HCMG101 Health Care System

The policy making process is not free from politics (far from it). That is, certain groups and individuals from the public and private sectors may exert an influence on the type of legislation that emerges from the policy making process. While healthcare policy does not in itself represent the best interests of any one entity, the ultimate goal of healthcare policy should be to enhance quality, increase access, and reduce costs. Consider for example, while the implementation of the PPACA may have opened up previously inaccessible healthcare services, the new mandate also requires employers and healthcare providers to become even more cost conscious given the downward pressure on reimbursement rates and employer coverage requirements. While the mandate opened up channels for consumers of health to obtain access, it similarly inhibited certain providers to maximize the services such access could provide.

For this Discussion, you will be assigned to one of two groups that will adopt either the a) employer or b) government perspective in the policy making process. Review the resources for the week and consider how employers and the government may influence healthcare policy in the policy making process. Reflect on how the influence of employers and the government may impact population health and healthcare delivery.

Post an explanation of how employers and healthcare providers influence healthcare expenditures and the impact on population health.

The provision of a health benefit is a significant tool for a competitive workforce. In this case, due to the slow economic growth and rise in healthcare costs, employers are redefining and reassessing their roles as the subsidizers and providers of employee’s healthcare benefit. Healthcare benefits are vital as they cater for the employee’s medical expenses which reduce the employee’s burden of hospitalization. In this case, most of the employers are changing the way in which they sponsor their employee with healthcare benefits. For instance, they are integrating a “pay for performance” program into the employee healthcare benefit. This is imperative in improving and maintaining the health of the employees and a competitive workforce, thus contributing to a considerable reduction in the cost of health and the overall population health (Holben, Rambo, Howe, Murray and Shubrook, 2017)

Similarly, healthcare providers play a vital role in the promotion of the population health through the reduction of healthcare costs. Hospitalization is the leading cause of healthcare costs; therefore, it is important for healthcare providers to reduce healthcare cost.  The first way in which they can reduce healthcare costs is through patient education. Healthcare providers offer health information to patients during discharge, which helps them avoid the high costs that relate to readmissions. Patient education is also important as it enhances the quality of care, thus impacting population health. Second, healthcare providers provide patients with home healthcare services after discharge as a way of enhancing patient care transition. Such programs are important in the reduction of readmissions, therefore reducing general medical costs (Adaji, Melin, Campbell, Lohse, Westphal & Katzelnick, 2017).

References

Adaji, A., Melin, G. J., Campbell, R. L., Lohse, C. M., Westphal, J. J., & Katzelnick, D. J. (2017). Patient-Centered Medical Home Membership Is Associated with Decreased Hospital Admissions for Emergency Department Behavioral Health Patients. Population Health Management. 3(5) 56- 78

Holben, D.H., Rambo, C., Howe, C., Murray, D.H. and Shubrook, J.H., (2017). Cardiovascular Disease Risk Factors After an Employer-Based Risk Reduction Program: An Observational Cohort Study. The Journal of the American Osteopathic Association, 117(7), p.425.