Week 5 Assignment
What are three major problems facing the health care system in the United
The healthcare system in America needs serious reform. In my opinion, the three major problems with our health care system are that people are uninsured; many don’t have access to affordable healthcare, and that the quality of our healthcare isn’t the best. The lack of health insurance cause taxes to go up, and requires the government to take money from other social programs to cover the cost. Due to the recession and economic downturn, many Americans have been out of work. A lot of workers were able to obtain health insurance through their jobs, which had plans that they could include their immediate families on. Due to staggering cost of private insurance, American families could no longer afford to be insured. The quality of healthcare is also at an all time low. Due to the immense need for doctors and nurses, hospital and clinic wait times are ridiculous. You can spend up to an hour waiting to see a doctor, who will only spend fifteen minutes with you. Fifteen minutes is not an adequate amount of time to properly see and diagnose the patient. Many leave the doctor’s offices untreated and feeling duped because they did not receive the service they paid for. This is a vicious cycle that’s going on in America. People are struggling to pay for healthcare, and in return are forced to see doctors who are not treating them properly.
American Prospect (2012, November 2). Ten Reasons Why American Health Care Is so Bad. The American Prospect. Retrieved September 24, 2012, from http://prospect.org/article/ten-reasons-why-american-health-care-so-bad
Real Truth (2010, February 10). America’s Healthcare Crisis – Is There a Solution? The Real Truth - A Magazine Restoring Plain Understanding. Retrieved September 24, 2012, from http://realtruth.org/articles/090203-005-health.html
What is the basic concept upon which insurance is based?
The basic concept of insurance is based on people paying into a system, that will help them during their time of need. A premium is paid every month for medical coverage. If you fall sick, you have access to a pool of money that ensures that a large percentage of your medical bill is paid for. The problem is that a lot of people don’t have money to buy health insurance, so many are left untreated, or are in debt to the medical facility they received treatment from. According to the business of medicine website, “It is important to know how the hospital is compensated for its time and resources, because your salary may be based on a specific payment structure.” There are five overall payment structures: 1) Payment Per Procedure: Fee-for-Service 2) Payment Per Day: Per Diem 3) Payment Per Episode of Hospitalization: Diagnosis-Related Groups (DRG) 4) Payment Per Patient: Capitation 5) Payment Per Institution: Global Budget
There have been many adjustments to Medicare/Medicaid payment reimbursements. Medicaid/ Medicare payment rates are set by law rather than negotiation process. Medicaid/Medicare uses a prospective payment system, meaning that there is a set fee that will be paid for services rendered, regardless as to the actual cost of the service. The actual amount is set by the physician’s diagnoses. This can cause a lot of problems because the hospital can keep the remainder of the money if the doctor feels that the initial diagnose does not require the extensive treatment he suggested. Physicians have also been compensated by their productivity, in which a physician time and operating expenses were used to determine how much he would be paid. Every plan has its ups and downs. Patient health should be the primary focus.
HOW DO HOSPITALS GET PAID? (n.d.). Falcon Reviews | USMLE, COMLEX. Retrieved September 15, 2012, from http://www.falconreviews.com/v3/blog/2011/02/how-do-hospitals-get-paid/