PHC 4104 PAPER FINAL COPY
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Taralynn Norman
Professor Oberne
PHC 4101-310
11 June 2023
Healthcare Paper
The United States arguably has one of the most complex healthcare systems in the world. It supports intertwining relationships between organizations, institutions, payers, and providers that deliver services to meet the health needs of patients. Compared to international countries, the
most notable way the U.S. differs is the absence of universal health insurance coverage (Davis et al., 2014). Countries like Austria, France, Denmark, Greece, and Germany, to name a few, ensure
the accessibility of quality health care through universal systems meaning that all people have access to services when needed without experiencing financial hardship. This paper will examine
similarities and differences between global healthcare systems through specific dimensions while
also analyzing the Patient Protection and Affordable Care Act's (PPACA) impact on
healthcare delivery in the United States. Every country operates differently in organizing and delivering health coverage for its residents, offering a unique approach for those receiving care. The Commonwealth Fund conducted an international survey that assessed the performance of various multinational healthcare systems, measuring across five domains—access to care, care process, administrative efficiency, equity, and healthcare outcomes. Data from the Organization for Economic Co-
operation and Development and the World Health Organization also contributed to this research. This survey aims to generate insights into the policies and practices associated with superior performance (Schneider et al., 2021). The first dimension, access to care, refers to the
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affordability and timeliness of healthcare, which includes coverage costs and availability of promptly getting care. The next dimension is the care process, which contains four relevant subdomains: preventative care, safe care, coordinated care, and engagement/patient preferences. Surveys conducted within this dimension examine the entire operating process of standard patient care. Next, the administrative efficiency dimension assesses the effort involved in the documentation process that clinicians, insurance companies, and government agencies often complete. Moreover, this dimension also describes any limitations to care due to a physician's availability. The equity domain requires all patients to attain their full health and well-being potential regardless of their social, economic, demographic, geographic status, or other dimensions of inequality (WHO, n.d.). Lastly, the final dimension used to rank systems is healthcare outcomes, which includes ten measures focusing on improving practices to deliver more satisfactory patient outcomes. Although all domains are essential within patient care, access to care is crucial for overall
wellness and positive patient outcomes. This segment refers to the capability of obtaining health services that are affordable, convenient, and effective in preventing and combating illnesses. Of the eleven nations surveyed, the Netherlands ranked first in this category, followed by Norway and Australia as the top-performing countries. Healthcare in the Netherlands is known
for its high standards and a
vailabil
ity through a universal program managed by the government and supplemented by private insurers (Stadhouders et al., 2020). All residents must carry health insurance, and the government monitors all access, quality, and costs. Over the past decade, there
has been a consistent decline in the number of uninsured individuals in the Netherlands, leaving only 23,000 people without insurance. Unfortunately, the United States ranked
last in terms of affordability a
nd timeliness c
ompared to other nations. Reports suggest that adults are more
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likely to go without health insurance and necessary treatment due to financial difficulties, such as
securing proper housing and nutritious food. These issues lead to poor physical and mental health. To address these concerns, expanding Medicaid eligibility in all states would improve health outcomes, reduce disparities, and increase access. Although the U.S. has made significant progress in expanding insuran
ce coverage under the Patient Protection and Affordable Care Act, it remains an outli
er among high-income countries (Osborn et al., 2016). The Affordable Care Act, commonly known as Obamacare, was enacted in 2010 to enhance the accessibility and quality of healthcare services for American citizens. It sought to expand health insurance coverage to more individuals and families, as well as to reduce healthcare costs and improve the overall health outcomes of the population. This law consists of nine critical components that affect different aspects of healthcare delivery, such as access to public assistance programs and coverage of preventive services. These elements have far-
reaching effects on issues, and it is crucial to understand the significance of each of these elements to ensure that healthcare delivery is efficient and effective.
Public programs, such as Medicaid and the Children's Health Insurance Program (CHIP), have significantly reduced the number of uninsured nonelderly individuals. The uninsured population dropped from 48 million in 2010 to 28 million in 2016 before rising to 30 million in 2020, due to new policy changes (Finegold et al., 2021). When the expansion first took effect in 2014, only 26 states, including the District of Colombia, adapted to the change. Over the years, more and more states have chosen to expand, as the current count is 41. On May 11, 2023, the Department of Health and Human Services declared the end of the Public Health Emergency as the COVID-19 pandemic concluded. This triggered the "Unwinding" phase, which involves resuming annual Medicaid eligibility reviews after the end of the continuous coverage
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requirement (Wikle & Wagner, 2023). According to reports conducted by the Kaiser Family Foundation, 17 million people are expected to lose their health insurance during this process, significantly increasing uninsured individuals. Experts suggest expanding Medicaid in the remaining states would provide coverage for approximately 4 million people and create over 1 million jobs nationwide.
