USA’s Medical Insurance Essay Example

potential 40% reduction in medical insurance reimbursement has caused problems for physicians, barriers to accessing healthcare services, and challenges for Medicare recipients. To fully comprehend these issues, a thorough study according to Wiley-Blackwell (2010) is essential.

Medical insurance serves as protection against the financial risks individuals face when they incur high medical expenses during treatment. In order to ensure funds are available for healthcare benefits outlined in insurance agreements, medical insurers commonly utilize financial structures such as payroll taxes or monthly premiums. Central organizations within a country are responsible for managing the distribution of medical insurance benefits, which can include private businesses, government agencies, or not-for-profit entities. According to research conducted by the CBC, most Americans rely on private medical insurance as their primary source of coverage.Public programs primarily serve low-income children, senior citizens, and the poor (Kessler & Summerton, 2006). Currently, various groups in the USA are actively seeking solutions to address potential issues arising from a significant decrease of 40% in medical insurance reimbursement. These groups include economists, interest groups, physician organizations, and hospital organizations. The USA House of Representatives and Senate are separately working towards reducing expenses and reimbursements while also looking for long-term solutions. The main challenge lies in understanding how this reduction will impact providers who heavily rely on reimbursements such as physicians and hospitals. Since medical insurance plays a crucial role in generating revenue for healthcare facilities and providers, any potential reduction would have a substantial financial effect. Healthcare communities strongly oppose additional cuts due to their understanding of the consequences it would have on both the community and patients. Implementing a 40% reduction in medical insurance reimbursement has faced

resistance, making it challenging to implement. Health advocacy groups in the USA began assisting patients with navigating the medical system in the late 1990s to early 2000s, resulting in public problems related to finances. A study conducted in 2007 found that approximately 62% of Americans attributed financial issues and bankruptcy to unpaid medical expenses.
A surprising finding is that 92% of those who filed for bankruptcy had medical debts, while nearly 80% had medical insurance. This highlights the significant role of Medicaid and Medicare programs, which account for approximately half of national spending. Consequently, these financial challenges have caused confusion within the healthcare and medical insurance sectors.

To address these issues, President Barack Obama enacted America's Health Insurance Plans into law in 2010, making it mandatory for every American to possess some form of medical insurance. Failure to comply may result in substantial fines. The primary objective was to replace unpopular aspects of the American insurance system, such as pre-existing condition exclusions, premium weightings, and applicant screenings.

Another important legislation signed by President Obama was the Patient Protection and Affordable Care Act (PPACA). All these measures aim to streamline America's healthcare sector holistically (Kessler & Summerton, 2006).

Experts refer to one major problem plaguing American healthcare today as "perverse incentives". Currently, doctors and hospitals receive payments for each specific service provided – be it MRI scans, office visits, or time spent in the operating room. This fee-for-service approach creates an incentive for providers to order potentially unnecessary tests or perform surgeries that may not be required. Furthermore, it even rewards them for surgical errors made during procedures.Additionally, the readmission of a patient to the hospital leads to billable expenses

for the hospital administration. The high fees paid to doctors can also cause financial strain for hospitals (Kite-Powell, 2011). A proposal has been made to decrease medical insurance reimbursement by 40%, which would greatly affect patients. To address these negative effects on patients, both the hospital administration and government intervention are necessary in reducing fees paid to doctors for all services, including cases of patient readmission. By eliminating these 'perverse incentives', equality can be ensured and the nation's healthcare problems can be addressed.

Financial issues are one of the main concerns impacting healthcare, particularly regarding the reduction of medical insurance reimbursement rates. Comparisons between countries indicate that America's healthcare costs are 40% higher than those in other nations (Kite-Powell, 2011). As a result, more people are seeking treatment abroad in countries such as India and Germany. Despite the higher costs, there is no apparent improvement in health outcomes compared to other advanced countries. Lowering medical insurance reimbursements would significantly impact reform groups.

Healthcare savings can be achieved through reducing administrative expenses, cutting marketing and underwriting costs while focusing on prevention rather than solely treating acute diseases like cancer and heart disease.These issues are especially common in the US, a leading country in healthcare (Warner, 2012). The potential decrease in medical insurance reimbursement has significant implications for the community and patients. Three financial issues exemplify this impact: if insurance firms only cover 12% of costs, patients are responsible for nearly 88% of expenses; reduced medical insurance reimbursements would result in less money available to both patients and the community for healthcare services; renowned healthcare facilities that offer excellent care tend to charge excessively for certain prevalent acute diseases,

