Running Head: HEALTHCARE SYSTEM Healthcare System of the of the Healthcare System What is the public’s view of the U.S health care system
We must acknowledge the limitations of our current health care system even as we work to reform it. The perception of the public is that the system is rife with both inefficiency and inequities. Widespread inappropriate and unnecessary care exists side by side with substantial "under care." U.S current patchwork system forces public to take each target group–men, older women, minorities, children–and fashion separate strategies to fill the gaps and address the special needs of each group. But they must recognize that such strategies are ineffective in the face of the flaws in our present healthcare system, which ultimately must be fundamentally overhauled. (Hanchak,1996)
Neglecting public’s health is not only inefficient, but also takes a terrible toll on the quality of life, generates human suffering, and leads to premature deaths. Controllable chronic illnesses, such as hypertension, diabetes, and asthma, go unchecked, generating serious adverse health effects. The incidence of all these problems is much higher among men of color, creating a deep national health crisis that is generally obscured from public view.
How was that perception shaped by the insurers
The high rate of medical errors in U.S health care system is no secret to insurers and their reinsures. Medical-malpractice insurers pay liability claims to patients injured by medical errors, and health insurers pay for the additional treatment to deal with the medical complications of those errors. Health-care costs represent about one-half that figure, with the rest accounting for lost income, lost household production and disability costs. Nevertheless, insurers’ efforts to reduce medical errors did not receive much attention. Health insurers are feeling pressure from private and public purchasers as well as the National Committee for Quality Assurance, which is changing its accreditation requirements to include patient safety. Physicians and hospitals are seeking help from medical-malpractice insurers in identifying problems and implementing risk-management programs.
How was that perception shaped by the provider groups
A crucial threshold issue is whether even to have a separate appeals system for provider disputes over payment and other issues. Specifically, providers may want to challenge coverage and other decisions and policies of health plans and payers, particularly if denied payment for services already provided and precluded from recovering payment from patients. Providers also may want to challenge an adverse health plan coverage policy or even governing medical practice guidelines prospectively on behalf of patients, particularly when organized provider groups believe that coverage policy is inconsistent with good medical practice. (Hanchak, 1995)
Adjudication of provider disputes over selection by health plans. Provider disputes over health plan selection policies and practices may be more prevalent than payment disputes. Many states now have "any willing provider" laws that prohibit health insurers from excluding providers willing to meet plan contract terms from participating in any state regulated health insurance plans. However, these statutes would probably be preempted by federal health reform legislation in order to permit health plans to contract with specific providers and achieve discounts needed in cost savings.
How was that perception shaped by the purchasers of healthcare
U.S. Healthcare’s current membership includes more than 2,250,000 fully insured members, 130,000 Medicare members, 86,000 Medicaid members, 10,000 State-sponsored uninsured children, and more than 500,000 employees of self-insured employers who contract with U.S. Healthcare for medical management services.. Small and large employers, as well as government agencies, are the primary purchasers of the company’s health plans. These purchasers have begun to demand value (cost and quality) for the increasingly large number of dollars they spend on health care. U.S. Healthcare’s premise is that by emphasizing quality, both improved member outcomes and cost savings will follow. In this way, U.S. Healthcare has balanced the ‘incentive for cost-effective delivery of care with the incentive to maximize quality.
Hanchak, NA.: Managed Care, Accountability, and the Physician. Clinics of North America 80(2):245261, March 1996.
Hanchak, N.A, and Schlackman, N.: The Measurement of Physician. Performance. Quality Management in Health Care 4(1): 1-2, 1995.