Improving quality and the value of health should be an essential sector of state policies in any country. However, health care system often faces numerous challenges, concerning the care provided, particularly its accessibility, costs, and quality. The research article outlines the major points about theses three aspects mentioned above, informing about different policies and reforms launched or needed in order to improve the situation. Particularly, the research article focuses on Affordable Care Act, Medicare, as well as a concept of patient-centered medical home (PCMH), and their impacts on health care system.
Accessible health care presupposes, that it is available, affordable and appropriate. It means that people should not only be diagnosed promptly, getting necessary treatment, but also obtain preventive care of the highest quality in order to avoid illnesses or complications. Services should be offered in a reasonable distance where people live. Cultural and linguistic barriers should not prevent neither from effective communication with a provider nor from getting a proper diagnose. It also includes basic health care insurance coverage, additional out-of-pocket costs being adjusted for people with low incomes (Kidzhaber, 2005).
The US main public insurance program for low-income people Medicaid, established nearly 45 years ago, increases access to care and health care use, eliminating out-of-pocket spending. The recently launched US Affordable Care Act aims at creating insurance marketplaces, which will enable families and individuals purchase private health insurance comparing coverage options based on price, benefits and quality. Since most people do not currently have insurance, they will be eligible for assistance with their premiums of health insurance, paying from 2 to 10 percent of their household income.
The overall cost of health care just keep rising, particularly in the USA, on the background of high level of unemployment and lower incomes of people (Goldman, 2005). Addressing this problem is a major policy priority, putting even more attention of the government on health spending and affordability. Among the driving forces of health care spending are technology and prescription drugs, rise in chronic disease, as well as administrative costs.
There is a number of policy measures concerning health care costs in the US, including Health Saving Accounts (tax-free savings and accounts owned and controlled by individuals, used to cover regular, predictable medical expenses, and each HAS being tied to a traditional catastrophic insurance plan), Guaranteed Issue for Self-Employed Group of One (meaning that individuals may not be turned down for health insurance coverage, the condition of their health or risk status not being taken into account; it raises health care costs for self-employees), Community Rating for Small Group Market (meaning that no matter what health risk is involved, everybody should pay equal price for insurance), State High-Risk Pools (for those who cannot get health insurance due to pre-existing conditions high-risk pools are set in some states), Number of Mandates (a host of mandated benefits can be imposed on insurers, which carries significant costs) and others (Brennan, 2009).
As for the quality of health care, The Commonwealth Fund identifies primary care and the patient-centered medical home (PCMH) as a key to improving health care quality during the next decade. In order to improve the health care system’s performance, the following strategies should be considered: policies which arm consumers with information concerning the quality and cost of care, expanding their options, policies to improve health care market functioning by reducing administrative costs, as well as setting targets for spending growth. Relying heavily on primary health care, revision of Medicare fees and payment updates and other reforms are needed in order to achieve a balance between health care costs and quality(Collins, 2013).
It can be concluded that health care is a high-priority issue for any country, measures on improving access, quality and costs being constantly urgent. Different policies should be developed in order to make a health care system safe, effective, patient-oriented, timely and equitable.
BURCU AKAN, M.P.H ADMINISTRATOR
Brennan, N. (2009).Improving quality and value in the U.S. health care system. Retrieved from http://www.brookings.edu/research/reports/2009/08/21-bpc-qualityreport
Collins, K. (2013). Primary care, PCMH key to improving health care quality, saving billions, says report. Retrieved from http://www.aafp.org/news-now/practice-professional- issues/20130121commonwealthreport.html
Goldman, D. (2005).US health care: facts about access, quality and costs. Retrieved from http://www.rand.org/content/dam/rand/pubs/corporate_pubs/2005/RAND_CP484.1.pdf
Kidzhaber, J. (2005).Improving improving health care health care access: Access. Retrieved from http://www.policyconsensus.org/publications/reports/docs/Healthcare.pdf