Option #1: Influence of Cost, Quality, or Access on the U.S. Healthcare System PaperCost, quality, and access to care have been identified as significant contributing factors to the U.S. healthcare system. Choose one of these factors and write a two to three page paper addressing the following:Describe the historical background of the factor and its influence on healthcare delivery, including benchmark events.Examine the impact of current healthcare reform, such as the Affordable Care Act, on this factor.Your paper should meet the following requirements:Be two to three pages in length, not including the cover or reference pages.Be formatted according to the CSU-Global Guide to Writing & APA.A minimum of four references with associated in-text citations. Two of these sources may be from the class readings, textbook, or lectures, but two must be external and should be from peer-reviewed or quality academic sources. Each reference must be cited at least once in the paper. The CSU-Global Library is a good place to find these references.Headings to organize the content in your work.
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Introduction to the U.S. Healthcare System
U.S. Healthcare System: Overview and Historical Background
1. Overview of the U.S. Healthcare System
The history of the U.S. healthcare system is complex and mirrors changes occurring in
the nation. A number of significant events have affected how healthcare services are
delivered and who receives these services, as you learned about in our class readings.
In this module we focus our attention on the development of the modern U.S.
healthcare system. Watch the following video to learn more about significant events
that contributed to where we are today.
Healthcare is changing, and these changes are being brought about by both economic
and social developments that are altering the way the American public views the
providers, facilities, and services within the industry. There are also significant conflicts
that exist between policymakers and insurers. Many providers, insurers, and institutions
have become commercial enterprises. As of 2015, healthcare expenditures exceed $3.2
trillion annually and equate to 17.8% of the U.S. gross domestic product, which
increased from $2.7 trillion and 17.4% respectively from 2014 (Martin, et al., 2016). To
place this in perspective, the healthcare industry in the United States represents the
world’s eighth largest economy and is larger than the total economy of Italy (Sultz &
There are more than 49 million Americans without insurance (Sultz & Young, 2014).
While this number has changed due to the mandatory health insurance requirement
from the Affordable Care Act, some communities in the U.S. still remain uninsured or
underinsured. Starting in 2014, state-based health exchanges were created to assist
people with sign-up for affordable insurance options. There are major concerns over the
future of healthcare, and frustrations have increased on many levels. Physicians assert
that insurers constrain fees, have misplaced priorities, and have an inadequate concern
over quality. Policymakers tend to blame providers for resisting accountability. As a
result, patients are faced with a confusing system and services that can appear to be
Contradictions in objectives, including prevention vs. intervention, extreme variations in
performance, inefficiency, and challenging relationships are but some of the significant
problems facing healthcare delivery today.
2. Healthcare Priorities
In order to move toward solutions, it is important to recognize the current situation with
regards to healthcare delivery in the United States. Cost, quality, and access are the top
three priorities in healthcare today, and as we move through this course we will explore
each of these in detail.
The following video provides a good overview of cost, quality, and access as they relate
to healthcare today. Although the video was made in the year before the Affordable
Care Act passed, the information is still very relevant to the issues we face today.
Exploring the Past and Future of Health Care Quality
( Source: https://www.youtube.com/watch?v=_zNtg04UcEQ)
Description: In this video, experts from the NCQA examine issues that still plague quality of
care in the U.S. healthcare system.
Most would agree that changes are needed in our healthcare system to meet the needs
of the populace, particularly in regard to the cost, quality, and access to care as
discussed in the video above. These efforts to refine our healthcare system are referred
to as “healthcare reform” and have been a topic of conversation among physicians,
healthcare providers, administrators, industry vendors, politicians and the government.
It should be noted that there is discord about how these changes should occur, which
prohibits consensus on what to do and when.
As patients, policymakers, providers, and politicians, we are unable to agree on exactly
how the system should be reformed. Since the current system has many positive
aspects, Americans have been reluctant to risk those strengths to produce the needed
reforms. To date, the market has tried to deal with the challenges by controlling costs,
while the legislative reforms have been focused on balancing cost and access without
impacting the positive aspects of the current system. These efforts have influenced how
we plan and deliver healthcare.
