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Healthcare Public Financing and Insurance

Public Financing

Bodenheimer and Grumbach (2012) specify that there are four ways of paying for the health care services; they are out-of-pocket payments (paid personally by the recipient of the care), individual private insurance that covers the services provided, group insurance paid by the employer, and government financing. According to WHO (2015), the lack of public (or government) financing of healthcare tends to result in such issues as the cost recovery by the medical institutions which triggers to policies that promote the charging of user fees. Also, when public financing is unavailable, the private sector begins to take over the facilities and privatize them. That way, the role of the marker forces in the field becomes stronger due to the implementation of the market user fees (WHO, 2015).

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In the United States, the coverage of the individual care has become better over the last years; as a result, more patients became able to obtain insurance provided either by the employers or privately purchased, and in turn, their spending grew by 3-5% over the last several years (NCSL, 2016). The coverage by the government-financed programs such as Medicare and Medicaid made healthcare services easier to access and more available to the populations who tended to be underserved or vulnerable in this area.

For example, all the people who are older than 65 are eligible for Medicare part A if they have Social Security. That way, a large section of the population is covered automatically and given the opportunity to obtain health care as soon as the need for it arises. At the same time, the institutions that are funded publically are subject to many policies that force them to provide more careful care to avoid a waste of resources.

Health Insurance

When it comes to the eligibility for Medicare and Medicaid, the immigrants who are legally present in the United States are covered; the low-income individuals are eligible for the premium tax credits when their income is 400% of FPL (federal poverty level) (Coverage for lawfully present immigrants, n. d.).

In the United States of America, there is a large portion of the population that does not have health insurance. This tendency occurs because health insurance is quite expensive and many people simply cannot afford it (The Uninsured and the Difference Health Insurance Makes, 2012). The majority of the population who are insured obtain their health insurance with the help of their employers; however, the individuals who do basic jobs and have low salaries are at risk of not being provided with health insurance at all (The Uninsured and the Difference Health Insurance Makes, 2012).

Due to the fear of high-priced services and large medical bills, the uninsured population is more likely to postpone visits to a doctor and have more negative health outcomes (The Uninsured and the Difference Health Insurance Makes, 2012). At the same time, the populations covered by private insurance or a health program, do not have such a problem. However, those covered by the health programs may receive limited care due to the policies that standardize the costs of services provided in each specific case.

The implementation of HIE requires specifically outlined objectives and goals; when it is used for the collection of data, it is crucial to determine the main focus of the information gathered, the criteria based on which it will be assessed, and the people who will be involved in the evaluation process (Vest & Gamm, 2010).

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Bodenheimer, T., & Grumbach, K. (2012). The health care workforce and the education of health professionals. In T. Bodenheimer & K. Grumbach (Eds.), Understanding health policy: A clinical approach (6th ed.). New York, NY: McGraw-Hill Medical.

Coverage for lawfully present immigrants. (n. d.). Web.

NCSL. (2016). The Uninsured and the Difference Health Insurance Makes. Web.

Vest, J. R., & Gamm, L. D. (2010). Health information exchange: persistent challenges and new strategies. Journal of American Medical Informatics Association, 17(3): 288–294.

WHO. (2015). Strategy on health care financing. Web.

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