Healthcare

Background of Healthcare Policy in the United States

The modern conception of healthcare is involved with an access to professionals from medical fields and medical technology, having knowledge in surgical equipments and medications (Welch et al., 1993). It also involves accessing the latest information as well as evidence from health service research and medical research. In most countries healthcare is left to individuals to pay for health care services and goods that they access. It is also left to the private sector in pharmaceuticals and medical industries to develop health service research and medical research. Other countries have healthcare policy to ensure that all citizens get an access to health care by running, funding, and regulating health care delivery. Health care is among the largest areas that spend a lot of funds for both individuals and governments across the world. For instance, in the United States, medical debt is a leading cause of bankruptcy (Welch et al., 1993).

Schiller (1999) defines healthcare policy as the myriad guidelines, rules, and regulations that exist to run, fund, and regulate healthcare delivery. Healthcare policy addresses a number of health related issues such as the preventive health care, mental health, chronic disability and illness, the funding of health care, long-term care, and public health. Healthcare is funded primarily by the private insurance companies and the citizens access the funds through their employers. In the United States, the most important government sponsored programs include the Medicare, Medicaid, and the State Children’s Health Insurance program. The Medicare health program offers health insurance to individuals from the age of 65 years as well as some disabled individuals. Medicaid health program offers health insurance to economically poor individuals. The Medicaid is restricted to particular categories of people such as the disabled and those who receive welfare payments. The state Children’s Health Insurance program offers health insurance to the uninsured children from low income families (Welch et al., 1993).

Strengths and weaknesses of the U.S. Healthcare System   

The current United States health care system includes many types of publicly and privately financed health insurance plans and they offer a variety of health care services. The United States health care system has its own strengths and weaknesses. In the world, one of the most advanced medical research systems is found in the United States. Researchers from prestigious institutions such as the Cleveland Clinic, the Mayo Clinic, and Harvard Medical School are making advances in the field of medicine and therefore offering services of the highest quality. The United States insurance plans are classified among the best in the world, although very expensive. In spite of its accomplishments, the United States health care system has been faced with substantial shortcomings (Schiller, 1999).

Health care costs are extremely high as compared to other modern societies in the world. These escalating health care costs will force individuals and businesses to drop coverage, bankrupt companies, erode the global competitiveness of America, and destroy the long-run viability of Medicaid and Medicare. Medical accidents in the United States have been found to be unacceptably high. About 98,000 American citizens die every year from medical mistakes that can be prevented. This can result to heartbreak and pain, which also raises the costs health care system (Diamond, 2004). Most health providers do not have the information Technology systems that can bring together various health providers to support a patient’s care. Therefore, it becomes impossible for caregivers to provide the highest quality of care, which raises the costs due to redundant tests and errors (Schiller, 1999).

Features of major government health care programs

The major government health care programs include Medicaid, Medicare, the TRICARE for Life program and Department of Defense TRICARE, the State Children’s Health Insurance Program, the Indian Health Service program, and the Veteran Health Administration program (Jerome, Pinger, & McKenzie, 2008). These government healthcare programs offer health services to about 30 percent of Americans. It is a responsibility of the federal government to ensure that finances are utilized wisely in these programs every year to keep the burden of injury, illness, and disability at a minimum for improved health as well as functioning of its population. These programs serve Native Americans, disabled individuals, old people, veterans, and children and mothers from low income families. The State Children’s Health Insurance Program, Medicare, and Medicaid are meant for those groups that are characterized by low socioeconomic status and higher health care needs, while the Veteran Health Administration program, the Indian Health Service program, and the TRICARE for Life program and Department of Defense TRICARE are meant for Native Americans, veterans, and the military personnel (Jerome, Pinger, & McKenzie, 2008).

The Medicare health program offers health insurance to individuals from the age of 65 years as well as some disabled individuals. It is entirely financed and run by the federal government and the health services are delivered through the private sector. Medicaid health program offers health insurance to economically poor individuals. The Medicaid is restricted to particular categories of people such as the disabled and those who receive welfare payments. The state Children’s Health Insurance program offers health insurance to the uninsured children from low income families. The Veterans Health Administration meets the needs of the United States veterans as far as health care is concerned. The population served by this program is usually older, suffering from chronic illness, and characterized by low-income (Jerome, Pinger, & McKenzie, 2008).

