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Policy Structure in the Healthcare System

The responsibility of the policy-making process is the prerogative of the United States Department of Health and Human Services (HHS) which is regulated by a secretary who submits directly to the president. Governmental policy within healthcare has its benefits and challenges, such as various healthcare laws, regulations, acts and high medical expenses and bills for people. On the one side, the U.S. government, by policy-making, develops programs for medical support such as Medicaid or Medicare, which help some low-income citizens fully or partly cover their healthcare expenses. On the other side, the head of the country does not make them available for every person in need, therefore, many people remain with low chances of getting medical aid. Additionally, hospitals, healthcare regulations, and laws differ from state to state, and sometimes state regulations drastically differ from federal ones, which makes the USA healthcare policy even more compound.

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An example of a difference in healthcare policies of various states is the certificate-of-need and related laws. Such a certificate is a legal document that is required in some states before a medical provider can interact with new facilities or services in any way, such as building, expanding (Stratmann and Backer 1). His research proves that people from states with the presence of CON laws are 3-4 times more likely to travel outside their counties to obtain imaging services than citizens of non-CON states (Stratmann and Backer 1). In conclusion, the regulations within healthcare differ from state to state, and although the policy-making process can be considered citizen-oriented, it shows some discrepancies as well.

Some of the most important features that build high medical costs are federal and state bills in the healthcare sector. Bills apply to all patients regardless of their race, age, financial situation, and other factors, and even supportive organizations such as Medicare or Medicaid practice them as well. Kliethermes argues that Medicare billing processes are a common practice for the healthcare system of the United States (58). The bill is taken for any kind of medical service, and the costs are counted according to various criteria concerning the patient’s situation. Such taxes increase the USA’s GDP and heighten the profit for organizations as well. However, they create limited access to medical treatment in the country as many people simply cannot afford to pay high sums of money to various organizations, hospitals, and the government.

Additionally, the taxes raise citizens’ dissatisfaction with the healthcare system. For example, the known surprise medical bills are implemented in many hospitals across the United States and refer to unexpected expenses when the patient receives medical aid from an out-of-network physician (Steinbrook 1465). Although their cost varies from patient to patient, the requirement of higher medical expenses is usually a surprise for former patients. It has some advantages for hospitals, such as higher financial support and the ability to afford more modern facilities, however, some disadvantages also occur. The risks mostly concern the patients for whom it is impossible to cover all costs, even with their insurance.

The government considered challenges more crucial than benefits, therefore, a No Surprises Act was introduced and will take full effect in 2022. It aims to stop those Surprise Medical Bills and prevent patients from getting high medical costs for their treatment. Steinbrook states that in 2019 at least nine states had enacted and utilized laws with an innovative approach to the “surprises,” and four more states enacted the same regulations (1465). Therefore, federal and state policies provide modernizations in the healthcare system that sometimes aim to heighten the profitability for the government and sometimes to broaden the access to medical aid for all citizens.

Works Cited

Stratmann, Thomas, and Matthew Baker. “Barriers to Entry in the Healthcare Markets: Winners and Losers from Certificate-of-need Laws.” Socio-Economic Planning Sciences, vol. 77, no. 101007, 2021, pp. 1-10. Web.

Steinbrook, Robert. “Ending Surprise Medical Bills.” JAMA International Medicine, vol. 179, no. 11, 2019, pp. 1465-1466. Web.

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Kliethermes, Mary Ann. “Understanding Health Care Billing Basics.” Pharmacy Today, vol. 23, no. 7, 2017, pp. 57-68. Web.

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