Health Care Financing

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Health Care Financing

Health Care Financing

A.  Compare the U.S. healthcare system with the healthcare system of Great Britain, Japan, Germany, or Switzerland, by doing the following:

1.  Identify one country from the following list whose healthcare system you will compare to the U.S. healthcare system: Great Britain, Japan, Germany, or Switzerland.

2.  Compare access between the two healthcare systems for children, people who are unemployed, and people who are retired.

a.  Discuss coverage for medications in the two healthcare systems.

b.  Determine the requirements to get a referral to see a specialist in the two healthcare systems.

c.  Discuss coverage for preexisting conditions in the two healthcare systems.

3.  Explain two financial implications for patients with regard to the healthcare delivery differences between the two countries (i.e.; how are the patients financially impacted).
B.  Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

 

Several legislative, public policy, and insurance company-driven initiatives have already attempted to radically alter the way health care is financed and delivered in the United States. 
Although those initiatives may have appeared to be significant changes at the time—think of managed care—the results turned out to be more akin to minor tweaks to a health-care system that appeared to be nearly unmanageable in terms of controlling costs and delivering a uniformly high level of quality. 
In truth, the United States’ health-care system is still on an unsustainable financial path. 
Spending continues to grow faster than inflation. 
Meanwhile, despite the large sums of money spent, patient health results in the United States frequently lag behind those in other nations that spend significantly less.

 

When the Patient Protection and Affordable Care Act (PPACA) was passed into law in March of 2010, it brought about comprehensive health-care reform. 
Depending on one’s perspective, the Affordable Care Act (ACA) set the United States’ health-care system on a drastically divergent route. 
Whether or whether that trajectory is regarded positive depends on one’s political views. 
In any case, we look to be entering a period of health-care reform that aims to bring about a structural transformation in health-care funding unlike anything we’ve seen before.

 

The way physician assistants (PAs), physicians, and other health professionals will be compensated for the services they provide is undergoing tremendous change. 
PAs must comprehend how they will adapt to a “new normal” in health care as practices, hospitals, and health systems reinvent themselves and build new practice and payment models.

 

Value-based reimbursement, value-based purchasing, and a transition from fee-for-service to fee-for-value are all important concepts in health care today. 
Depending on who you are and where you are in the health-care system, value might have many different connotations. 
In the context of reimbursement, value is defined as the health outcome obtained for the amount of money spent. 
1,2

 

What does value-based reimbursement or value-based payments imply? 
It focuses on providing preventive care and intervention earlier in the disease process, delivering that care in lower-cost settings (for example, in the office or at the patient’s home rather than in an acute or urgent care setting), and having health professionals focus on improving both individual and population health. 
All of this must happen while minimizing the amount of unnecessary emergency department visits and hospitalizations, as well as hospital readmissions.

 

The shift to more creative health-care delivery system concepts like community health, value-based reimbursement, and bundled and episodic payments is still underway. 
However, the shift has taken longer than many had anticipated. 
Despite the efforts of the Medicare program and a few of commercial insurers to move the needle ahead, many health-care professionals remain firmly entrenched in the fee-for-service compensation universe.
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