Rising health care costs  

Health care costs are extremely high as compared to other modern societies in the world. Drug companies very expensive drugs About 98,000 American citizens die every year from medical mistakes that can be prevented. This can result to heartbreak and pain, which also raises the costs health care system. Health care costs are extremely high as compared to other modern societies in the world. These escalating health care costs will force individuals and businesses to drop coverage, bankrupt companies, erode the global competitiveness of America, and destroy the long-run viability of Medicaid and Medicare (Diamond, 2004).

Environment of managed care

Managed care is defined as an approach used in healthcare to make services more efficient and provide high quality healthcare that is cost effective (Birenbaum, 1997). By advising, supervision, and monitoring, managed care programs control costs, measure performance, and ensure a definite standard of care. The managed care programs also assist individuals to stay health by use of infection prevention strategies. Managed care plans usually cover all costs or part of the costs of getting healthcare services and goods (Diamond 2004). This includes those programs that are aimed at reducing unnecessary costs of health care through a number of mechanisms such as: economic motivators for patients and physicians to select those forms of care that are less costly; increased cost sharing among beneficiaries; the formation of cost-sharing motivators for outpatient surgery; intensively managed high-cost healthcare events; and making selective contracts with providers of healthcare. These programs are provided in various settings, such as Preferred Provider Organizations and Health Maintenance Organizations (Birenbaum, 1997).

Changing demographics of social security

Diamond (2004) defines social security as a social insurance program that provides protection against social conditions such as poverty, disability, old age, and unemployment. These services usually include disability insurance, unemployment insurance, survivor pensions, medical care insurance, and retirement pensions. The changing demographics of the retirees have effects on the retirement policies and Social Security financing. The life expectancy has been found to increase faster than expected. The fertility rate is decreasing than expected and this will negatively affect the demographics of social security because the existing population will not be replaced fully. The percentage of the elderly in the population is expected to rise. The shifting racial composition and marital status of the population will raise the numbers of retired individuals in groups such as the minorities and divorced women, who have been vulnerable to poverty (Diamond, 2004).

Problems with social security

The life expectancy has been found to increase faster than expected and therefore retirees continue to benefit from the social security funds beyond what they contributed. The fertility rate is decreasing than expected and this will negatively affect the demographics of social security because the existing population will not be replaced fully. The percentage of the elderly in the population is expected to rise therefore increasing the total number of retirees, which will highly expense social security. The elderly population will be larger than the working age population, which will result to increased expenditure on the less taxes from the few tax payers (Diamond, 2004).

Financing social security

Social security systems are experiencing a number of challenges which involve significant implications for their funding. There is a broad agreement on people’s expectations from social security systems, for instance, provision of enough benefits, and the coverage extension. The schemes of Nationals Social Security contribute to the population’s social protection by the redistribution of a substantial portion of the Gross Domestic Product. This enormous amount of resources include: social contribution from the governments, employees, and employers; transfers from governments, that is, earmarked profits and taxes, international loans, and general revenues; and other arrangements like community-based, micro-credit, and micro-insurance protection schemes (Diamond, 2004).

Many countries have recently started to put through and strengthen the reserve account to achieve long-run sustainability of their social security systems and to act as a buffer for unforeseen and anticipated hard times. Some countries are now considering putting through social pensions funded by taxes. Social security finances are significantly growing in most countries with sound governance. This is because of the friendly environment that attracts investment opportunities. If a country is characterized by financial market crisis, it social security institutions find the environment hostile, which hampers the optimum investment of social security finances. Therefore, social security institutions are required to adopt effectual governance in order to reduce the associated risks. So that the social security systems are financially sustainable, the existing sources of finances must be sufficient. (Diamond, 2004)

Welfare

Welfare is a form of aid that is provided to individuals who are in need. In many developed nations, welfare is given by the government (Moffitt, 1992). Welfare may also be arranged by religious groups; informal social groups; inter-governmental organizations; or charities. The forms of welfare in various countries include monetary payments, vouchers and subsidies, housing or health services. Employed mothers must use their gains from employment to improve the daily settings of children at home, school, in child care, or generally in the community (Schiller, 1999). The child care plays an important role in enhancing the development of low-income children and increases their life opportunities. Since welfare reform the total state and federal financing for child care for working poor homes and welfare families, has increased impressively. Most of the welfare mothers depend on the informal child care systems at first while they participate in the Welfare to Work Programs. But when the mothers advance from welfare to more stable jobs, there is a higher likelihood to prefer a Family Child Care Home. Children from poor families benefit most from the high quality care. The Welfare to Work program promotes learning and development of children in working poor homes and welfare families (Moffitt, 1992).

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