placing a heavy burden on patients. The potential decrease in medical insurance reimbursement will strain patients who will have to pay a portion of their bills. One solution is for hospitals to reduce administrative expenses and allocate resources towards assisting patients with acute diseases (Dedi, 2007). Physicians face challenges with Medicare and proposed funding solutions, including possible decreases in Medicare insurance reimbursements. Failure by Congress to act could lead to a 5% reduction in doctors' payments and medical insurance benefits, causing financial instability within medical practices. The federal government's proposed cuts would result in a 31% decrease in medical reimbursement.The American Medical Association has issued a warning that if the cuts to Medicare payment rates for physicians in 2013 are not adjusted for inflation, these rates would be less than half of what they were in 1991. Without addressing the issue of reduced medical insurance reimbursement, physicians' practices will be greatly impacted, which in turn will affect the community and patients, potentially leading to higher mortality rates. Many physicians' practices already struggle due to rising costs associated with professional liability. Therefore, it is crucial to address this issue for the viability and survival of physicians' practices. One major concern is the potential reduction in Medicare reimbursement, which puts access to healthcare at risk for older patients and children who rely on it. Between 2006 and 2009, physician Medicare reimbursement saw an estimated decrease of 4.8%. It is essential that before making any decisions, the government addresses physicians' concerns and ensures their satisfaction. Poverty is another crucial aspect that requires consideration as a clear plan must be outlined to prevent complications arising from a reduction in

medical insurance reimbursement. It would be unfair to reduce medical insurance reimbursements as not all individuals can afford top-quality healthcare. The federal government should consider certain individuals' circumstances before implementing any reductions as limited access to quality healthcare due to insufficient insurance coverage would greatly affect poor citizens.Medicaid benefits are not automatically granted solely based on poverty; specific eligibility criteria must also be met (Decker, 2007). In the USA, Medicaid does not fully provide healthcare services for impoverished individuals unless they fall within a specific eligibility group. The reduction of medical insurance reimbursements not only leads to subpar healthcare but also leaves citizens with no alternatives. This decrease also directly impacts the community's living standards, particularly in relation to poverty. When medical benefits are reduced, the community's life standards decrease and mortality rates increase due to increased susceptibility to diseases.

Legal issues surrounding healthcare must be considered when discussing the issues that affect patients and the community as a whole. The National Health Law Program, working with healthcare advocates and policy makers, has been educating consumers on the benefits provided by the Affordable Care Act (ACA). The ACA ensures that healthcare costs adhere to the law and protects consumers from unfair practices by medical insurance companies. Additionally, it promotes better coverage for preventive care and allows young adults to remain on their parents' insurance plans up until age 26.

In the USA, there is a current focus on women's access to proper healthcare, which has received legislative attention and media coverage (Warner, 2012).The focus on healthcare in the United States is a priority issue that has been part of President Barack Obama's policies since the 2008 presidential

election. Despite high annual costs, there are still a significant number of Americans who do not have health insurance, which raises concerns about rising healthcare costs. The federal government allocates a larger portion of its budget to healthcare compared to other sectors and projections suggest that spending per citizen will increase by close to 17,000% by 2017.

Reduced access to medical benefits negatively impacts community life standards and increases mortality rates due to heightened vulnerability towards illnesses. When discussing matters affecting patients and society as a whole, it is crucial to consider the legal implications related to healthcare. The National Health Law Program collaborates with advocates and policymakers in order to educate consumers about the benefits provided by the Affordable Care Act (ACA). This act ensures adherence of healthcare expenses with legal regulations while safeguarding individuals from unjust practices exercised by health insurance companies. Additionally, it highlights improved coverage for preventive care and allows individuals below 26 years old to remain included in their parent's insurance plans.

Currently, there is increased attention on women's accessibility to appropriate healthcare in the United States. This issue receives both legislative attention and media coverage (Warner, 2012).The emphasis on healthcare has been a priority for President Barack Obama since the 2008 presidential election. Despite significant costs, a large portion of Americans still lack insurance, raising concerns about increasing healthcare expenses. The federal government devotes a significant portion of its budget to healthcare and it is predicted that spending per citizen will increase by almost 17,000% by 2017. Around 60% of Americans rely on employer-provided health insurance while approximately 27% are covered by government programs like Medicaid. Studies have shown that nearly

