Discussion 5.1 Response to Cyndi
Demonstrates building on peer postings and extending the discussion.
Questions posed are thoughtful and relevant. Includes substantial factually correct content which demonstrates evidence of comprehension, application, and/or appraisal.
Includes evidence of self- reflective content which demonstrates views, beliefs, and/or feelings.
Interaction demonstrates respect and sensitivity to others.
Healthcare differs from other consumer transactions in several ways. When a person buys a consumer product other than health care, he or she has the freedom to choose, and they can choose a service based on accessibility, value, and quality. (CrashCourse, 2016). In healthcare options are limit, if you need health care services you will go to the nearest physician or hospital. You do not have the option to choose the cost of the service. The most common place where anyone can get health care is through employment. One of the advantages of the Affordable Care Act is that it screens people in accordance with income and it provides plans that are affordable to your level of income. The affordable care act helps them with discounts depending on the poverty level. Another good thing about the affordable care act is that is a marketplace that you can choose the best plan that fits your healthcare needs rather than just a single payer. Private insurances workout plans with companies and depending on the plan that the company picks that’s the plans that they offer to their employees. Often these plans do not give employees a lot of choices to pick from. The marketplace on the other hand was created by the Affordable Care Act which provides options to individuals depending on their own needs.
Individuals who chose not to have health insurance were required to pay a penalty each year. Beginning in 2014, businesses with 50 or more employees and at least one employee who qualify for a tax credit were required to provide affordable health insurance or face a penalty. The idea was too many American citizens can afford health insurances. The Affordable Care Act (ACA) aims to expand health coverage by requiring private health insurers to insure individuals regardless of pre-existing conditions, and by lowering the cost of insurance for healthier people in the same age range. (Nickitas et al, 2018, P. 146).
Insurances created higher premiums for individuals that use medical insurance often. A person with high premium has a lower deductible making them share costs with the insurance company sooner than those with lower premiums. A person with lower premium has fewer options but a high deductible to choose from. Insurance often offers copayments depending on the plan that they have work with each company. These companies often just take the copayments for each visit with no further charges. Other visits have a percentage that individuals must pay but it will count towards their deductible.
People take advantage of insurance by overusing unneeded health services, causing the insurance company to go bankrupt. As a result, moral hazard was addressed by establishing deductibles and copayments. The Aka subsidizes health insurance premiums for those who cannot afford to pay market prices. Insurances have the options to choose from PPO to HMO depending on what works best on the person and their medical needs. The majority of PPO plans have a copayment while HMOS have a percentage of payments of their visit. This resulted in a reallocation of government funds, which could have an influence on other government programs because Medicare and Medicaid needed additional financing to cover the health care needs of underprivileged children and the elderly (Kaiser family foundation, 2012).
Through the Centers for Medicare and Medicaid programs, the government controls costs, and services. The hospital pays a set fee for specific diagnosis depending on the information that this patient would take to recover. The government can use this to monitor the quality of services offered by hospitals to individuals and ensure that the hospital does not discharge patients early to make more money or have a re-admission (CrashoCourse, 2016).
CrashCourse.(2016, April 6) The economics of healthcare: Crash course econ#29 (video file). Retrieved February 5, 202, from https://www.youtube.com/watch?v=cbBKoyjFLUY
Dogra, Anjali P, and Todd Dorman. “Critical Care Implications of the Affordable Care Act.” Critical Care Medicine, U.S. National Library of Medicine, Mar. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764431/.
Kaiser Family Foundation. (2012, April 24). Policy and political implications of the Supreme Court case on the Affordable Care Act (video file). Retrieved on February 5, 2022, from https://www.youtube.com/watch?v=PU8cmaNY45c
Nickitas, D. M., Middaugh, D. J., & Feeg. V. D. (2018). Policy and politics for nurses and other health professionals: Advocacy and action (3rd. ed. pg.146). Burlington, MA: Jones & Bartlett Learning
It is accurate to state that there are a lot of differences in healthcare matters. Healthcare comes with its own cost, and the differences are linked to income level. However, the Affordable Care Act provides a platform whereby individuals get better and equal services regardless of their income. These insurance companies are more on providing better services to the clients and with regards to matters healthcare. In enacting the health insurance policies, their government comes in place to ensure that different employers pay for their employee’s health insurance and failure to which there are penalties awarded. The initiative has been imperative in creating better healthcare outcomes for patients regardless of their financial situation.
However, we can agree that the insurance firms sometimes have unfair plays, especially on individuals who often use the plan. The effects come around because of the high premiums and lower deductibles, thus making share costs lower than the premium. Fewer options make the patient have fewer options in accessing better treatment, thus affecting their overall healthcare outcome (Dogra, & Dorman, 2016). On the other hand, the issue of overusing the unneeded health services tends to disadvantage other users more so those who use the service often. There is a need to CAP these issues and ensure that the services are used appropriately to eliminate disadvantages for the patient and the company. Additionally, PPO plans are essential to healthcare and the overall payment plans. Basically, PPO and HMO work hand in hand to push for better reallocation of governmental resources, which fuels the likes of Medicare and Medicaid. The initiative relieves the patients from financial burden, especially the underprivileged children and the elderly.
Dogra, A. P., & Dorman, T. (2016). Critical care implications of the Affordable Care Act. Critical care medicine, 44(3), e168.