In the United States, chronic diseases such as heart disease and cancer are the primary causes of long-term disability and death. This places a burden on both patients and the healthcare
system. Fortunately, the Affordable Care Act requires most health plans to cover recommended preventive services at no cost. These services include screenings, check-ups, immunizations, and many other services to prevent illnesses or diseases from occurring or detecting them early. In 2020 alone, more than 150 million people received free preventive care, which led to improved health outcomes and reduced health disparities (Baron & Twinamatsiko, 2023). Since the law was put into effect, these services have been available for free. However, federal Judge Reed O'Connor ruled on March 30, 2023; the government cannot require commercial health plans to provide certain preventive health services for free to patients across the United States. If this decision is upheld, insurers may choose not to cover such services or require consumers to bear some expenses. As a result, millions of Americans may lose access to these services.
The future of healthcare in the United States is uncertain but has the potential to make significant advancements should stakeholders, policymakers, and clinical staffs prioritize focus in critical areas. In addition to the current preventative care protocols, healthcare providers must facilitate prevention to a greater degree to improve overall health rather than simply treating sick patients. For example, this could include primary care doctors connecting patients to navigators or nurse educators to discover more necessary services allowing them to spend more time with
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patients at higher risk. Another issue within the current healthcare system is the presence of racial disparities. The key to combating these disparities is addressing social factors that influence health, also known as the social determinants of health. Addressing these economic differences makes progress toward equality, allowing every patient to attain their highest level of health. To conclude, America must take multiple proactive steps to enable and deliver an effective transformation of healthcare delivery.
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References
Davis, K., Stremikis, K., Squires, D., & Schoen, C. (2014, June 16). Mirror, mirror on the wall, 2014 update
. How the U.S. Health Care System Compares Internationally. https://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror-wall-2014-
update-how-us-health-care-system
Drake, P., Tolbert, J., & Damico, A. (2023, May 12). Key facts about the uninsured population
. KFF. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-
population/#:~:text=The%20number%20of%20uninsured%20individuals,to
%2027.5%20million%20in%202021. Finegold, K., Conmy, A., Chu, R., Bosworth, A., & Sommers, B. (n.d.). Trends in the U.S. Uninsured Population, 2010-2020
. ASPE HHS. https://aspe.hhs.gov/sites/default/files/private/pdf/265041/trends-in-the-us-uninsured.pdf
Ku, L. (2021, May 20). Expanding Medicaid in all states under the american rescue plan would add more than a million new jobs, study shows
. Commonwealth Fund. https://www.commonwealthfund.org/press-release/2021/expanding-medicaid-all-states-
under-american-rescue-plan-would-add-more-million Osborn, R., Squires, D., Doty, M. M., Sarnak, D. O., & Schneider, E. C. (2016, November 16). In new survey of 11 countries, U.S. adults still struggle with access to and affordability of Health Care
. U.S. Adults Still Struggle with Access to and Affordability of Health Care. https://www.commonwealthfund.org/publications/journal-article/2016/nov/new-survey-11-
countries-us-adults-still-struggle-access-and
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References Contd.
Schneider, E. C., Shah, A., Doty, M. M., Tikkanen, R., Fields, K., & Williams, R. D. (2021, August 4). Mirror, mirror 2021: Reflecting poorly
. Commonwealth Fund. https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-
reflecting-poorly#how-we-measured-performance Stadhouders, N., Wammes, J., & Westert, G. (2020, June 5). Netherlands
. Home. https://www.commonwealthfund.org/international-health-policy-center/countries/netherlands Wikle, S., & Wagner, J. (2023, April 28). Unwinding the Medicaid continuous coverage requirement
. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/unwinding-the-medicaid-continuous-coverage-
requirement World Health Organization. (n.d.). Health Equity -- Global
. World Health Organization. https://www.who.int/health-topics/health-equity#tab=tab_1