Health Care Utilization Example Paper

Health Care Utilization Example Paper

Health Care Utilization Example Paper
Health care is one of the spheres, which is developed by any government and authorities of the country for the sake of its citizens. Thus in order to understand the difficulties and peculiarities of the system and possible reforms better, it is necessary to consider also public perception. According to Robert Blenden, who conducted a detailed study of perception of Americans of health care system and the costs of health care, concluded: “For more than two decades, polls have shown that Americans are dissatisfied with their current health care system. However, the public’s views on how to change the current system are more conflicted than often suggested by individual poll results. At the same time, Americans are both dissatisfied with the current health care system and relatively satisfied with their own health care arrangements.” (Blendon, Brodie, Benson,  2011, p. 6). The presence of this gap between public perception of the health care in the country and necessity of reforms, realized by the current administration is one of the key factors for moving forward.Health Care Utilization Example Paper
This fact is also a significant obstacle for the reforms in health care, which were planned by Obama administration. However it is not the only obstacle, upon thorough investigation it turned out that constitutional and procedural peculiarities in their turn make this task even more difficult. One of the examples of how reforms might fail is the situation with Clinton administration and the challenges still remain. Certainly there exist a lot of arguments for and against these reforms, however the actual results could never be predicted for 100 %. At the moment the fact is that President Obama signed the Affordable Care Act into law, which is based on long-term consideration of the problem. The idea of an individual mandate is not new, for the first time it was presented by the Heritage Foundation in 1989. There are several key aspects of this reform under this Act. It is not possible to trace the direct impact of this reform upon people, rather there are cost curbing provision, which are to help in reduction of Medicare spending and healthcare spending. (Blendon, Brodie, Benson,  2011, p. 7). This reform is also related to the quality of the services provided to patients along with general rising of the healthcare standards. ObamaCare is aimed at avoiding of gender discrimination in any form. One of the most important goals is to provide tens of millions of low-income or middle-income Americans access to health care or to quality health care. The system is supposed to be built in the way that Americans would have access to discounts through the Health Insurance Marketplace. Important is that health insurance companies are supposed to have less control over the level of health care services, obtained by each legal U.S. resident.
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Utilization is one of the important aspects of any health care system. Usually this term is defined as outcome of the interaction between professionals in the sphere of health care and their patients. Talking about the economic side of utilization, it is necessary to mention that utilization is related to production of health care services. In order to measure the success of these services, there are medical administrative banks created. Important is that utilization is always a multidimensional process. The researches, conducted in Chicago and Minnesota, prove that there is a correlation between the level of shifting in the market towards value-based care and the level of utilization and its decline. There is a hope that this trend would continue in the same way and could be applied by health care provides. “Specifically, providers that embrace the migration to value-based care will need to work aggressively to eliminate unnecessary and/or ineffective activities in order to thrive under risk contracts.” (Grube, Kaufman, York, 2013, p. 8). There is a need to make significant changes in culture, mindset, attitude. All the providers are to reconsider the organization and structure of the delivery networks, in order to be sure that they are not continuing to support the capacities, which are not needed in reality. This is also the way to securing the lowest possible cost for quality health care, provided to the patients. Such means as preventive and primary care service are vitally important for keeping patients healthy.Health Care Utilization Example Paper
The Health Care Cost Institute (HCCI) issued the 2013 Health Care Cost and Utilization Report, on the basis of examination and analysis of the 2013 data, in order to define the current utilization trends and the situation with health care costs for American people younger than 65, and under the condition that all of them have employer sponsored insurance (ESI). Health care spending increased 3.9 % in 2013. However, the reason for this was the rise of the prices and not utilization, which is the result of decline of numerous services. Increase of costs is related to the accessibility of the services, which in its turn influences utilization. It is early yet to make any definite conclusion about the new health care reform, at the moment however, there are no great positive outcomes for utilization. In order to make health care more accessible to all citizens there was the notion of universal health care worked out. “Universal health care, also known as universal health coverage, is a specific type of health care where everyone is provided coverage regardless of their income, race, age, pre-existing conditions, gender, or wealth. In other words, as long as you are a legal resident of the region that is being covered, (i.e. the United States), you are eligible for universal health care.” (Tumulty, Pickert, Park, 2010, p. 5). Generally the costs of privatized health care systems are rather high, because private companies are able to set their costs for insurance programs and medical services. If all of these companies were run by government, there would most luckily be the way to reduce these costs and make the services more accessible to patients. In short, universal health care is aimed at making health care more affordable to all categories of patients. The current health care reform, worked out by Obama administration seems to be working in the same direction, in other words making the health insurances cheaper and thus more accessible for individuals. They concentrate more on low-income people, create tax credits, make the actions of insurance companies illegal, in case they deny coverage because of preexisting conditions. Still this system could not be considered purely universal health care, because it is not a public system, which includes absolutely all people, as they are still to buy health insurances, this means there will still remain individuals, who will have no insurances because of lack of money or over complexity of the insurance system.
