Report Sample on the U.S. Healthcare System: A Complex Network of Providers and Regulators

Introduction

The healthcare system of the United States comprises of various clinicians, healthcare facilities, hospitals, healthcare service purchasers and insurance plans, which operate in networks, as well as independent practices. Some operate in the public sector, while others in the private sector for profit or not-for-profit. The sector has regulators, some of which are governmental and others are voluntary. Even though the care providers, organizations and individuals form the healthcare delivery system, it tends to suggest accountability and integration that are non-existent in the system. The entities have limited collaboration, communication and systems planning. Due to the structure, history and the health services market, which is highly competitive, the healthcare delivery system would not interact effectively with different components of public health system.

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Technology drives the healthcare structure and incentives, which fail to support time needed for inquiry, communication, reflection and relationship building that would enhance effective prevention of diseases and health promotion. In the U.S. state departments are legally authorized to help in regulating the entry of care providers and purchasers into the market. They also set rates of insurance reimbursement for the public, and in some cases for private practitioners and purchasers (Burstin, Leatherman & Goldmann, 2016). At circumstances, the state health departments control the ability of practitioners to acquire the most appropriate technology and undertake complex and costly procedures, which are vital to the hospital even though the demand on state revenues increases. All the states have the legal role of virtually monitoring the quality of healthcare services offered both in the private and public sectors.

Most of the care practitioners argue that the regulation adds to the costs that they incur and complex problems that lead to additional tensions, thereby impeding collaboration between the health agency of the state and the healthcare delivery system. In situations where the private sector fails to deliver health services efficiently, public health agencies run by the government will be required to provide basic health services to special groups and vulnerable populations.

Comparison of the U.S. Healthcare Delivery and Financing Systems With That of Germany and Canada

Ideally, the prices and expenditures on medical services tend to continue rising in the U.S. even though the rate is slower when compared to the past. As the United States transitions to the healthcare system of managed care, the system promotes savings on cost in different medical care markets, as well as leading to healthcare rationing (Burstin et al. 2016). The autonomy and choice of physicians, income status, inpatient admissions in hospitals, as well as selection of pharmaceutical products have been limited by the managed care system. The limitations regard the insurance plans of private managed care and the managed care plans within Medicaid and Medicare programs. Additionally, in the U.S., competition in the health sector induces demand in the industry that provides physician services.

As opposed to the U.S. healthcare sector that uses a multi-payer delivery system, the healthcare systems in Germany and Canada use a system of a single-payer. The healthcare systems of these two nations provide universal access to care and medical services, while also involving a huge financing and regulatory role for federal governments. The amount spent by the U.S. on medical services as a fraction of its GDP is higher than that of Canada and Germany. Due to high expenditures in healthcare and low rates of utilization of medical services, some people believe that the prices of medical services and products are higher in the U.S. compared to the other two nations. It is also evident that the duration taken before one can acquire medical services in the U.S. is comparatively shorter.

Moreover, the United States government finances approximately 44% of all the spending on healthcare, which is different from the case of Canada and Germany that spend over 90% on their healthcare services (Burstin et al. 2016). In these countries, the costs of healthcare and infant mortality rates are lower than the U.S. as the governments play vital roles in the healthcare sector. The access to health insurance is also universal. Several people in the United States are not satisfied with how the healthcare system performs as the costs of care rises faster than the other countries.

Through national insurance system, the healthcare coverage is universal for every citizen. The income tax helps in financing medical coverage. Some of the funds meant for Medicaid and Medicare can be diverted to enable the healthcare delivery system offset costs of the plan. Through global budgeting, a constant relation is established between the GDP and expenditures on healthcare. The U.S. has an active role in initiating healthcare reforms through its states. However, the policies tend to vary across different states but the aim is to ensure that the increasing costs of healthcare are contained and ensure improved access to quality medical services and care.

