Paper Example on High Healthcare Costs: An Imperfect US Health Care Market

In the United States, the health care market is known as imperfect based on the reasoning that it does not cover every individual within the nation. In essence, healthcare is considered a heterogeneous product. For that reason, individuals are more willing to pay any price to access healthcare (Faria, 2016). Since the product is more important, health care practitioners had engaged in charging exorbitant prices for medical treatment despite the inflated cost of health insurance.

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Surprisingly, the people who yearn for medical services are not necessarily real users. Ideally, a perfect market is perceived by demand and supply factor; in the US, the economic theory is not applicable. Usually, there exist third party players who pay for direct market expenses making the market imperfect (Faria, 2016). The United States has failed to create a proper market that shall oversee every third party players in its healthcare program.

Introduction

Imperfect market arises when the allocation of services and goods are not efficient. In a typical market, the product quantity consumer demands should not be equal to the supply quantity by suppliers. The situation arises when there are inadequate ideal economic factors that prevent equilibrium.

The imperfect market in the United States is contributed by the unregulated market, where the fee charged for medical care might be optimal. The situation is caused by the barrier entry of third-party payers, asymmetric information, and imperfect information. In a medical market, patients do not have a practical idea of the medical transaction (Faria, 2016). In the United States, the Health Care initiative entails many players and does not overburden to a single docket, which shall help them solve the situation of an imperfect market.

Part I

Development of Health Services Professional

Health services development is influenced by the trends of diseases and illness, advances of research and technology, changes in health care delivery and financing services, and population trends (McCray, 2018). These factors perform various wonders in the health care world. Advanced research and technology in health care are vital since they curb multiple barriers that prevent people from receiving care such as the language barrier.

With the emergence of technology in chemotherapy and biotherapy department, the country has improved the well-being of the patients by using watches and fitness apps that allow patients to track calories and footsteps. Studies conducted on devices and apps shape the US health care.

In terms of health care trends, the United State have sorted to the used of computerized medical records in clinics and hospitals. Companies strive to improve health care delivery by developing a technology that can connect doctors to translate medical information to those who do not understand a particular language.

The idea of having a merger and acquisition has helped improve health care professionals. In essence, professionals in the health care department merge in the first phase with an assurance that the company shall produce a positive net present value (McCray, 2018). For instance, SME health care is rendered with no option but to merge to allow them to improve their operational and financial efficiencies.

Primary and Specialty Care

Primary care and specialty care vary with scope, focus, and time a service is provided to the patients. However, primary care covers all services rendered to the person as a whole, whereas specialty care deals with a specific organ system and diseases (Tynan, 2014). There exist a more significant imbalance between specialty care and primary care since specialists are the top driving force in medical technology development.

Electronic Health Record System

Electronic health record system has four main settings, namely care in the community, nursing home, ambulatory care, and hospital acre. These settings are essential for the Electronic Health Record system to support the delivery of personal health care services such as administrative processes, care support processes, care management, and care delivery (Jamoom, 2013). If a person can actively manage their lives, they become vital users of electronic health information. The electronic health record system covers various aspects such as policy support, public health and homeland security, clinical and health services research, regulation, and education.

Electronic health record system entails every virtual patient information with others limited to data types that involve ancillary and medication results. The functionality of the system varies on these settings based on the resources available to the vendor and what is implemented. The system helps the vendors to develop software. Also, EHR, system helps the providers to compare and contrast other systems (Jamoom, 2013). Thus, the system assists vendors in meeting the providers' expectations. In the four settings, a fully implemented Electronic Health Record system should improve efficiency, quality, and safety. The system, if implemented carefully can enhance clinical decision making and strict following of the clinical guidelines and focus on patients.

Changes in Hospital Inpatient Days and a Growth in Ambulatory Services

Many changes in the health care service delivery contribute to a decline in the growth of ambulatory services and hospital inpatients. The two main factors that fuel the drop are cost-saving efforts and Medicare reimbursement. Currently, most of the hospitals have stronger incentives that allow them to the length of stay of the patient. Also, the strong incentive helps the hospital to continue with the treatment in an outpatient setting based on Medicare reimbursement (Molodynski, 2019). In a health care setting, the managed care adopts cost-containment strategies to lower the stress of the inpatient with a corresponding focus on outpatient services.

