Essay on "Healthcare in the United States"

Essay 8 pages (2445 words) Sources: 10

[EXCERPT] . . . .

Physicians increased the number of surgeries performed in their offices, hospitals increased the number of outpatient surgeries, and psychiatric hospitals created partial and outpatient programs. This is especially true in psychiatric settings, where patients are forced into these alternative levels of care without appropriate medical consideration of their needs and conditions. The Official Journal of the American Academy of Pediatrics (Committee on Health Care Access and Economics Task Force on Mental Health, 2009) published a special report to the Surgeon General of the United States that there is today a "high prevalence of mental health needs of America's youth (p. 1248)." Mental healthcare continues to be an ongoing tug of war between managed care, psychiatric hospital providers, physicians, and other mental health practitioners. There has been a seemingly continual movement in managed care to completely eliminate inpatient psychiatric care. Recommendations made in the special report to the Surgeon General included:

1. Allow primary care clinicians to provide and authorize services for common mental health conditions of childhood adolescence.

2. Compensate primary care clinicians for the mental health services they provide, including steps in the assessment and engagement process preceding definitive diagnosis.

3. Promptly implement procedures to fully support parity in benefits packages, eliminating separate deductibles, high copays, and annual spending limits lower than those established for medical services.

4. Support the principle of diagnostic parity. Mental health disorders result in distress and functional impairment just as medical illnesses do (The Official Journal of the American Academy of Pediatrics, 2009, p. 1250).

We can see from this partial list that withholding services and treatment for psychiatric care to children has become a problem in America.

There has been a shift in employer-based group benefit plans in transferring the cost of insurance plans to the employee with increased employee contributions, deductibles, and copayments. As a result, many full-time working Americans have been unable to afford the cost of insurance, and opt not to take the coverage. Small businesses with less than ten employees offering health insurance benefits dropped from 57% in 2000 to 46% in 2009 (Healthreform.gov, 2010). The current economic downturn and loss of jobs has increased the number of people applying for state Medicaid assistance, but they have to meet strict conditions of eligibility and many adults find they are not eligible for assistance.

In February, 2010, Healthcare For America Now! (Healthcareforamericanow.org, 2010) reported that 2.7 million Americans lost their jobs, while health insurance companies reported record breaking profits. Five of the largest insurers and managed care organizations realized a combined 12.2 billion dollar profit; an increase of 56% over the previous year (Healthcareforamericanow.org, 2010). The companies cited -- United Healthcare Group Inc., WellPoint Inc., Aetna Inc., Humana Inc., and Cigna Corp. provided private coverage to 2.7 million fewer people (Healthcareforamericanow.org). This is reflective of the shift from private insurance to state programs (Healthcareforamericanow.org). At the same time, state Medicaid programs and Medicare are hiring these insurance companies as managed care entities and gatekeepers for managing the cost of their state and federal programs (Healthcareforamerianow.org).

The recent healthcare reform legislation initiated by the Obama Administration requires most Americans to be insured by 2014 (The Henry J. Kaiser Family Foundation, 2010). This means that insurance companies will realize an increase in premium revenues, but will continue to follow their managed care-based model that restricts access to benefits and services. During the debates and discussion on healthcare reform the issue of managed care was seldom raised or debated. This suggests that legislators and President Obama are aware of the role of managed care and its role. Certainly, as President Obama promised, people will be able to choose their physicians, because any number of consortium insurers or state or federal programs to which people will enroll in will include the physicians that individuals now see -- but to ensure that they continue seeing that family doctor or specialist, they will have to take the specific plan that includes the physician in their preferred provider list. But managed care will continue to be an integral part of containing costs, and insurance companies will recognize an increase in their enrollments and premiums, and profit margins.

While the reform creates guidelines as to the percentages that the insurers must pay on direct healthcare as opposed to administrative costs, it does not mention managed care. Managed care case workers are considered by most insurers to be a part of the patient care team, and, therefore, would ostensibly come under Obama's direct care stipulation.

The present healthcare reform law will not resolve the healthcare crisis in America. Our legislators and president have failed to recognize that the problem in healthcare today is managed care: it is an entity that was created to contain costs, but has become a huge cost to patients, physicians, and providers. Managed care is the healthcare crisis in America.

Reference List

Bernstein, A.B., Hing, E., Moss, A.J., Allen, K., Siller, A., and Tiggle, R. (2003). Health Care in America: Trends in Utilization. Hyattsville, MD: National Center for Health Statistics.

Birenbaum, A. (2002). Wounded Profession: American Medicine Enters the Age of Managed Care. Westport, CT: Praeger.

Birenbaum, A. (1997). Managed Care: Made in America. Westport, CT: Praeger.

Committee on Health Care Access and Economics Task Force on Mental Health (2009). Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration. The Official Journal of the American Academy of Pediatrics, March, 30, 2009, pp. 1248-1251.

Conover, C. And Wiechers, L. (2006). HMO Act of 1973. Health Insurance Regulation Working Paper No. I-1. Center for Health Policy, Law, and Management, Duke University.

Health Insurers Break Profit Records as 2.7 Million Americans… READ MORE

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