Essay on "Healthcare Issues Country. How Solve"

Essay 11 pages (3055 words) Sources: 7

[EXCERPT] . . . .

Creating partnerships between the private and the public healthcare institutions

2. Making the insurance more flexible and allowing the employees to select their own packages

3. The creation of individualized offers for medical insurance

4. Focus on the quality of the medical services offered

5. Reduction of fraud and abuse of medical coverage packages

6. Reshaping the role of the government.

1. Public-private partnerships

One major problem of the healthcare system is that it is being provided by either state or private institution, due to the nature of the insurance possessed by the individuals. At this stage however, it is proposed that the private and the public institutions join forces and combine the services they offer in order to improve their quality and the population's access to these services. Such an objective would be attained through strategic partnerships between the private and public institutions, through the sharing of resources and responsibilities, as well as through an integrated managerial system.

2. Flexibility of insurance

A second recommendation was pegged to the fact that the medical insurance system in the United States is an employer-based one, meaning that the employee does not have any control over their medical coverage. Within this scenario, the recommendation is that of liberalizing the field of medical coverage insurance and allowing for more insurance companies to provide such services directly to the population, not only to the employers.

In such a context, the employers would offer their employees the money to be paid for medical coverage -- computed based on industry averages -- and the individual would be able to choose the type of medical coverage they desire. This would not only increase coverage, but would also support competition in the healthcare industry, eliminate redundancies and increase the efficiency of the medical sector by offering the exact services which are required. A young woman looking to start her family for instance would require a different medical coverage package than an older male senior citizen.

An economic problem which could be raised by this approach is obvious at the level of the employers, who would be forced to pay larger sums for employee based insurance, than they would pay in the context of the employer-based insurance. This is explained by the fact that when the employer purchases bulk insurances for all staff members, they will negotiation on a minimum price. However, when the medical coverage packages are individually bought by the employees, they are not sold at negotiated prices and they as such cost more.

This economic cost encountered by the economic agents is however lower than the current cost encountered by the society due to inadequate medical insurances. Additionally, the economic problem of employers could be addressed through internal; processes of increasing operational efficiency or even through governmental contracts that offer financial support throughout the transition period.

3. Customization of medical insurance

Another concern raised by the creation of individual coverage packages is represented by the fact that this would lead to economic inefficiencies for the insurance organizations. In other words, they would assume higher degrees of risk and they would be forced to cover wider areas of medical services, as demanded for each person. This limitation is however manageable through the same specifics of personalization, adopted this time by the insurance company.

In this line of thoughts, the insurance company would negotiate each medical coverage package with the individual clients. These would be subjected to medical check-ups and would be insured based on the results of the medical verifications. Specifically, if an individual is already suffering from asthma, the medical coverage for respiratory problems would be limited as the risks in this respect are higher. Also, it would be possible for the company to provide this coverage, but do so in exchange for a higher insurance premium.

The selection of the clients and the creation of the medical insurance to be provided would as such be based on a multitude of customer specific issues, the most important of them being their current health, as a generator of future risks. Still a determinant of future risks is represented by the assessment of current features which characterize the individual, such as their status of being smokers or non-smokers or of facing obesity. Correlated to the findings of this analysis, the company would create specific packages which integrated the economic principles of efficiency in the provision of health care.

4. Focus on quality

A fourth recommendation is represented by the decisions to place more emphasis on the quality of the medical services provided. Currently, the quality of the medical services does not represent a focal point, as accent is placed on the actual delivery of the services. Based on this realization, it is necessary to reintegrate quality as a primary force to creating patient satisfaction.

Aside from patient satisfaction, the incremental focus on quality would also be beneficial for the entire development of the medical system, as it would generate and support competition. In a context in which competition between the various providers of medical services and medical coverage insurance is intensified, these parties are forced to develop. They need to continually improve their product and service offer in order to generate satisfaction and the necessary revenues. In such a context then, the medical field would evolve.

5. Reduction of fraud and abuse of medical coverage packages

The problems of fraud and abuse are more common within the public system of medical coverage, as this system is wider and more complex, as well as it is more difficult to verify. In order to address this threat, higher levels of control should be implemented by both state as well as private institutions providing medical insurance.

At a more specific level, these agencies ought to verify if the services and supplies which are billed by the medical parties have in fact been offered and used by the person with the respective healthcare coverage number. This effort, however tedious, would reduce the numbers of fraud and abuse cases and would further discourage such behaviors.

6. Readdressing the role of government

The government of today struggles to provide medical coverage for the population, or at least for specific segments of the population, but funds itself incapable of doing so at high levels of quality. In order to overcome its shortages, it is necessary for the government to reshape its role. In this order of ideas, it is believed that it should develop and implement a single payer system, in which a single party pays for the medical services -- through the public or private agency, as mentioned previously -- and then the individuals use their insurance to access medical care in the principles of the free market, based on quality of the services, specialization and so on.

"What we need is a national single-payer system that would eliminate unnecessary administrative costs, duplication and profits. In many ways, this would be tantamount to extending Medicare to the entire population. Medicare is, after all, a government-financed single-payer system embedded within our private, market-based system. It's by far the most efficient part of our health-care system, with overhead costs of less than 3%, and it covers virtually everyone over the age of 65. Medicare is not perfect, but it's the most popular part of the American health-care system" (Angell, 2002).

4. Conclusions

The United States is currently facing its deepest economic recession since the Great Depression of 1929-1933, and the severity of the crisis is given by the fact that the worst might yet to come. The government is seeking solutions to overcoming the crisis, but political and economic instabilities linger.

In this pressing context, America is also facing the problems of an insufficiently developed medical system. The healthcare system in the United States is the most expensive one at the global level, yet its performances are below the expectations of the nation.

This situation is linked to the existence of numerous issues, such as the large number of uninsured people, the tremendous role of the employer-based insurance (and the economic goals of the economic agents), the frauds in the system, the inefficiencies or insufficient efforts of the federal institution. Each of these problems can nevertheless be addressed and the American healthcare system can be improved. And it is crucial for these issues to be addressed and resolved, especially as the challenges and the need for medical services evolve, as the healthcare problems of the population change and develop.

References:

Angell, M.,2002, The forgotten domestic crisis, The New York Times, http://www.nytimes.com/2002/10/13/opinion/the-forgotten-domestic-crisis.html last accessed on August 8, 2011

Cunningham, W., 2003, The development of the U.S. health care system and its problems, UCLA Schools of Medicine / Public Health, http://www.ph.ucla.edu/hs/hs_100_4_02_lecture_cunningham.pdf last accessed on August 8, 2011

Garson, A., 2000, The U.S. healthcare system 2010, Current Perspectives, http://circ.ahajournals.org/content/101/16/2015.full last accessed on August 8, 2011

Gratzer, D., Why isn't government healthcare the answer? Free Market Cure, http://freemarketcure.com/whynotgovhc.php last accessed on August 8, 2011

Klein, E., 2007, Ten reasons why American health care is… READ MORE

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