Introduction
American health insurance has been a common topic for discussion during the last several decades because of various internal and external factors affecting care quality and access. In this paper, attention will be paid to the history of the U.S. health care system, current reimbursement methodologies, technological advancements, costs, and operational changes. It is not enough to explain recent modifications but to demonstrate what decisions to make to stabilize U.S. health care and ensure the feasibility of the offered ideas. According to Feldstein (2012), national health insurance (NHI) should be examined through three aspects: population groups, health care costs, and equitable financing methods. Despite the intention to create equal living and care conditions, some Americans remain uninsured even after applying the Affordable Care Act (ACA) (McIntyre & Song, 2019). At this moment, the United States cannot implement universal health insurance coverage as many other European countries do, and the transition to an approved health insurance form is highly promoted. Although the legislation does not effectively support NHI steps in the country, the implications on access, utilization, technology, cost, and reimbursement continue developing to enhance successful operational changes and positive outcomes.
The Impact of Legislation on National Health Insurance
In the United States, many attempts have already been made to create solid legislation to support the development of a proper health care system and apply adjustments if necessary. In the middle of the 20th century, two government NHI programs were introduced: Medicaid and Medicare (Wray et al., 2021). There are situations when health insurance from employers is impossible or terminated, and individuals should define additional sources of financial support and professional help. Medicaid offers comprehensive care to people from low-income families and meets their main health needs. Medicare is another way to support older adults aged 65 and older. Both programs allow cost reduction, care promotion in urgent cases, and control of rising medical requirements (Feldstein, 2012). When federal and state governments have to raise taxes, they face additional challenges of increased deficits and subsidies for new medical services (Feldstein, 2012). As a result, NHI would be characterized by serious financial instability but high efficiency with time. Equitable modifications to Medicare and Medicaid and redistributive programs will help avoid past mistakes with Medicare and Medicaid and choose the best NHI alternatives.
In American history, there are many cases when NHI proposals failed or promoted positive shifts. One of the most remarkable achievements was the decision of Barack Obama to implement the ACA in 2010 (McIntyre & Song, 2019). Most Americans define this law as a critical mark on the current health care system because of the possibility of expanding insurance coverage and improving the conditions under which care is delivered (McIntyre & Song, 2019). The ACA focuses on reforming the private insurance market and expanding Medicaid coverage (Feldstein, 2012). This legislation turns out to be an effective solution to improving individual medical decisions and reducing mortality ratings among uninsured Americans (Wray et al., 2021). Thus, it was expected to see positive shifts in private insurance coverage and implement NHI programs successfully.
Expanding Medicare and Medicare with the help of the ACA has become one of the most recognizable changes during the last several decades in the American health care system. On the one hand, the number of private insurance purchases has increased; on the other hand, employer-based insurance plans have decreased (Garfield et al., 2019, as cited in Wray et al., 2021). Some coverage gaps were closed, but many concerns remain open, questioning the worth of legislation for NHI. The ACA and the expansion of Medicare and Medicaid seemed to be a good idea to help uninsured people in theory. However, in practice, it was hard to achieve the desired goals and protect all Americans, which challenges the supporters of NHI today.
The Implications of National Health Insurance
The implications of NHI on different aspects of health care vary, depending on what has been already achieved and what must be changed soon. For example, comparing care access before Medicare/Medicaid, before the ACA, and after the offered programs, some changes could not be ignored. According to Wray et al. (2021), Medicaid contributed certain benefits to individuals with no insurance, but it hardly covered the costs of special services compared to national coverage. Following the example of Veterans Health Administration (VHA) coverage, NHI programs will offer more benefits to patients with special needs (Wray et al., 2021). Medicare beneficiaries (older adults) can use their insurance to cover various preventive services (cardiovascular and cancer assessments) and chronic disease treatment costs (diabetes and hypertension) (Fong, 2019). Although patients with private insurance report poor care access and high care costs compared to publicly sponsored insurance programs, it is wrong to believe that all implications are positive (Wray et al., 2021). NHI changes would create better options for patients in terms of access and cost to save people’s time, reduce payments, and cover all health problems.
National health reforms in the American health care system provoke positive changes in utilization and growth. Park et al. (2020) use dementia patients for examination to show that the owners of advanced insurance plans have lower utilization compared to individuals within traditional insurance programs. They report high satisfaction levels and better health statuses because care is efficiently delivered (Park et al., 2020). However, no significant changes are related to growth issues because the chosen programs hardly cover the needs of younger populations in the United States. It is the goal of NHI in the United States to expand patient age and support growth.
