North American Healthcare Policy

Research on American Healthcare Policy

Abstract

This paper presents a synthesis of the American healthcare policy. It analyses the healthcare challenges that include cost, accessibility, and quality and discusses various health care regulations in the United States. Examples of government healthcare policies are cited from the Canadian Comprehensive Cover. The paper then reviews the effectiveness of American Medicare and Medicaid policies and draws recommendations for improving medical services for the constituents of Kentucky.

Introduction

A public policy is defined as a document that is developed by the government to govern its activities and help in the realization of governmental goals and objectives towards the citizens. Such activities are considered very influential to people’s lives either directly or indirectly yet their operations involve diversified actors from the public and private sectors. The policy thus provides a general guide to politicians, administrators, and civil servants that are granted authority to execute and use the power to influence the lives of the citizens. In the United States, health care services are provided by numerous organizations ranging from public, private, nonprofit making, and profit-making institutions. For public servants, government-sponsored health insurance is the primary origin of the finances to manage medical care. Despite vast policy regulations, medical care in the United States is still marked by several challenges relating to accessibility, cost, and quality. In an attempt to solve these issues, the government has established and is implementing legislator regulations that are meant to improve the provision of healthcare services and promotion of public well-being (Peters, 2012).

Healthcare Problems in America

Although the U.S. government is spending approximately 15% of its gross income on health care, the policy is still less effective about cost, accessibility, and quality of health services. America, therefore, remains one of the countries that spend so heavily on health care yet are not healthier than many other nations of the world. The financial burden of healthcare is considerably high for both the state and private individuals. For the government, the bulk of the expenses is channeled towards the payment of physicians and other healthcare workers. Maintenance of health facilities, home health care, and drug prescriptions also account for high expenditures (Peters, 2012).

To individual citizens, people who age above 65 years spend almost four times more on those who are under 65. The cost of healthcare thus increases with an increase in age. This becomes very challenging to the aging based on the fact that their ability to work and meet such costs is impaired (Peters, 2012). Although both portions of the population spend on hospital care, physician cost, and prescriptions, the elderly spend more on home care nursing. Employers are very significant partners in healthcare policy in the United States. As a result of this, the cost spent on employees’ medical cover has consistently increased over the years. The insurance cover also relies heavily on the number of employees in a particular organization. For instance, by 2004, it was noted that only 24% of firms, which had less than 50 employees, had their employees insured. However, all firms with more than 50 employees offer the insurance cover as a matter of legal requirement. Consequently, industrial investors have recorded an increase in expenditure on medical care. In 2004, it was observed that the insurance cost had increased by 9% from the previous year. Workers’ contribution towards their family members had also increased by 10% within the same period (Peters, 2012).

Since the insurance policies are only compatible for those who are economically stable, like those who are employed, the larger population living in poverty has continued to experience challenges in meeting medical care costs. For instance, it was recognized in 2002 that at least one-third of the entire American population was not under insurance cover. Some of them lived in families with no workers at all while others had one or few working members who had to bear the cost of their medication. The young and the elderly have dominated the uninsured group (Joynt & Jha, 2012).

The cost of medication has also consistently increased in the U.S. over the years. For instance, the cost per day’s hospital admission was $128 by 1965. By 2002, the cost had risen to $ 1,289. The cost of prescription and homecare has also increased commendably over decades. This puts a heavy burden on pocket-paying patients as well as insurers (Joynt & Jha, 2012). Even though healthcare is recognized by the American government as one of the basic rights for its citizens, there has been a lot of concern regarding quality, efficiency, choices, and value. It has been observed that healthcare institutions do not deliver the services that are worth the cost paid by clients. The U.S., therefore, records high infant mortality and low life expectancy than other developed states. Specific cases that have been cited as health challenges to American society include drug abuse, HIV and AIDS, obesity, diabetes, heart disease, and various forms of disabilities. This makes the states rank lower than other developed counterparts such as Japan, the United Kingdom, and Germany. The U.S. medical care thus remains the most expensive but less effective (Peters, 2012).