Usually stakeholders consist of those, who have formal bureaucratic and political authority to take concrete decisions, which are important for health care system and those, who are interested in the outcomes of these decisions. In this case the concrete examples of stakeholders would include representatives of governmental, political, health care system, business and social sectors. All of them have either impact on the reforms’ flow or are directly interested in the future outcomes. It is important not to forget about the category of stakeholder, who have much less power, still are directly dependant upon the results of the reforms and decisions taken – these are patients or in other words, all citizens of the country. Stakeholders are not only complete organizations, but also minor units or groups of people. In the American health care system there are patients, physicians, hospitals, insurers, regulators, employers and other stakeholders, who might have different views and attitudes towards the actual situation in the health care sphere, as well as the ways of reforming it. “A significant change impacting one component will reshape the entire system. The conflated nature of modern health care is what made 2010’s dramatic reform effort difficult for Congress to navigate and for  many people to understand. This confusion also made it easy for reform critics to exploit consumers’ fears.” (Cafasso, 2011, p. 13).Health Care Utilization Example Paper
Any reform, including health care reform, can not take place without change of roles in this sphere. The current approach with private insurance made the focus and the definition of roles more concrete and strict, as the aim is to reduce costs. At the same time there is a demand to make the maximum efficiency of operating of the health care professionals for the sake of improvement of patients’ care. All this results in changes in daily tasks of health care workforce; medical assistants, pharmacy technicians, even representatives of clerical staff received the expanded roles in result of this reform. Most of them are asked to work closer to the patients, for example medical assistants are to collect the information about patients, which was done by nurses before. Expanding of roles is related to demand of higher level of clinical training, which at the same time is related to reconsideration of their salaries.
Overall, due to various reasons the need of introduction of health case reform became necessary; In 2010 the program, which was officially called the Patient Protection and Affordable Care Act (PPACA) was launched by Obama administration. Certainly there are a lot of debates in relation to his program and till the moment it is not clear yet, whether it will be that effective, as it is expected by the president. The program has a lot of positive directions, like for example its orientation upon low-income and middle-income citizens, at the same time it could not be at the moment considered an example of universal health care system.Health Care Utilization Example Paper
References:
Aizenman, N. C. (2011). “House Republicans Begin Effort to Defund Health Care Overhaul”, Online, The Washington Post: National
 Blendon, R. J., Brodie, M., Benson, J. M.( 2011).  “Americans’ Views of Health Care Costs, Access, and Quality” in The Milbank Quarterly Vol.84 No.4
Brauchli, M. W. (2011). “Republicans Need to Take a Stand on Health Care Reform”, Online, The Washington Post
Cafasso, E. (2011). How health-reform stakeholders will be affected by recent changes.
Grube, M., Kaufman K., York, R. (2013). Decline In Utilization Rates Signals A Change In The Inpatient Business Model
Tumulty, K., Pickert, K., Park, A. (2010). “America, The Doctor Will See You Now”. Time.Health Care Utilization Example Paper