Technological advancement cannot be ignored in the modern implications of NHI. During the pandemic, adequate services had to be presented to all patients in isolation (Darwish et al., 2021). The current situation requires high-level professionalism of care providers to understand the worth of advanced health technology. Telehealth implementation reveals new privacy concerns and the inability to educate people in all the necessary aspects. Therefore, NHI would help cover the gaps in knowledge and practice and discover the most appropriate forms of communication between care providers, patients, and their families.
National health insurance may be considered another human right to be offered to all citizens of the United States. The advantages of this insurance approach include low costs of health care, life improvement, affordable care services for all individuals, and economic productivity in terms of public health (Feldstein, 2012). At the same time, challenges in documentation, the inability to control national debt and deficit, additional resources to manage wait time for services, and increased taxes challenge the system (Feldstein, 2012). Many European countries are able to accept NHI because of high taxes and improved legislation. In the United States, not all communities are ready to accept such conditions and follow the norms. Therefore, the feasibility of most NHI implications is not as strong and definite as it is expected. Additional reimbursement strategies and operational changes have to be promoted.
The Necessity of Reimbursement Changes
Considering a favorable background for creating NHI in the United States, several reimbursement changes should be mentioned. Any improvement has its price, and the task of modern policymakers, care providers, and administrators is to define what changes should be implemented to reduce losses and decrease costs. For example, diagnosis-related groups and multiplayer systems were chosen as Medicare reimbursement methods (Feldstein, 2012). In the NHI context, the method of reimbursement would prevail over the Medicare or other insurance program’s methods to eliminate price competition and promote price discrimination (Feldstein, 2012). These strategies would allow offering various charges for various people, depending on particular demographic and economic factors. Audit results would define medical expenses and populations’ possibilities under a particular condition. Cost-based reimbursement might help the payer cooperate with the provider and pay for services that are offered at the moment. However, prospective payment seems to be a more rational reimbursement strategy for NHI because patients can learn about the services and their prices before the procedure, except in urgent cases when professional help is required.
The United States is one of the most successful developed countries across the globe. Thus, it is possible to observe the examples of other nations and their attempts to implement NHI. The South African example proves the effectiveness of three sources of reimbursement policies: discharge summaries, patient folders, and source registers (Nicol et al., 2021). This study proves that the more information about patients is gathered during the first appointment, the better further collaboration can be. In the United States, such methods are characterized by easy implementation because most medical facilities have electronic record systems with patient data being properly stored. The only requirement for NHI supporters to discuss is the question of privacy and the distribution of personal information.
The Necessity of Operational Changes
Operational changes must be properly identified and implemented in the health care system to ensure that the country is ready for national health insurance. These modifications would affect the structure, human resource management, and financial options. The government should take responsibility for the main organizational changes and begin with promoting a refundable tax credit approach (Feldstein, 2012). This idea would help generate larger federal tax refunds than regular annual taxes. Such change should help individuals with different incomes to buy health insurance even if they have no tax liability (Feldstein, 2012). All families would get an equal amount of money, and such credit is supported and increased by the conditions defined in the ACA.
Another organizational change would address health insurance levels and make everyone have a minimum level as a part of an individual mandate. There are many examples when people have substantial financial resources and the possibility to buy health insurance but decide not to do so because of personal preferences (Feldstein, 2012). Therefore, it is necessary to make individuals provide themselves with national health insurance, which contributes to improved employment conditions and reduced costs on insurance premiums for employees. Finally, an insurance exchange idea would be promoted to make it possible for insurers to offer different types of programs for the same individuals. This change would promote competition between insurance organizations and allow ordinary citizens to analyze their opportunities regardless of their current risks and incomes.
All stakeholders in the health care system, including physicians, hospitals, insurers, patients, and the government, play an important role in the transition to national health insurance in the United States. Physicians would use medical and scientific knowledge and strengthen ethical training to identify and meet the needs of underserved populations. Hospitals would ensure that all patients, regardless of their demographical and economic factors, get an opportunity for the continuous availability of services. Insurers must address negotiations as a possible way to establish communication between patients and the hospital staff. The government’s role has already been discussed, and patients should understand that their contributions to the national health insurance transition are also critical. They become meaningful participants in the process because they are related to the mandate of buying at least some insurance on their own.
Conclusion
In general, the U.S. health care system has undergone significant improvements and changes during the last several decades. Most stakeholders have recognized their roles and continue making some contributions to promote a high quality of life and positive health outcomes. However, compared to other developed and developing countries, the United States is not ready to take a step and accept national health insurance so care can be accessible to everyone. Many physicians need to decrease their earnings, and patients should take certain actions to cover their basic insurance obligations, following new reimbursement strategies. Analyzing the impact of Medicare and Medicaid, the ACA would not be enough to create appropriate conditions for national health insurance transitions. Thus, the participation of the government and cooperation with patients, insurers, and physicians are required to identify if national health insurance would be beneficial for Americans.
References
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