveness accurately, but while my gut instinct wants to say “no” the data supports that it is functioning better than any other system worldwide of its size. The vast array of institutions includes 5,700 hospitals, 15,900 nursing homes, almost 2,900 inpatient mental health facilities, and 11,000 home health agencies and hospices (Cleveland et al., 2019). Despite spending far more on healthcare than other high-income nations, the US scores poorly on many key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality. And for all that expense, satisfaction with the current healthcare system is low. By making health coverage more affordable and accessible and thus increasing the number of Americans with coverage, by funding community-based public health and prevention programs, and by supporting research and tracking on key health measures, the ACA can help begin to reduce disparities, improve access to preventive care, improve health outcomes and reduce the nation’s health spending.

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Cleveland, K.A., Motter, T., Smith, Y., (2019) “Affordable Care: Harnessing the Power of Nurses” OJIN: The Online Journal of Issues in Nursing Vol. 24, No. 2, Manuscript 2.

the health care delivery system was described as a “cottage industry.” The main characteristic of a cottage industry is that it comprises many units operating independently, each focused on its own performance. Each unit has considerable freedom to set standards of performance and measure itself against metrics of its own choosing. In addition, cottage industries do not generally attempt to standardize or coordinate the processes or performance of Unit A with those of Units B, C, and so on.

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Indeed, this is an apt characterization of the current health care delivery system. Even in many hospitals, individual departments operate more or less autonomously, creating so-called “silos.” Many physicians practice independently or in small groups, and ambulatory clinics, pharmacies, laboratories, rehabilitation clinics, and other organizations—although part of the delivery system—often act as independent entities. We often call this arrangement a “health care system,” even though it was not created as a system and has never performed as a system.

Moving from the current conglomeration of independent entities toward a “system” will require that every participating unit recognize its dependence and influence on all other units. Each unit must not only achieve high performance but must also recognize the imperative of joining with other units to optimize the performance of the system as a whole. Moreover, each individual care provider must recognize his or her dependence and influence on other care team members (e.g., specialists in different fields, pharmacists, nurses, social workers, psychologists, physical therapists, etc.) (IOM,2003). These are the underlying attitudes that support a systems approach to solving problems.

Changing attitudes to embrace teamwork and systems “thinking” can be extremely difficult and may encounter resistance. Nevertheless, a concerted, visible commitment by management will be necessary to achieve this new way of thinking as a giant step toward the improvements identified in Crossing the Quality Chasm.




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Affordable care act gives middle class families better health security by putting in place comprehensive health

NRS 428 Describe the effect of health care reform on the U.S. health care system and its respective stakeholders
NRS 428 Describe the effect of health care reform on the U.S. health care system and its respective stakeholders

insurance reforms that will hold insurance companies accountable, lower health care costs, guarantee more choice, and enhance the quality of care for all Americans.

Here are some of the most important ways health care reform will benefit middle class Americans, several of which are already in place:

Ending insurance industry abuses: The patients’ bill of Rights puts consumers, not insurance companies, in control of their health care. Insurance companies can no longer deny coverage to children with existing conditions, cancel coverage when people get sick, and place lifetime dollar limits on the amount of care you can get.

Expanding coverage for women: In July 2011, the U.S. Department of Health and Human Services announced historic new guidelines that will help meet women’s health needs. Beginning August 1, 2012, women’s preventive services will be covered with no cost sharing in new health plans. These additional services include, among others, well-woman visits, gestational diabetes screening, breastfeeding support, domestic violence screening, contraception, HPV DNA testing, and HIV screening and counseling. These preventive services help women stay healthy, and because they enhance long-term detection and treatment, they also reduce long-term health costs.

Coverage for those who need it most: Uninsured people with a pre-existing condition now have a guaranteed, affordable health insurance options.The Pre-Existing Condition Insurance Plan (PCIP) provides coverage until 2014, when you will have access to affordable health insurance choices through an Exchange, and you can no longer be discriminated against based on a pre-existing condition.

Sticking Up for Seniors: The law ensures that we continue to protect seniors’ guaranteed Medicare benefits while taking important steps to fight waste, fraud, and abuse. The new law will close the prescription drug coverage gap known as the “donut hole” completely by 2020. In 2010, 4 million people with Medicare who fell into the “donut hole” received $250 rebate checks. In 2011, people with Medicare in the donut hole receive a 50 percent discount  on their covered brand name prescription drugs. In addition, people with Medicare are now eligible for an annual wellness visit and free preventive services. such as mammograms and colonoscopies.

Helping small business protect their workers: small businesses may be eligible for tax credits, making it easier for them to provide coverage to their workers. Small businesses can learn more about their health insurance options via the insuranceI. In 2014, the amount of the tax credit will increase, and a new health care marketplace will ensure American businesses can offer quality, affordable health care coverage options.

Easy to understand your options: Starting in March 2012, consumers will have an important new tool to understand their coverage. Health insurers and employers who offer coverage to their workers must provide clear and consistent information about your health plan – similar to the kind of nutritional information you find on the food you buy at the grocery store. Specifically, you will have access to an easy-to-understand Summary of Benefits and Coverage, which will include basic information that every person should have, including: What is my annual premium? What is my annual deductible? What services are NOT covered by my policy? What will my costs be if I go to a provider in my network versus one that is not in my network? Coverage examples will illustrate what you pay in certain circumstances.

Putting Patients First: New regulations require health insurers to spend 80 to 85 percent of consumers’ premiums on direct care for patients and efforts to improve care quality. This regulation, known as the “medical loss ratio” provision of the Affordable Care Act, will make the insurance marketplace more transparent and make it easier for consumers to purchase plans that provide better value for their money. Proposed premium increases of 10 percent or more will also be subject to new scrutiny.