HCMG101 Health Care System

Federal, state, and local health care policies are continually instituted or amended to address emerging issues and trends and to rectify problems in health care delivery. For instance, reform may be required to address cost containment challenges or disparities in access to health care services.

Identify an issue currently in the news that relates to federal, state, or local reform.

Research the issue in a variety of news sources, such as government sites (e.g., the National Institutes of Health and the National Institute of Mental Health) and online newspapers. Do not use blogs or other informal sources.

Select one article or news item on which to focus for this Discussion.

Reflect on the information in the article/news item and consider how it relates to your understanding of the U.S. health care delivery system. Review the information in the Learning Resources and conduct additional research using the Walden Library and credible websites to assess this issue and associated reform efforts.

Analyze the social, economic, and political circumstances surrounding this instance of health care reform, and evaluate what this development might mean for your work in health care administration.

1.According to Sinaiko and Rosenthal, “one approach for decreasing spending is to increase price pellucidity in health care” (Sinaiko & Rosenthal, 2011). Reducing excessive health care costs is a substantive topic in the US health care system. Rising costs contribute to long-term deficits that hinder the United States’ ability to grow the economy and create jobs ("Deficit-Reducing Health Care Reform", 2016). Slowing the growth of these costs is vital to fiscal stability (Sinaiko & Rosenthal, 2011).

Recently, more patients are obtaining high-deductible health plans (HDHPs). Therefore, the need for transparent pricing has become more important to these patients. Before their plan covers any costs, they can be liable for thousands of dollars (Kane & Harvey, 2015). In 2014, only Maine and Massachusetts performed well in regards to medical price transparency laws. Some laws require providers to respond to patient cost inquiries by providing direct cost estimates or procedure codes that the patient can submit to their insurance provider and obtain an estimate (Kane & Harvey, 2015) Additionally, there are health systems, such as Texas Health Resources (THR) that use pricing tools offering estimates.

The opacity regarding cost in health care contributes to high costs. If patients knew approximate costs of certain procedures, it would allow them to shop around. It would empower the patient and give them control over their expenditures. The result of this would hopefully be a uniform pricing system, where one hospital cannot charge 2,000 dollars for an MRI while another charges 1,000. Dialogue between insurers and providers are necessary for proper negotiations of reimbursements..

2.Women Denied Necessary Coverage

The article I selected highlighted continued gaps in health coverage specifically related to women. Since the implementation of the Affordable Care Act (ACA), more women have obtained coverage because it forbids practices that victimize women. The authors reviewed health plans from 109 health providers throughout sixteen states for 2014, 2015, or both years. They discovered that six services were consistently not covered.

These service include maintenance therapy for conditions that typically affect women; genetic testing which can help women determine best treatment plans for breast or gynecological cancers; fetal reduction surgery to improve chances of a successful pregnancy; treatment of injuries associated with attempted suicide; and prophylactic services such as mastectomies, removal of ovaries and fallopian tubes (Palanker & Davenport, 2016).

Lack of Coverage Equals Lack of Access

According to Shi and Singh, “access to health care is a right that should be definite to all Americans” (Shi & Singh, 2015). However, there are two disparities to this social justice principle. The first is “all citizens have a right to the identical level of care” and the second is “all citizens have a right to some minimal care level” (Shi & Singh, 2015). The US has not defined their definition of access to care regarding policy. In the article, the authors showed that women in various parts of the United States were being denied coverage on certain items they needed, which ultimately denies them access to care. Therefore, women who obtain health care coverage which can be a significant investment for some women, are still unable to receive the care they need.

Evaluation

As a female health care administrator, this would impact my work because these issues could affect me depending on where I work. Being a health care administrator, part of our job is to have knowledge about events that occur in legislature. As health care delivery changes, this issue would be something that I would follow closely. It is surprising that women still face discrimination when it comes to health care. The fact that an insurance company would not cover a procedure that would increase the chances of a successful pregnancy or increase women’s mortality through a prophylactic mastectomy is disheartening.

References

Deficit-Reducing Health Care Reform. (2016). The White House. Retrieved 3 August 2016, from https://www.whitehouse.gov/economy/reform/deficit-reducing-health-care-reform

Hostetter, M. & Klein, S. (2016). Health Care Price Transparency: Can It Promote High-Value Care?. Commonwealthfund.org. Retrieved 3 August 2016, from http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/april-may/in-focus

Kane, C. S., & Harvey, G. (2015). Demystifying patient price estimates. The advantages of transparency. Healthcare Financial Management: Journal Of The Healthcare Financial Management Association, 69(5), 78-82.

Laureate Education (Producer). (2015b). Future challenges of the health care system - Part 1 [Video file]. Baltimore, MD: Author.

Palanker, D. & Davenport, K. (2016). Women's Health Coverage Since the ACA: Improvements for Most, But Insurer Exclusions Put Many at Risk. Commonwealthfund.org. Retrieved 12 August 2016, from http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/womens-health-coverage-since-aca

Shi, L., & Singh, D. (2015). Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett.

Sinaiko, A. & Rosenthal, M. (2011). Increased Price Transparency in Health Care — Challenges and Potential Effects. New England Journal Of Medicine, 364(10), 891-894. http://dx.doi.org/10.1056/nejmp1100041