Healthcare reform is covered more in depth in Module 6. Since reform is a significant
driver for change and how to meet the needs of the public and specific population
groups, it is important that it be mentioned in conjunction with cost, quality, and access
to care. The U.S. spends more on healthcare than other nations; however, the product
of those costs does not necessarily equate to better healthcare.
While quality, costs, and access are the overriding issues facing the industry today, the
behaviors of patients and providers are also changing, making needed reform even more
difficult. Patients vary widely in how much personal responsibility they take for their healthcare,
as many patients tend to take on a “sick role,” relying on the providers for answers and not
assuming responsibility for the illness or the cure.
some ways the Affordable Care Act impacts Americans.
Individual Shared Responsibility
Each American who does not qualify for Medicaid or Medicare is required to purchase a
plan or risk paying a fee also referred to as a “penalty” or “fine.” This is not considered
a tax. The fee is calculated in different ways either as a percentage of your household
income or per person. You pay whichever fee is higher.
Medicaid would be extended to families who are at the 133% poverty level instead of
the previous 100% poverty level for states who are willing to participate
Virtual marketplaces exist in each state where individuals and people employed in small
businesses pool their purchasing power to shop for plans
Beginning in 2014, no one can be denied insurance or given a higher premium because of a
pre-existing condition (a health problem you had prior to obtaining coverage).
Lifetime and Annual Limits
Health plans can no longer implement annual or lifetime limits on the essential healthcare
benefits you receive.
Coverage Extended to Age 26
Children are able to stay on their parents’ insurance plan until the age of 26, and children under
the age of 19 are eligible for more service such as dental/vision coverage and hearing tests.
3. Emerging Issues and Challenges
As an industry, healthcare is facing a variety of challenges, which include advances in
technology, an increase in the aging population as the Baby Boomer Generation retires,
gaps in care, a culturally diverse group of Americans, limitations of payer sources, the
burden of longterm care, and limitations in access, cost, and quality.
While most agree that reforms to the system are necessary, an inability to agree on
how the specific reforms needed will likely continue. At the same time, health care costs
will likely continue to increase. An aging population, with more chronic illnesses and the
availability of new, expensive treatments and medications, will add to the complexity of
the problem but will not reduce healthcare expenditures.
These issues continue to concern the healthcare industry and will likely do so in the
future. As healthcare managers and administrators, we must face these issues head-on
and work together toward solutions. Throughout the remainder of this course, keep
these issues in mind and consider potential solutions.
Healthcare Reform: Overview of Cost and Financing
Summary: In this video, Kenneth Thorpe, Professor and Chair, Department of Health Policy
and Management in the Rollins School of Public Health at Emory University, talks about health
care reform through the Affordable Care Act.
Technology derived from American science and innovation is directly responsible for
some of the world’s best innovations and treatment options available to patients
worldwide. With that said, technology can be expensive. As a society, we will likely
begin to examine the beneficial uses of technology and its limitations.
While the focus on costs in the delivery system of health care is prominent, new
technology will require significant capital investment. Additional training will be needed
to ensure qualified staff, and there will be a need for institutions and providers to adopt
Information technology will continue to play a major role in the healthcare system of
the United States. Significant efforts are underway to manage records and information
with standard, timely, accessible data systems, and the government is providing
financial incentives to do so. The information technology efforts are not without
criticism and challenge, however. These challenges include multiple providers offering
services to patients, confidentiality and privacy concerns and safeguards, provider and
consumer resistance to change, and record conversion costs (Sultz & Young, 2014).
Changing Population Composition Impacting the Future of Health Care
Delivery in the United States
Increased proportion of older adults
Social changes impacting family care giving
Special health and cultural needs of ethnic minorities
Health workforce mind-shift to chronic care and geriatric model (Sultz & Young,
Martin, A. B., Hartman, M., Washington, B., Catlin, A., & National Health Expenditure Accounts
Team. (2016). National health spending: Faster growth in 2015 as coverage expands
and utilization increases. Health Affairs, 10, 1377.
Sultz, H., & Young, K. (2014). Health care USA: Understanding its organization and
delivery (8th ed.). Sudbury, MA: Jones and Bartlett.
U.S. Department of Health and Human Services. (2016). Retrieved from
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