Health Care Regulations in America

Regulation of healthcare in the United States is conducted through federal and state governmental agencies. According to the government’s medical policy, primary functions such as food and drug administration, licensing of health care providers, pharmaceuticals, and medical devices at the states level have been ceded to the state’s governments. The state governments also have a mandate to regulate market rules including regulation of insurance companies that offer medical cover within their respective administrative jurisdictions (Peters, 2012).

During president Barrack Obama’s administration, the Patient Protection and Affordable Care Act have been enacted as a means through which the Federal government regulates medical care. In this act, the federal government encourages all able adults to purchase an insurance policy, as a complement to Medicare and Medicaid policies that are under government sponsorship. The department of Health and Human Services also remains a national agency through which the federal government oversees other government healthcare-based agencies (Peters, 2012).

Regulation on Physician and Hospital Costs

The Medical Care Oversight has, as part of its mandate, the duty of regulating the performance and conduct of healthcare professionals such as physicians and nurses. The government, through the American Medical Association, admits qualified personnel into the profession and awards them a legal license of practice without which one cannot exercise his/her medical career within the American territory. However, this opportunity has been abused by the licensed physicians who dominate the pool, limit other practitioners and raise the cost of their services (Peters, 2012). The regulation also prohibits physicians from being involved in unethical conduct and behaviors that may be considered gross misconduct. This compels practitioners to embrace professionalism as a way of maintaining their positions as licensed physicians and medical professionals.

Regulation on Healthcare Quality

Hospitals, nursing homes, and other health care institutions are also key targets in the health care regulation process. This mainly regards the quality of the services offered. Health institutions are highly encouraged to improve the quality, expand accessibility and limit the cost. In this case, the government has been keen on the decency of the physical structures that host hospitals, general environmental hygiene in health institutions, the functionality of the machines, and efficiency in bureaucratic structures and protocols in hospitals (Peters, 2012). The government is also keen to observe the qualifications of the personnel, behavior in handling emergencies, and general patient care. Despite the agreement that quality healthcare is a priority, this regulatory measure has been challenged due to an inexistence of a uniform measure of value for the outcomes of healthcare.

Regulations Regarding Drug Use

Food and Drugs Administration is the leading agency through which the production of drugs and other consumables are regulated in the United States. Unlike other medical services that are regulated during operations, drugs are managed even before the final product into the market. This is based on the knowledge that drugs can be very dangerous hence careless and unauthorized usage can lead to harm and even death. The Food and Drugs Administration thus engages in serious scrutiny on the suitability of any drug that the pharmaceutical companies intend to release into the market. The government passed the Prescription Drug Use Fee Act to meet this cost (PDUFA) in 1992. This law allows the government to collect fees from the pharmaceutical companies, which are used to facilitate FDAs’ drug approval research processes (Peters, 2012).

Once drugs are already floated into the market, FDA continues its mandate to evaluate their side effects and other hazards that the pre-market reviews could have failed to reveal. However, this stage of regulation is not very perfect since the side effects of drugs can only be analyzed after frequent and prolonged usage in diversified segments of the population. Furthermore, the FDA has been often accused of slow response to post-market drug risks (Peters, 2012).

Canadian Style of Comprehensive Coverage

Canada is one of the states, which have the most people’s friendly health care policy. According to their law, the provision of health care services is a constitutional mandate of provincial governments. Through their policy that is popularly known as comprehensive health care coverage, the federal government transfers sufficient funds to the provincial governments, which are utilized to cater for all medical insurance costs of citizens. According to the Canadian Health Act, these funds are meant to facilitate free access to basic health services to all citizens across the republic (Woolhandler et al., 2003).

The Act specifies that basic health care services include prescription, hospitalization, and nursing costs for long-term resident patients. To ensure that all provinces adhere to this legislation, the federal governments assert that any province that allows doctors or medical institutions to charge patients for basic medical services will suffer from the reduction of disbursements that are worth the amount collected from the people (Woolhandler et al., 2003).

Besides, the rule also creates room for private health care insurance, especially for services that are not considered basic. For instance, Canadians are allowed to utilize private insurance to pay for services such as cosmetic surgery, laser vision correction surgery, private and semi-private rooms in hospitals. Most of these private insurance costs are met by employers hence relieving the burden from civilians (Woolhandler et al., 2003).

