Executive summary
The current issues with health care prices and money are issues of concern in this article, along with solutions. The healthcare system must be changed to become more accessible, affordable, and equitable. The primary issue is the unaffordable increase in healthcare prices, which has increased consumers’ out-of-pocket expenses and made it more difficult for payers to fund treatment adequately. Based on the authors’ backgrounds, the article presents consensus-based policy suggestions on health finance and costs. This research aims to examine the issues and suggestions for financing health care in the United States. The writers examine the condition of healthcare expenditures and how they are paid for in detail, taking into consideration the many solutions that have been proposed to address this significant issue. They also consider politics and its impact on health care reform. The writers provide the incoming government with some recommendations on how to pay for and pay for health care. They include initiatives to reduce bureaucracy, introduce value-based payment systems more quickly, and improve the clarity of health treatment. The authors also urge the future administration to ensure that resources are appropriately distributed and that the disadvantaged have improved access to healthcare. Important elected officials and political appointees get suggestions for achieving each aim from the publication. These concepts might serve as a springboard for developing evidence-based policies that enhance the American healthcare system’s effectiveness, fairness, and quality.
Finally, this essay offers several recommendations for the next government to consider as it addresses the significant issue of increasing healthcare expenses and a lack of funding in the US.
Introduction
With an expected $3.8 trillion in healthcare costs in 2019, the United States has the highest costs in the world (Kearney, 2020). Customers’ out-of-pocket expenses have increased due to this unsustainable increase in healthcare expenditures, and payers’ capacity to finance treatment effectively needs to be improved. Many reasons, such as growing healthcare expenses, greater demand for healthcare services, and a lack of transparency and accountability in the healthcare system, have escalated the problem. Healthcare expenses are also rising due to an ageing population and an increase in the frequency of chronic illnesses (Dzau et al., 2021).
Redesigning the healthcare system to improve accessibility, affordability, and justice is both an urgent necessity and an exciting opportunity. There is optimism that the problem of health care expenses and finance will be dealt with more thoroughly and successfully under the incoming government. By exploring current issues with health care finance and expenditures in the United States, this essay aims to do just that (Kearney & 2020, 2020). We analyze the present state of healthcare finance and expenditure, research the factors that influence price increases, and analyze the initiatives put in place so far. The political environment is examined today and how it may affect healthcare reform (Dzau et al., 2021). Lastly, we provide many suggestions for the next government to consider while addressing healthcare costs and finance.
The issue, need, or objective
The unsustainable increase in healthcare prices, which has increased consumers’ out-of-pocket expenses while making it more difficult for payers to cover the total cost of treatment, is the main issue being addressed (Keehan et al., 2020). The authors provide consensus-based policy suggestions on health costs and funding based on their combined expertise in health finance, delivery, and innovation. This paper’s objective is to provide the incoming administration with evidence-based policy suggestions that will aid in lowering healthcare costs while boosting access to care.
A decision that needs to be made
In response to these problems, the National Academy of Medicine has launched Vital Directions for Health and Health Care: Priorities for 2021, a follow-up to the 2016-launched Vital Directions for Health and Health Care project (Dzau et al., 2021). In this article, the author offers a variety of policy proposals based on their knowledge of healthcare funding, delivery, and innovation. Our suggestions for changing the American healthcare system are based on usability, affordability, and equality.
Recommendations
Access
Health care coverage for all Americans is a fundamental right. Nonetheless, the number of Americans lacking health insurance is rising. The number of uninsured is projected to increase from its 2016 low of 28.7 million (8.9 per cent of the population) to a peak of 37.2 million (10.6 per cent of the population) in 2028. (Keehan et al., 2020). This occurs when evidence is mounting that insurance increases one’s safety net, quality of life, and lifespan (Sommers et al., 2017).
Affordability
Health care at a reasonable price should be available to every Citizen. However, healthcare costs are rising at an unsustainable pace. While budget increases initially slowed due to the Affordable Care Act, they have recently picked up speed again (Keehan et al., 2020). The growing national debt, stretched federal, state, and municipal budgets, wage stagnation, and greater financial insecurity for Americans are all well-established results of this acceleration (Medicine & America, 2013). Medical treatment costs are rising, even for people with health insurance. Around half of all individuals in the United States have either put off or wholly avoided medical treatment because of its high cost (Kearney et al., 2022)
Equity
Affordable health care for all Americans should be a national priority. Unacceptable gaps persist, however, regarding who has access to care and who benefits from it based on race, ethnicity, socioeconomic level, and other factors (AHRQ, 2018). The current COVID-19 epidemic has made this point quite clear since it has disproportionately affected communities of colour and those who live in poverty (Azar et al., 2020)
Access, affordability, and equality are interconnected. Complementary enhancements exist. Access improves equity (Buchmueller & Levy, 2020)—some dispute. System-wide access expansion is expensive. Notwithstanding inherent trade-offs, researchers think there are ways to increase access, affordability, and equality.
Key Policy Priorities
The article sought policy proposals that would enhance all three areas.
Expand Insurance Coverage
Expanding insurance coverage is essential for ensuring all Americans access affordable health care. Multifaceted and economically sensible measures to bridge the widening coverage gap are necessary but confront substantial hurdles (Sommers et al., 2017). The new administration should support policies that expand insurance coverage, such as expanding Medicaid in all states, increasing subsidies for private insurance plans, and introducing a public option. Additionally, the new administration should ensure that these policies are targeted towards those most needing health care coverage.