The idea of offering a lower-cost to the employees helps them to be treated and diagnosed without moving outside the door. For that reason, the patients can get the health care they desire conveniently and quickly. The benefits such as telemedicine as a competent health care cost-containment strategy enable workers to refrain from getting expensive healthcare alternatives such as care in the emergency rooms, urgent care, and primary care.

Population Health Care Management Programs assess the demographic data to allow the practitioner to identify chronic disorders such as heart disease, diabetes, and hypertension. The program helps various organizations to combat high treatment costs by offering case management strategies for the conditions causing significant challenges.

Savings can be generated by limiting office visits and ER claims that need telemedicine to be used. For instance, if individuals are not using the service, they can still access urgent care facilities and visits to the doctor's office (Molodynski, 2019). The Cost-saving strategies utilized by managed care can reduce the stress level of inpatient utilization which complies with outpatient services which is the idea of creating new technology shifts the inpatient guidelines to outpatient settings.

Part II

Public and Private Health Insurance Programs

The working people who earn slightly low wages in the United States are more likely to be uninsured. The reason is that most people cannot afford premium cost-sharing. The reality is that the premium cost-sharing is not allowed for public benefits. The increased bill raises various questions about the reason why jobs shall be eliminated based on reduced hours and wages (Library, 2018). In the past years, the solid gain per household income has returned to the median forcing Americans who work for a year to have a flat number of private health insurance.

The number of uninsured people also rises based on the previous repealed fines under Obama care. The intervention by the federal government can make some citizens be uninsured. For instance, in his first year in office, Trump unsuccessfully tried to get the Republican Congress to repeal ACA. He removed insurer subsidy which triggered a jump in premium.

The idea of having the Affordable care act shall change the situation by relaxing the standards to realize public benefits. Also, the system is web-based and allows the government to run exchanges that provide the function to assess if a person qualifies for public benefits. Besides, the government can determine whether ACA can help a person compares health care plans provided by a private insurer to buy a suitable policy. A person who fails to comply with the requirement has to pay a tax.

The affordable care act makes Medicaid be used as healthcare insurance in the US. Despite opposition in some states like Texas, the affordable care act provides coverage to every uninsured adult (Library, 2018). The affordable care act can be used by the working poor who cannot afford the money to pay for their own health insurance.

Policy-Makers and Administrators

Healthcare administrators and policymakers use various measures of health status and service utilization to address health and health care disparities. The health care system comprises a diverse set of public and private data collection systems such as medical records, billing records, official enrollment, and health surveys (Beatty, 2014). Once data is collected on language, ethnicity, and race, measures are taken to give substantial information on enrollees and patients. The usefulness of the data can be increased by healthcare administrators and policymakers to integrate the data from other sources.

Clinical preventive services such as medical counseling, tests, and procedures help the administrators to promote health and prevent disease. The services provided include counseling, screening test, and immunizations to change personal health behaviors. In health care, behavioral intervention and counseling techniques give clear evidence that has impacts on health on issues such as illicit drug, alcohol and tobacco use, poor diets, lack of exercise, and unsafe sexual behaviors (Beatty, 2014). The use of preventive services among older patients is relatively low. The results show that there is a limited range of benefits that Medicare covers among older adults.

Supreme Court

The legal question before the Supreme Court made their ruling was based on the constitutionality of mandating every American to pay the penalty or buy health care insurance. The Supreme Court decided that since the penalty is applied as a tax and supported by the idea that Congress has the right to impose a fee, the affordable care Act was constitutional (Jaffe, 2015). The ruling also raised the purpose of the federal funding of Medicaid.

The Supreme Court was also asked to give its verdict on Medicaid expansion. Initial, the Affordable Care Act had allowed Medicaid expansion to be 133% of the poverty level ad given federal funding to the state for the same course. The affordable care act had provided that states should expand eligibility; otherwise, they shall lose Medicaid funding. The Supreme Court concluded in a 7 to 2 vote that the states should not be coerced to increase their Medicaid offering (Jaffe, 2015). The Supreme Court was clear such that if states portend to expand their Medicaid program, the federal government will not be allowed to withdraw Medicaid funding to the states. The Supreme Court provided that if a state chooses to expand its coverage, it has to accept every federal regulation linked to that expansion. A state cannot choose and pick where to expand. Thus, Medicaid expansion is optional for all states.

Provisions of HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) has provisions name...