Instructions: Response must be at least 150 words and written in current APA format with at least two academic references. References must be within the last five years. Response must extend, refute/correct, or add additional nuance.
Health care delivery systems in the United States of America
In the United States, people’s access to health care is dependent on a variety of factors such as their location and their employment status, as well as whether or not they have insurance and what type Few doctors and hospitals exist in rural areas whereas people have a wide range of options in large urban areas. In the early 20th century, private, employer-sponsored health insurance emerged. Even though health insurance costs and coverage options vary widely, by the 1960s, most large employers offered some form of health insurance (Johnson, 2021). As of 1965, Medicare and Medicaid were created by the federal government. Americans 65 and older have access to Medicare, while low-income Americans have access to Medicaid. In addition to Medicaid, CHIP provides coverage for eligible children through state-run CHIP programs. Veterans’ Health Administration (VA) is a federal agency that provides health care to older retired persons.
Medicare covers 14% of Americans, 19% by Medicaid including CHIP, 7% privately purchased plans, 49% are employer-sponsored plans, 9% are uninsured, while other health insurance programs cover 2%. The concept of managed care emerged in the second half of the 20th century. Health insurance systems that offer managed care create contracts with networks of health care providers and approve or deny care under these arrangements (Johnson, 2021). As part of their agreement, patients agree only to receive care from approved providers, while health insurance companies keep Providers like doctors and other healthcare professionals agree to be paid a set amount for each type of As well as Medicare, Medicaid, and the VA, many private health insurance companies also use this approach.
Many people in the United States do not have health insurance. Those who do not qualify for Medicaid or Medicare, or who do not work for a company that offers cheap coverage, frequently go without insurance and treatment. The Patient Protection and Affordable Care Act, also known as Obamacare or the Affordable Care Act, was passed by the federal government in 2010 (ACA). The Patient Protection and Affordable Care Act (PPACA) aims to expand health insurance coverage to more Americans. It includes several provisions, including prohibiting coverage denial based on preexisting health conditions and providing subsidies (funding) to assist some people in paying for coverage (Johnson, 2021). Before the passing of the PPACA, approximately 45 million people in the United States lacked health insurance, accounting for around 15% of the population. By the end of 2016, the population has shrunk to around 28 million people or around 9%. It is noteworthy that the United States is an exception among wealthy countries in that it does not give universal health care coverage to all residents. Age, occupation, socioeconomic level, and race are all significant factors determining who receives health insurance in the United States. African Americans, Hispanics, and Native Americans are more likely to be without health insurance. To a certain extent, this is because these groups have statistically lower income and wealth levels, as well as higher levels of unemployment and employment in lower- If you are a member of one of these categories, you may not have the income, wealth, insurance, or employment that corresponds to these (Johnson, 2021). As a result of this, there is a wide variation in income and wealth. They all contribute to the lack of health insurance and the consequent lack of access to medical care.
In the United States, health maintenance organizations are frequently used to deliver care. A health maintenance organization (HMO) is a company that provides medical care based on pre-paid contracts and agreed-upon prices. HMOs were created to keep medical costs under control by deterring doctors from prescribing superfluous medications or performing unnecessary treatments. Managed care, a system of authorizing or denying treatments, prescriptions, and consultations with primary care doctors and specialists, is used by HMOs (Knickman & Elbel, 2019). Many hospitals keep a chargemaster, a detailed record of medical services, and their associated charges to negotiate with HMOs. This list may overstate rates for some operations to boost the hospital’s negotiating position, and some services may be rejected due to their cost. The United States has the world’s highest per-capita healthcare expenses, prompting some analysts to question how these costs are established and negotiated.
The topic of who can classify therapy as necessary or superfluous is a social issue surrounding managed care and HMOs (Zhang, Lin, Pforsich & Lin, 2020). Managed care has been chastised for denying treatment. An insurance company may deny a doctor’s preferred medicines and treatments, forcing the patient to choose a less expensive, less compelling option. When a for-profit corporation controls health care, power is concentrated in the hands of administrators whose duty is to keep costs low. This may strengthen companies’ social power while weakening doctors’ and patients’.
Large hospitals in the United States conduct illness and medicine research, teach new doctors, and treat patients. Smaller community hospitals are solely dedicated to patient care. Hospitals are complicated bureaucracies, and adequately running one while delivering medical treatment equally throughout a population can be difficult. Hospitals in the United States are experiencing doctor and nurse shortages, albeit the problem is not evenly distributed (Zhang, Lin, Pforsich & Lin, 2020). The most severe shortages are in rural areas and hospital emergency rooms. Both of these professions pay less. This relates to another problem in hospitals: physician sleep deprivation. Doctors frequently work lengthy shifts, sometimes exceeding 24 hours in a row, emphasizing the significance of collaborative care between nurses and doctors and other healthcare staff.
