Research Paper Example on Healthcare Financing: An Overview of U.S. Systems & Networks

Introduction

In this paper, the issue of concern would be on healthcare financing, which is a vital aspect in the delivery of health services that meet the required safety and quality standards. 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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Public Policy Issue

When the government regulates the costs of care through adequate financing of the healthcare system, people will realize positive health outcomes regarding access to care due to affordability. 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.

Issue Selection

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. Based on this, it would be crucial to consider the need for financing the sector, while comparing it with other nations of the world. 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.

Issue Relevance

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.

Financial Impact

The failure to appropriately finance the healthcare system makes the public to incur huge costs to access medical care and services and those with low incomes would find it difficult to acquire the quality care that they might require. 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.

Personal Values

In the policy that deals with healthcare financing, personal values concerning the policy, which include financial security, knowledge and health tend to be driven by socioeconomic factors. 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).

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.

Ethical Principle/Theory

Through dynamic engagement, the processes enable nurses to maintain ethical stance when delivering care to patients within the complex healthcare environments. The ethical theory promotes engagement in systems thinking to reflect upon and manage the competing values in situations of care, which might arise. When the skills are integrated, it will be easy to understand different values in healthcare context. Importantly, nurses have a code of ethics that serves as a fundamental tool for their practice. Even though the nursing does not change in terms of its foundational values, there are regular updates on the code so that it reflects any changes that might be evident in the structure of healthcare, financing of the health system, as well as delivery of services. The code of ethics supports nurses in the provision of dignified and respectful care. The values serve as second nature as nurses provide care to the patients but the constraints in the U.S. healthcare and negative determinants of health frequently challenge them.

The Top-Down Approach to Policy Advocacy

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.

Conclusion

Importantly, different individuals or entities may be involved in establishing informed decisions about the policy brief. 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.