Influence of Health Policies on Access to Services
Healthcare policies refer to laws and legislation enacted to secure a country’s health system. A sound healthcare system is characterized by patients’ enhanced access to care services and affordability. For a comprehensive understanding of healthcare policies and their impact, all health system stakeholders encompassing healthcare professionals, the government, pharmaceutical industries, the insurance sector, and health information technology drivers must be interconnected. In the United States, two healthcare policies, Medicaid and Medicare, have continued to influence patient service delivery. Therefore, it is imperative to assess their impact on how patients obtain medical treatment and the frequency of taking up care options to identify policy improvement methods.
Health Policies Influence on Access to Care
The first health policy, Medicaid, provides health coverage to low-income individuals who would otherwise not afford care services. It is estimated that as of 2017, more than 70 million citizens in the United States are beneficiaries of Medicaid (Mazurenko et al., 2018). The insurance plan implemented by Medicaid covers children, adults, pregnant women, geriatrics, and disabled populations. Recently, the average expenditure on health has exponentially increased due to the high cost of care in the US. This policy is essential as it facilitates medical bills and nursing care payments. It is especially helpful for older patients who need assisted living within long-term care facilities. As such, it provides comprehensive coverage for this group of people who at times cannot meet financial obligations at the nursing homes. Moreover, geriatrics can access covered services at facilities and hospitals of their choice.
The second policy, Medicare, is provided by the federal government through availing health insurance coverage to patients above 65 years of age and allows only younger individuals living with disabilities or certain chronic illnesses to enroll. However, about half of those insured experience delayed care because of cost (Shrank et al., 2021). Individuals get the Medicare cover through monthly premiums contribution, with the government paying significant amounts for the services. Original Medicare plan has both inpatient/hospital and outpatient/medical coverage termed part A and part B, respectively. One can access virtually all doctors and hospitals countrywide with this plan, thus substantially improving the delivery of quality healthcare. On the other hand, the advantage plan limits patients to a controlled network of hospitals or doctors. Therefore, it is prudent to choose one’s Medicare plan carefully to access the services an individual may need.
Health Policy Influence on Amount of Access to Care
Remarkably, Medicaid enhances the degree of access to patient care across all states in the USA. Cumulative expenditure on this insurance accounts for one-sixth of the federal health budget (Rudowitz & Valentine, 2017). Medicaid extension to include a wider demographic under the Affordable Care Act caused this tremendous shift in government contribution. The increased degree of care was reportedly captured through documentation of upward shifts in preventive health testing, health-seeking behavior, increased number of patients, and decreased mortality rates. New York, Maine, and Arizona recorded an approximately 6 percent decrease in all-cause mortality rates among the adult population (Seervai & Blumenthal, 2019). The high overall degree of access to care and the relatively large proportion of patients seeking services were well documented within these first three states to expand Medicaid eligibility. On the contrary, other states could not match that outstanding milestone due to the expansion’s lack.
Likewise, Medicare policy enabled access to physicians and other consultants, increasing the amount of care for geriatrics. Medicare eligibility was correlated to about a 51 percent reduction in the inability to access required healthcare services and about 45.3 percent reduced hindrance to care due to cost (Jacobs, 2021). In essence, the statistics above reveal that Medicare uptake increased the frequency of health-seeking behavior among older patients. It also translated to reduced morbidity and mortality from chronic diseases. As a result of Medicare expansion, the emerging affordability has eliminated access barriers due to cost.
Policy Adjustment
Medicaid had a positive impact on improving health systems within the United States, and policy adjustment can increase further enrollment of the state populations by widening eligibility criteria. In turn, the different states must identify alternative financing options for expanded insurance needs of citizens to reduce the impending financial burden of such an adjustment. As for Medicare, the monthly premium payments made to the Centers for Medicare and Medicaid Services (CMS) require individualized reconciliation with projected hospital care needs. CMS needs to derive risk adjustment factors for evaluating anticipated healthcare costs and regulate each patient’s premiums (Shah & Viturro, 2019). The original and the advantage Medicare plans should both effectively undergo this rationalization to ensure uniformity. The objectivity of this policy adjustment is to reduce financial implications on individuals who do not need assisted living, are generally healthy, or do not have age-related chronic illnesses.
Conclusion
Health policies have a huge impact on healthcare quality and access. Hence it is necessary to frequently review them for inclusion of unmatched needs. The enactment of the Affordable Care Act revamped both Medicaid and Medicare policies in the United States with positive statistics on the performance of the federal health system. However, healthcare timely delivery, affordability, and access could improve with frequent policy adjustments. Early identification of factors that hinder treatment services can eventually lead to a robust health system.
References
Jacobs, P.D. (2021). The impact of Medicare on access to and affordability of health care. Health Affairs Journal, 40(2), 266-273. https://doi.org/10.1377/hlthaff.2020.00940
Mazurenko, O., Balio, C.P., Agarwal, R., Carroll, A.E., & Menachemi, N. (2018). The effects of Medicaid expansion under the ACA: A systematic review. Health Affairs Journal, 37(6), 944-950. https://doi.org/10.1377/hlthaff.2017.1491
Rudowitz, R. & Valentine, A. (2017, Oct 19). Medicaid enrollment & spending growth: FY 2017 & 2018. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2017-2018/
Seervai, S., & Blumenthal, D. (2019, Aug 9). Insurance coverage saves lives. The Commonwealth Fund. https://www.commonwealthfund.org/blog/2019/insurance-coverage-saves-lives
Shah, T., & Viturro, R. (2019, April 23). 4 Strategies for improved Medicare advantage plan performance. Healthcare Financial Management Association. https://www.hfma.org/topics/payment-reimbursement-and-managed-care/article/4-strategies-for-improved-medicare-advantage-plan-performance.html
Shrank, W.H., DeParle, N., Gottlieb, S., Jain, S.H., Orszag, P., Powers, B.W., & Wilensky, G.R. (2021). Health costs and financing: Challenges and strategies for a new administration. Health Affairs Journal, 40(2), 235-242. https://doi.org/10.1377/hlthaff.2020.01560
