Health insurance and reimbursement mechanisms form the basis of healthcare financing, ensuring patient accessibility, affordability, and equity. “Health Costs and Financing: Challenges and Strategies for A New Administration” by Shrank et al. (2021) and “Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: A Qualitative Study among Sub-national Level Actors, healthcare and insurance providers” by Alawode and Adewole (2021) address the intricacies and challenges of these strategies. This research synthesizes the findings from several articles to show the main results and outcomes in the financial structure of healthcare. Health insurance can contribute to increasing access to healthcare and overcoming financial obstacles. On the other hand, reimbursement methods contribute to healthcare costs and quality by deciding how doctors are paid. Shrank et al. (2021) and Alawode and Adewole (2021) identify the web of interactions and their impacts on healthcare delivery. Here, I am describing these articles to get a firm grasp of the intricate workings of healthcare finance.
Shrank et al. (2021) believe that the American healthcare system reform should consider issues of access, costs, and equity. The writers support three US healthcare system goals: affordability, access, and fairness. They contend that all people of America should be able to obtain healthcare services without considering social status or demographic features. Despite the astonishing enactment of the Affordable Care Act (ACA) to grow the number of people with health insurance, the uninsured population in the US continues to increase. This indicates an increase in the cost of health services and poor allocation of resources that, in turn, affect income disparities. Shrank et al. (2021) propose five policy priorities to drive system goals: expanding insurance, providing support for families, value-based care model, improving home health care, making drugs and other treatments more affordable, and training a high-value workforce. The plan’s elements are drawn together to reduce allocations to pay for healthcare, improve the quality of services, and guarantee healthcare fairness in society. Health insurance broadening is imperative in securing a financially accessible healthcare system for all Americans. Value-based care becoming the new focus shifts healthcare providers to deliver high-quality, cost-effective services. Through moving from volume to value, healthcare companies are now motivated to take on the responsibility of producing outcomes and maximizing efficiency, which aligns them with the system’s goals.
On the other hand, Alawode and Adewole (2021) raise the point of design and implementation of NHIS in Nigeria. NHIS was introduced in 2005 and has so far needed more effectiveness to increase health insurance coverage in Nigeria, which has a large population that is uncovered. It is mentioned that widespread poverty, low insurance awareness, poor payment procedures and incompetent management are the main reasons for this situation. These hindrances prevent the NHIS from fully reaching its potential and achieving universal health coverage. Alawode and Adewole (2021) also stressed that subnational health insurance laws must be amended. No mandated insurance brings about more healthcare inequality, mainly for the poor groups. Community-based Health Insurance(CBHI) plans are another option the authors indicate can be used to fill the insurance gap, especially in rural areas where formal insurance coverage is low. CBHI programs supply a community-based financial mechanism for health which is tailored to local needs. CBHI plans are poised to increase the knowledge and uptake of informal sector health insurance in rural areas by using social structures and community networks to reduce out-of-pocket costs. Alawode and Adewole (2021) focused on the NHIS systemic issues as critical barriers to achieving universal health coverage in Nigeria. Subnational mandatory health insurance laws and community-based methods form the foundation of the solution to healthcare access and affordability obstacles. Through tackling these issues, policymakers can make healthcare available to Nigerians from all walks of life and in any part of the country.
Both articles strive to shed light on the fact that these problems, such as unequal healthcare access and cost, should be addressed. US policy should foster insurance coverage, value-based care, and care payments that people can afford. On the other hand, Nigeria needs much work to address the implementation issues and to extend coverage to the uninsured through health insurance. The two journals highlight how the lowering of socio-economic inequalities and the promotion of healthcare equity are needed. Expanding health insurance coverage in the US is vital to ensure that the country has an excellent healthcare system available to all, regardless of financial constraints. By implementing value-based reimbursement models, providers will be inspired to render high-quality, low-cost healthcare services to the patients, thus improving healthcare results. Healthcare affordability campaigns are necessary to decrease the financial burden on individuals and families. The implementation of health insurance in Nigeria has faced several issues. Understanding the need for adequate coverage, the governments can ensure that the underrepresented populations are included. This would involve educating the public, strengthening the administrative mechanisms, and adopting the legislative framework to widen the social health insurance plans. Both writings underscore that efforts should be coordinated to attain quality healthcare services for every individual, irrespective of socio-economic background or geography. Policymakers can improve healthcare systems to become more inclusive and resilient everywhere with the assistance of the elimination of systemic barriers and the implementation of evidence-based reforms.
In conclusion, the reviewed articles shed light on the complicated terrain of health insurance and reimbursement. The US and worldwide healthcare systems can become more efficient with the appropriate policymakers who can address the fundamental problems and launch evidence-based reforms.
References
Alawode, G. O., & Adewole, D. A. (2021). Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare and insurance providers. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-020-10133-5
Shrank, W. H., DeParle, N.-A., Gottlieb, S., Jain, S. H., Orszag, P., Powers, B. W., & Wilensky, G. R. (2021). Health costs and financing: Challenges and strategies for a new administration. Health Affairs, 40(2), 235–242. https://doi.org/10.1377/hlthaff.2020.01560
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