Accelerate Transition to Value-Based Care
The transition to value-based care is crucial for controlling healthcare costs and improving quality. Value-based care models reward healthcare providers for the quality of care delivered rather than the number of services provided. First, most alternative payment models remain anchored in a fee-for-service architecture. Only 5 per cent of healthcare payments in 2018 were population-based (for example, global budgets) (Freed. Et al.2021). Broader adoption of advanced population-based payment is needed. Second, the penetration of value-based payment lags among commercial and Medicaid payers. Finally, there are growing concerns that specific value-based payment models may exacerbate inequities or penalize organizations that care for vulnerable populations (Sommers et al., 2017). Value-based payment help must ameliorate, not exacerbate, disparities. The new administration should support policies that accelerate the transition to value-based care, such as increasing the use of bundled payments, expanding the use of alternative payment models, and encouraging data-driven decision-making.
Advance Home-Based Care
Home-based care has been shown to reduce costs and improve the quality of care for patients with chronic conditions. Home-based care can also reduce hospital stays and improve overall health outcomes. It will be essential to ensure that reimbursement policies position telehealth as a substitute for more expensive and less accessible care sites and do not induce unnecessary spending and utilization (Sommers et al., 2017). The new administration should support policies that promote the adoption of home-based care, such as incentives to providers, telehealth expansion, and reimbursement reform.
Improve the Affordability of Drugs and Other Therapeutics
The high and rising cost of drugs and other therapeutics is a significant factor driving healthcare costs. Such a framework would expand opportunities for pre- and post-market evidence on safety and efficacy and be available to payers and other entities to support comparative effectiveness and cost-effectiveness analysis (Sommers et al., 2017). The new administration should consider policies to reduce the cost of drugs and other therapeutics, such as increasing competition through international reference pricing, allowing Medicare to negotiate drug prices, and promoting generic and biosimilars.
Develop a High-Value Workforce
A high-value workforce is essential for a high-performing healthcare system. The new administration should support policies that promote a high-value workforce, such as greater emphasis on primary care, investment in workforce training and education, and greater use of care teams (Kangovi et al., 2020). Policies should also be implemented to ensure that healthcare providers have the necessary data and technology to provide high-value care.
How can we develop a high-value workforce in our organizations?
Our businesses need a broad strategy to draw in high-value personnel. Companies should first identify the qualifications and talents required of their staff to provide high-quality care. Success depends on identifying and honing crucial skills and talents (Azar et al., 2020). Programs for education and training should be updated to reflect the changing nature of the healthcare industry and be suited to the firm’s demands. Companies should promote teamwork among employees and patient care. Encourage and reward excellence in care, provide feedback and support, and foster cross-disciplinary dialogue and cooperation. Lastly, businesses should invest in data-driven decision-making and technology to enhance clinical decision-making and care delivery.
What HR ideas help to reduce turnover?
- Invest in Quality Training and Development. Employees can improve their skills, confidence, and work happiness via customer service, management, and communication training and seminars.
- Enhance Workplace Culture: Low turnover results from a good workplace culture. Companies should foster a friendly, accommodating, and inclusive workplace where workers feel appreciated and have the chance to flourish. This might be done by improving communication, teamwork, and recognition.
- Provide Flexible Working Conditions: Flexibility may lower turnover while increasing employee satisfaction. Companies should support flexible and remote work options. People can balance work and life while still feeling valued because of this.
- Provide Competitive Compensation: Offering competitive pay and perks aids in lowering turnover. Companies should match the expectations of their employees by offering market-rate salaries and benefits.
Healthcare systems must entice talent. Job analysis, job design, recruiting, selection, and retention techniques should all be used to find the best people. These HR ideas will help the next government find and keep the best and brightest employees, enhancing the healthcare system.
Conclusion
The cost of healthcare in the United States rose to an all-time high of $3.8 trillion in 2019, making it unsustainable. Reforming the healthcare system to increase access, affordability, and fairness is exciting and vital (Azar et al., 2020). This essay offers suggestions for the next government and an insightful analysis of the problems with finance and healthcare prices in the United States. The next administration may improve access to care, cut healthcare costs, and promote resource justice by speeding up the adoption of value-based payment models, lowering regulatory obstacles to care delivery, and boosting system transparency.
References
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AHRQ. (2018). 2018 National Healthcare Quality and Disparities Report | Agency for Healthcare Research & Quality. Ahrq.gov. https://www.ahrq.gov/research/findings/nhqrdr/nhqdr18/index.html
Azar, K. M. J., Shen, Z., Romanelli, R. J., Lockhart, S. H., Smits, K., Robinson, S., Brown, S., & Pressman, A. R. (2020). Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California. Health Affairs, 39(7), 10.1377/staff. https://doi.org/10.1377/hlthaff.2020.00598
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Dzau, V. J., McClellan, M. B., McGinnis, J. M., Marx, J. C., Sullenger, R. D., & ElLaissi, W. (2021). Vital Directions For Health And Health Care: Priorities For 2021. Health Affairs, 40(2), 197–203. https://doi.org/10.1377/hlthaff.2020.02204
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Kearney, A., Hamel, L., Brodie, M., & Montero, A. (2022, July 14). Americans’ Challenges with Health Care Costs. Kaiser Family Foundation; KFF. https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/
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Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health Insurance Coverage and Health — What the Recent Evidence Tells Us. New England Journal of Medicine, 377(6), 586–593. https://doi.org/10.1056/nejmsb1706645
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