Health Care Organization and Finance - Paper Example

Introduction

Health care sector experiences many changes due to the changing needs and preferences of the patients and other stakeholders. The increased use of technology like Electronic Health Records (EHR) is one of the examples of the changes in the sector. The changes require the stakeholders to change their mode of operations to meet the needs of the patients effectively. The government also introduces many changes meant to improve the services delivery in the sector. For example, the Affordable Care Act (AC) that was introduced in 2010 led to many changes that affected the way services are delivered. The changes made in the health care sector are effective in improving the efficiency of the services and the organization and financing of health care operations.

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Impact of the Affordable Care Act (ACA)

The introduction of the ACA affected the health care organization and finance. On the organization of the healthcare operations, the ACA increases the access to Medicaid to the low-income families and this has been achieved through increasing the number of people who have access to medical insurance. The high number of insured people led to an increase in demand for medical services at a time when the sector was already experiencing a shortage. The requirement by the Act that the health plans should include preventive healthcare services like cancer screening and immunization changed the way hospitals and insurance companies operate. The risk pools changed because the Act required the insurance to cover a wider range of risks and this also affected the way the healthcare centers operate. For example, the increased access to healthcare affected the human resources organization to meet the increased demand. In the treatment of some of the diseases like hypertension, the ACA increased the insurance coverage and the health care sector had to adjust their delivery of the related services (Li, Bruen, Lantz & Mendez, 2015). Economic changes were also experienced in healthcare as a result of the Act.

The first economic impact was that there was higher transparency in the financial issues related to healthcare. The financial changes are because the patients now have many options to choose from when it comes to the compensation plans. The Act also reduced the financial burden that families have in healthcare and this means that the insurance was responsible for most of the medical expenses. Any delays from the insurance companies mean they would affect the efficiency of the health care centers. The positive impact is that healthcare centers had reduced uncompensated care costs (Li, Bruen, Lantz & Mendez, 2015). The Act improved the organization and financing of the sector.

Incorporation of Social Determinants of Health Into ACA

The Act incorporated the social determinants of health has attracted many researchers who have associated it with improved healthcare. Initially, it was believed that good health was as a result of good genetics and holistic healthcare services. However, the social determinants of health (SDH) also contribute to the well-being of the citizens (DeSalvo et al., 2017). Some of the social determinants of health include good working conditions, physical environments, literacy, childhood experiences, income, and social status, and healthy behaviors among others. The ACA considered the social disparities that lead to the SDH and it intended to reduce them and improve the delivery of the healthcare services. The Act acknowledges that the social challenges affect the healthcare status of the citizens and it localized the funding to empower the society and reduce the impacts of poverty. A survey done in Washington State in 2011 showed a close relationship between housing insecurity and poor health and unhealthy behaviors (Stahre, VanEenwyk, Siegel & Njai, 2015). The ACA has a multi-level federal and state initiatives meant to reduce the social disparities that affect healthcare.

The ACA introduced the National Prevention Council, which works with 20 federal departments, offices, agents and the National Advisory Group to identify the SDH and to provide the government with solutions. The senior leadership is meant to offer direction on how the SDH can be reduced and how society can be improved. In 2016, the Center for Medicare and Medicaid Innovation (CMMI), one of the products of ACA, started the Accountable Healthy Communities initiative that was meant to deal with the social disparities affecting healthcare. In this way, the ACA increased the access of communities to social services. CMMI also guides on dealing with the SDH and their impacts. ACA also improved the delivery and payment processes to reduce the effects of SDH. For example, the Delivery System Reform Incentive Payment" (DSRIP) initiatives were introduced. The Act also proposed the levels of poverty at which one is eligible for Medicaid. For example, those who make $1293 or below are eligible for the Medicaid coverage (Rambur, 2015). The above efforts have reduced the SDH effectively.

Proposed Changes to ACA

The current administration has proposed several changes to the CA that could change the way it is implemented. The changes include a change in the silver loading, change in premiums by 1%, and to end the automatic re-enrollment in the individual exchange plans. One of the main changes is on abortion. ACA allows insurers to cover abortion but some states have enacted laws against this. The other change is the reduction of the fees charged to the insurance companies that participate in ACA as a way to reduce the premiums by 2020. The other one is allowing individuals and small groups to make mid-year changes to allow for more use of generic drugs. The out-of-pocket maximum from the employer-sponsored coverage is also set to increase by $200 and the maximum family coverage to increase by $400. The administration also seeks to change the definition of a full-time worker from 30 hours a week to 40 hours a week. In conclusion, ACA introduced many changes to healthcare services delivery and the new administration may repeal some of them through the proposed modifications.

References

DeSalvo, K. B., Wang, Y. C., Harris, A., Auerbach, J., Koo, D., & O'Carroll, P. (2017). Peer Reviewed: Public Health 3.0: A Call to Action for Public Health to Meet the Challenges of the 21st Century. Preventing chronic disease, 14.

Li, S., Bruen, B. K., Lantz, P. M., & Mendez, D. (2015). Peer-reviewed: the impact of health insurance expansions on nonelderly adults with hypertension. Preventing chronic disease, 12.

Rambur, B. (2015). Health care finance, economics, and policy for nurses: A foundational guide. Springer Publishing Company.

Stahre, M., VanEenwyk, J., Siegel, P., & Njai, R. (2015). Peer-reviewed: Housing insecurity and the association with health outcomes and unhealthy behaviors, Washington State, 2011. Preventing chronic disease, 12.