Healthcare Financing
Healthcare Financing
- Country to Compare
The country under consideration is the United States. This is a unique country when it comes to healthcare financing because it is said that the cost of healthcare in the U.S. tends to be higher than the other countries, and it puts a strain on the country’s overall economy. The healthcare in this country is majorly paid through the government programs such as Medicaid and Medicare, the private health insurance plans, e.g., through the employers and the funds of the individuals. Here, healthcare tends to be technologically advanced but also very expensive. Therefore, the amount spent per person in healthcare is higher in the U.S. than in other countries (Jung, Tran & Chambers, 2017). Again, the percentage of gross domestic product (GDP) spent on health care is significantly higher than in any other nation.
A1. Access
Both Medicaid and Medicare Services support access to care in many ways. Having good access to healthcare means having a regular doctor, being able to schedule timely appointments, and being able to find new ones when needed. These have been guaranteed by both Medicare and Medicaid. However, the looming threats of Medicare payment cuts for the physician services as a result of sustainable growth rates continue to generate stories of doctors not willing to take the Medicare patients. Very few patients have been able to find one when needed. On the other hand, most physicians say they accept new Medicare and Medicaid patients, and only a few have opted out of the programs.
A2A. Coverage of Medications
The U.S. does not have universal health insurance coverage. About 92 per cent of the population is said to have coverage in the year 2018, leaving approximately 27 million people, or 8 per cent of the population, not insured. The movement towards securing health has been on the rise. The pubic insurance programs such as Medicaid and Medicare were put in place through the social security act, and others came in place late. Starting with Medicare, the program ensures a universal right to health care for people who have attained the age of 65 years and older (Jung, Tran & Chambers, 2017). The population that is eligible and the range of benefits covered have been gradually expanding. People under the age of 65 and with long-term disabilities and end-stage renal disease became eligible for the programs in place. All the beneficiaries are entitled to traditional Medicare, a fee for service program that is said to provide medical insurance and hospital insurance. The beneficiaries are allowed to receive their coverage through either Medicare Advantage or traditional Medicare, under which people are likely to enroll in managed care organizations and private health maintenance organizations. Later on, a voluntary outpatient prescription drug coverage option was provided through the private carriers, and it became part and parcel of Medicare coverage (Cai et al., 2020).
The Medicaid program gave the states the option to receive the federal matching funding for providing healthcare services to individuals with disabilities, blind and low-income families. Coverage was eventually made mandatory for infants and pregnant women from low-income families. It was later expanded to cover children up to the age of 18 years (Cai et al., 2020). At the moment, Medicaid covers about 18 per cent of the American. Given that the state administers the program and a program that is tested depending on the means, the eligibility of the program tends to be different from state to state. By 2019, over two-thirds of the beneficiaries were enrolled in the managed care organizations. About two decades ago, the Children’s Health Insurance Program or CHIP was formed as a public and state-administered program for the children who come from low-income families that earn too much to qualify for Medicaid but are not likely to be able to afford private insurance. Currently, the program covers about 9.6 million children (Cai et al., 2020). In some of the states, it operates as an affiliate organization of Medicaid. In others, it is a separate program.
Fiscally prudent and multifaceted approaches to closing the growing coverage gap are called for but face significant barriers. There is immense political resistance when it comes to expanding coverage through some of the mechanisms that have been set forth. Some states have reportedly failed to expand Medicaid, and several coverage-related provisions have been repealed. In addition, the support of marketplaces for individual coverage has been applied in a very uneven manner.
A2B. Referral to See a Specialist
A referral is allowed under Medicaid as long as it is issued by one’s primary care physician when she or he feels it is necessary for you to visit another health care provider for tests or treatment. In some cases, prior authorization of this referral may be necessary. Referrals to see a specialist under Medicare varies from plan to plan. For instance, Private Fee-for-Service (PFFS) Plans may not require one to see a specialist (Cai et al., 2020). However, others like Special Needs Plans (SNPs) may require one to get a referral except for a few services, e.g., yearly screening mammograms.
A2C. Coverage for Preexisting Conditions
Even though the Affordable Care Act (ACA) compels for coverage of preexisting conditions, Medicaid has always provided coverage for such people before even the passage of ACA. Before the ACA, people could be denied coverage in the private insurance market, especially if they had a preexisting condition (Cai et al., 2020). There are Medicare Supplement insurance plans sold by private health insurance companies that are allowed to use medical underwriting when evaluating the insurance applications.
A3. Finance Implications for Healthcare Delivery
Sustainable financing has always presented a challenge. For instance, the mechanisms of financing coverage expansion through public funds such as new revenue sources, revenue transfers, deficit spending, among others, come with inherent trade-offs and my call for bipartisan compromise. There has been an emphasis on the need to reallocate the substantial resources spent on care, which does not improve health. This represents an opportunity to expand coverage without sacrificing quality or affordability. The impact of the associated revenue reductions on the providers is supposed to be closely considered. As the country tends towards Universal Healthcare, everyone will eventually have affordable healthcare coverage that provides equal access to age-appropriate and evidence-based healthcare services (Schmid, Cacace & Rothgang 2010). A Medicaid or Medicare buy-in approach ought to be established upon the existing public programs by allowing people to purchase healthcare through these programs.
References
Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., … & Kahn, J. G. (2020). Projected costs of single-payer healthcare financing in the United States: a systematic review of economic analyses. PLoS medicine, 17(1), e1003013.
Jung, J., Tran, C., & Chambers, M. (2017). Aging and health financing in the U.S.: A general equilibrium analysis. European Economic Review, 100, 428-462.
Schmid, A., Cacace, M., & Rothgang, H. (2010). The changing role of the state in healthcare financing. In The State and Healthcare (pp. 25-52). Palgrave Macmillan, London.