Medicare Policy in America

Medicare is the most popular health care insurance program in the United States. This program has been in action since its official inception in 1966. It offers medical cover for people who have been working and paying for the scheme and are at least 65 years of age. The policy also caters to younger people with terminal renal infections and people with disabilities. Unlike private insurers, Medicare is a scheme that is run by the federal government and tends to spread the financial risks of medication across various segments of society. However, the scheme is limited in the sense that it only covers an average of 48% of the medical costs of the beneficiaries, therefore, any extra charges must be met through private insurance schemes or throughout of pocket payments (Medicare, Medicaid, and Dual Eligibles 2013 Programs, 2013).

Medicaid Analysis for Alternative Sampled Regions in the United States

Apart from the Medicare federal programs, all the states of the U.S. also run Medicaid programs. This policy targets people of all ages who can not afford the mainstream Medicare insurance policy. Medicaid thus funds health care costs for low-income earners and their children, people with disabilities, and expectant mothers. Apart from poverty and disability criteria, the beneficiaries must be Americans and those with constitutional or legal approvals to live in the United States (Medicare, Medicaid, and Dual Eligibles 2013 Programs, 2013).

The Medicaid policy has created different impacts in various parts of the United States. For instance, the State of Oregon has recorded an increase in the utilization of most basic health care services. Both emergency and outpatient departments have continued to record an increase in patients. The millions of people who were uninsured by the Medicare policy can now access medical services within their states.

In other states, Medicaid has resulted in expenditure by state governments on health care. In Florida, it was estimated that the Medicaid program would cost the state about $577 in 2014, and the cost is likely to increase by $1 billion within two years (Medicare, Medicaid, and Dual Eligibles 2013 Programs, 2013).

To the constituents of Kentucky, it is important to acknowledge that both the Medicare and Medicaid social security programs have improved the health status of the residents. The majority of the American residents can now access medical cover across all sections of the population. Medicaid has made it possible for the poor, disabled, and those who suffer from acute terminal illnesses to access medication through their state government (Medicare, Medicaid, and Dual Eligibles 2013 Programs, 2013).

However, the residents of Kentucky continue to experience health care limitations despite the two insurance policies. The state’s government spends heavily on the Medicaid program yet there are still several potential beneficiaries that are not covered. This creates the need to reduce the burden on the state government and also expand the coverage to all potential beneficiaries. Consequently, the federal should share the cost of the Medicaid expansion and make the services favorable to all uninsured low-income residents (Medicare, Medicaid, and Dual Eligibles 2013 Programs, 2013).

Recommendations

To the office of a republican congress from Kentucky, several actions need to be taken as one of the ways or strategies in dealing with healthcare challenges and improving the quality and cost of healthcare services provided. The plan proposes the preservation of traditional Medicare, but with very relevant adjustments, which include expansion of available choices, protection of the rights of the beneficiaries, and enhancing accountability and competitiveness within the Medicare program.

The plan also intends to strengthen and modernize the Medicare benefits through rationalization of cost-sharing and expanding access to incorporate more low-income earners. In addition to this, the congresswoman’s office intends to promote transparency to consumers, families, and businesses and streamline the quality reporting system. The office also plans to enhance cost reduction through the promotion of prevention programs and research innovation strategies, which are aimed at addressing chronic conditions. Lastly, the office shall promote policies, which will support value-driven health care and efficient payment systems. When these recommendations are enhanced, the quality, value, and accessibility of health care shall remain improved not only in Kentucky but also in other parts of the U.S.

Conclusion

America is one of the countries in the world that records the highest expenditures in medical care yet the efficiency, accessibility, and quality of the services do not match the cost. Canadian comprehensive medical coverage has been acknowledged as a benchmark from which many countries, especially the developing countries, can learn. Although America offers medical insurance services through Medicare and Medicaid policies, there is a need to improve these programs by focusing on innovative preventive measures. Healthcare should also be made more affordable and accessible to the citizens.