Policy Process

Concisely, socioeconomic factors lead to disparities in health. These consist of occupation, education and income, which provide different resources and display varying relationships to health outcomes, as well as requiring different policies to address. Education shapes occupational opportunities in the future and earn potential. Through the skills and knowledge acquired, better educated individuals gain ready access to fundamental resources and information that promote health. The policies that encourage proper schooling and support early childhood education tend to bring forth a range of health benefits (Yamada et al. 2015). When human capital is increased and there is a boost in productivity, socialization will improve following the improvements in attainment of education. Some of the collateral benefits would be a substantial decrease in the costs of healthcare due to increased investments in education. Income is another factor that affects the development of healthcare policy. In essence, higher incomes provide a means to purchase healthcare hence promoting the health of individuals. Income distribution across nations and states is linked to the mortality rates. Nevertheless inadequate investment in public commodities and welfare, as well as inequality are highly experienced in more stratified systems, thereby consequently affecting health.

Even though health and income have a stronger association when the incomes are lower, the effects of income persist above the level of poverty. When the incomes are highly distributed, the health effects would be a reflection of relative status in the society whereas societies with low income distribution tend to experience absolute deprivation. United States has economic policies, which are initiated to help in addressing poverty and minimize economic disparities.

Historically, policy tools have been created to reduce economic inequality. One of these is the progressive income tax that was introduced in 1913. Other historical policies include welfare and social security policies incorporated in the 1930s (Yamada et al. 2015). However, some policies are considered to have taken the nation to the opposite direction regarding wealth inequalities such as mortgage deduction allowance, decreased taxes on capital gains, as well as financing budgets of local education. Despite these policies exerting less influence in comparison to the trends in labor-market, they are worth considering for one to understand the relationship between societal stratification and inequalities in access to healthcare. The federal policy of Earned Income Tax Credit has contributed significantly in acquisition of medical services by raising the incomes of working-poor families. As such, it affects the distribution of resources and inequality hence dictating the costs of care and health outcomes.

Conversely, political factors that influence the costs and delivery of care may be evident in the health insurance coverage. For instance, a system that does not provide appropriate medical insurance covers for its citizens would make it difficult for the low-income population and other uninsured individuals to access quality care due to high costs and unaffordability. In essence, people who do not have insurance coverage always tend to have worse access to healthcare services than the insured persons. Lack of medical insurance is a crucial driver of disparities in healthcare. In most cases, uninsured individuals report constraints in affording the medical care that they require, which they end up delaying or forgoing due to costs as opposed to those with Medicaid and private coverage. The quality of care offered to different people depends on their ability to pay for such services.

Effects of Legal and Regulatory Policies

Ideally, governments incorporate laws and regulatory policies to help in the process of health planning as they provide a means by which to give effect to the health policy preferences. Through federal, state, and local governments, private and public sector agencies, as well as nongovernmental organizations, autonomous and informed decisions are made regarding the regulatory policies and their impact on healthcare. As such, regulation serves as an essential lever for different governments in affecting the distribution, quantity, safety and quality of medical services in health systems (Burstin et al. 2016). Governments use the regulatory policies and laws in different ways. For instance, countries tend to regulate to help establish and understand the legal architecture for their health systems, which subsequently ensures cohesion and efficiency of care. The law governing a health system has legal responsibility and accountability concerning the key functions of the health system such as planning, setting of priorities, financing, provision of services, supervision and integrity.

In cases where health systems have contracts that are used in governing service provision, governments come up with laws aimed at establishing the legal basis to contract in the system. The rights of patients, health providers, care practitioners and insurers are also established. Some governments set out the legal framework in the general contract laws of a country hence prohibiting anti-competitive behavior, and specific health regulations like laws that govern health insurance transactions. Moreover, governments can regulate their health systems to advance vital policy objectives for the health systems. These may include provision of universal access to the healthcare services, establishing floors for social protection, ensuring compliance with the international obligations of a country and encouraging the use of resources efficiently and equitably.

Conclusion

Finally, at circumstances, governments may regulate healthcare systems with the aim of protecting its citizens from harm and adverse effects that the health system may bring forth. As such, it would be easy to address any inefficiencies that may be experienced in the health system. An example would be the case in which private care providers segment their markets to enable them concentrate on market niches that are more profitable like patients with conditions that can be easily treated or who earn high incomes. In such situations, some regulatory policies would be required to incentivize the private providers so that they offer various services.