Health Care Policy Issues 1

Running Head: Health Care Policy Issues

Health Care Policy Issues

Matthew Mabalot

HCA-600

Week-Four Assignment

National University

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Health Care Policy Issues

There are several policy issues related to access to care, cost of care, and quality of care. Health policies are developed to help give patients access to care at a lower cost. Policies are dependent on the collaboration of our government, policy makers, policy designers, and decision makers in order for the policy to make a difference. Providing access to low cost, quality care must be considered from three different viewpoints because each issue poses its own challenge to the effort to create one comprehensive policy. The Affordable care act is a policy that attempts to take on all three. It involves the universal health insurance, access care for everyone, and hopefully results in lower costs for consumers.

The challenge in creating policies to help the health care delivery system in the United States is getting the groups affected to work together in to move into the affordable care act. The policy makers need to understand who it affects which are the consumers, employers, providers, insurers, and technology producers. Each group is connected together when it comes to distributing health care services to creating costs for those services. The health care reform sounds like a great idea except for the risks that come with it such as sustainability and affordability. It is a great concept to insure everyone and provide quality care at lower costs but in the end it is a larger issue than what it seems.

In order to provide access to health care for everyone, we need to find out where the allocation of money is coming from. Someone will have to pay for these services and someone needs to pay for the technology that the policies are mandating at the same time. As the United States move closer to the health care reform, policies need to be created to provide the access without taking a big loss in the health expenditures. The development in health technology is

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increasing so the need for technology and technology employees are also added to the expenditures which are already costly considering the volume of employed nurses and doctors. Although technology and hospital expenditures are costly, the government is able to get the job done when considering the amount the United States has paid on military expenditures if they even paid for that.

The Medicare payment policy is related to improving the quality of care while keep costs low. The design of the policy will help with quality by pin pointing each service for different groups. It is a challenge when trying to provider patients with a set package of quality services in a plan because services are dependent on a case by case service. Benefit plans and service packages can be created to lower costs but some patients may lose coverage that they already had through Medicare or Medi-cal. Changing the benefit plans may result in patients losing coverage or end up paying higher costs because of cost shifting.

Access to care mainly focuses on providing care to the people of low income or in more need which is another challenge. The older patients and people with AIDS for example will cost a lot of money to provide health care services to these groups. It is difficult to consider these costs for their access when the reality of it is that these groups may not be around for long. The access to care issue needs to be approached in a different way such as not providing hospital care but more creating more cost effective clinics and home health hospitals that only focus on these groups. For the lower income groups, access to care should be universal regardless of income.

The cost of care is one of the biggest issues when it comes to policy making because of price control. Policy makers try to focus on price makers such as RBVS which sets prices on services provided by physicians and DRG which bases the pricing on diagnosis submitted on the

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claims. Managed Care Organizations use RBVS and DRG to negotiate contracts with providers and determine what should and what should not be paid out to the providers based on reimbursements. It is difficult to reduce costs when costs are rising every time a new policy or change is made all revolving around negotiations.

The quality of care is the combination of both access to care and cost of care. Access to care and cost of care are important but are both useless if quality of care is lost in the process. To provide quality of care, there needs to be enough money to do research on preventing diseases and still have enough to provide services to the patients who have a current sickness. Managed Care Organizations focus on the quality of care by taking advantage of choosing the groups they cover and working with a network of doctors that can give input through research to provide the highest quality of service and at the same time lowering costs.

The Patient Protection and Affordable ACT (PPACA) is great start in providing access to care and lowering cost of care. The PPACA is focused on covering everyone with health insurance and for a lower cost for those services. Creating a universal insurance in which all insurance companies must abide by gives everyone access to a physician and restricts health insurance companies from denying patients and charging outrageous pricing for those services. The policy covers everyone and at the same time the services will be charged all at the same rate regardless of preexisting conditions are group. The challenge in this policy is the quality of health care and the sustainability of it all. The policy process is a long and tedious process but needs to be fully collaborated through everyone involved. In conclusion, the health care system can be improved but it will take the whole country and government to support the improvements.

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References

Shi, L. and Singh, D. (2008) Delivering Health Care in America. A systems Approach. Jones and Bartlett Publishers, Inc

Guterman, S., Davis, K., Schoenbaum, S., & Shih, A. (2009). Using Medicare Payment Policy To Transform The Health System: A Framework For Improving Performance. Health Affairs, 28(Supplement 1), W238-W250.

Thomas, S. (2008). What should our next president do about health care costs? PPI Insight On The Issues, (7), 1-6. Kenney, G. M., Dorn, S., Urban, I., & Robert Wood Johnson, F. (2009). Health Care Reform for Children with Public Coverage: How Can Policymakers Maximize Gains and Prevent Harm? Timely Analysis of Immediate Health Policy Issues. Urban Institute, Lane, J., & Schur, C. (2010). Balancing Access to Health Data and Privacy: A Review of the Issues and Approaches for the Future. Health Services Research, 45(5p2), 1456-1467. doi:10.1111/j.1475-6773.2010.01141.x