83% of insured Americans are satisfied with their coverage (NB & MB, 2006). The discussion surrounding healthcare sector reform in the USA is now closely linked to capital budgeting. Efforts by the US administration to control rising costs have led to increased scrutiny of the industry. Many citizens in the USA cannot afford healthcare due to high costs and it is viewed as more than just a necessity for survival. Inadequate capital budgeting policies can have severe consequences for hospitals as rising costs and decreasing government revenue negatively impact their financial performance when funds are limited. Therefore, it is crucial for the government to develop a strategic plan that includes cost reductions and wise allocation of funds.The absence of a plan may result in hospitals facing dire situations (Westin, 2005). Capital budgeting is crucial for evaluating investments related to healthcare expenses, such as healthcare reforms and reductions in medical insurance reimbursement rates in the USA. Analyzing scenarios involving hospitals is important to better comprehend capital budgeting within the US healthcare industry. The human resources department may propose incorporating a daycare facility for employees with children, which could reduce employee turnover rates and attract nurses to the hospital (Dedi, 2007). Additionally, acquiring more CT scanners can enhance imaging services and alleviate bottlenecks in various departments. Depending solely on one scanner increases tension among employees and the risk of breakdowns. It is also necessary to consider maintenance costs, overhead expenses, and overtime payments (Decker, 2007). Moreover, doctors purchasing an exceptional machine that eliminates the need for house hospitalization can decrease hospitalization and costs for patients. As part of addressing proposed funding cuts (K & M, 2010), the

hospital aims to lower variable costs by only retaining the sickest patients in-house. Addressing these impacts requires taking into account financial, legal, and healthcare costs.The USA Agency for Healthcare Research and Quality organized a meeting to develop a strategy for optimizing data availability in order to implement healthcare reform.Accurate data collection is vital for informing and monitoring healthcare reforms in the USA. The text discusses various aspects of the country's healthcare system, including insurance coverage, care delivery, and outcomes. MEPS (Medical Expenditure Panel Survey) provides information on insurance coverage, utilization, and expenditure by employers and patients. Recommendations aim to improve databases and simulation methods related to insurance coverage and expenditures. Attendees suggest enhancing the longitudinal design and clinical information in the database system.

In the USA, there are different healthcare models aimed at reducing costs. For instance, the National Health Insurance Model utilizes private sector providers with payment from a government-run insurance program funded by citizens' contributions. These programs mentioned in the text are more affordable and have simpler administration compared to profit-driven American insurance companies (Kite-Powell, 2011). Acting as a single payer system with substantial bargaining power, these programs result in lower prices and cost reduction.

Canada serves as an example of successfully negotiating lower prices from pharmaceutical companies, leading Americans to seek cheaper drugs in Canada. However, national health insurance plans with this approach may impose limits on covered medical services and patients may experience wait times for treatment.The Beveridge Model, developed by William Beveridge, is a type of healthcare system where the government provides and finances healthcare through tax payments. This model is similar to how public libraries and police forces operate. While some

clinics and hospitals may be privately owned under this model, many are under government ownership. The United States' Veterans Administration exemplifies the application of this model in socialized science medicine and healthcare.

Another widely implemented model, known as the Bismarck model, can be found in countries like Germany, Switzerland, Belgium, and Spain. Unlike the profit-driven healthcare insurance system observed in the United States, the Bismarck model ensures coverage for all individuals without prioritizing profits.

In January 2006, the USA Medicare Payment Advisory Commission recommended increasing physicians' rates to address potential reductions in Medicare Insurance Reimbursement. They projected a 3.6% increase in practice expenses and emphasized considering doctors' welfare in healthcare provision and medical insurance. Senator Edward M. Kennedy also opposed cutting physicians' reimbursements.

Furthermore, there are plans to expand USA Medicaid by 2013 to cover around 16 million lower-income citizens.Numerous studies indicate that efficient healthcare management can prevent a significant 40% decrease in medical insurance reimbursement while enhancing its quality. To achieve this, key factors such as the meaningful use of information technology, redesigning payment systems (both private and public), and prioritizing prevention are crucial. By streamlining the administrative system, substantial savings can be redirected towards patient welfare, potentially saving more than ten billion dollars. Additionally, encouraging individuals to seek healthcare from larger firms may aid in cost reduction. Taking preventive measures effectively reduces the need for medical care in the first place. Considering these approaches assists in mitigating the impact of potential reductions in medical insurance reimbursement. However, an alternative solution within the healthcare system itself exists. By implementing a reform bill that focuses on controlling healthcare costs with minimal expenses associated with it, we can effectively

address the issue of reduced reimbursement. In conclusion, this report's thesis statement asserts that reducing medical insurance reimbursements would have negative consequences for citizens. The report underscores various problems that would arise if funding cuts occur. It is imperative for the government to allocate sufficient funds for healthcare provision and develop effective strategies to mitigate the effects of reduced funding.
It is imperative to address the issue of excessively high healthcare costs in the USA, which surpass those of other countries by 40%. Reforms need to be put into place to guarantee that all citizens can access quality healthcare. In addition, adequate funds should be allocated by Congress for the healthcare department.