Healthcare Industry Overview
As medical technology / knowledge advanced so did the quality of care physicians could provide to patients. This advancement coupled with physicians utilizing hospitals increased physician / hospital charges; these cost were past off to the consumer which Just became worse with the start of the great depression. In an effort to assist in the healthcare needs during the depression Baylor Hospital in Dallas created a system that would revolutionize the market for health insurance (Carrolton, 2009).
The plan shortly became known as Blue Cross, this plan was specifically designed as a pre-paid plan for hospital services. Shortly thereafter Blue Shield was created for physician services. With the success of Blue Cross and Blue Shield more consumers were willing to participate which led other private insurance companies to enter the market, it was obvious competition was inevitable. The government also offered tax breaks to employers who provided healthcare to their employees.
The Blues were doing so well but they changed how they did business based on the private companies raising premium rates based on age, gender, health status and pre-existing conditions. These behaviors led the Blues to change their one flat rate premium for all insured’s in order to remain in the
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Then in 1965 Congress enacted Medicare and Medicaid to guarantee that the elderly and poor Americans would not be denied healthcare. To ensure physicians would not combat the new legislation the government knew they had to tread lightly and they did this by paying physicians their usual and customary rate but by 2001 32 % of By Jaycee Medicare / Medicaid reimbursement are being reduced, health care cost are being driven higher due to medical technology, law suits, competition amongst physicians / hospitals, and increased pharmaceutical costs.
These factors where never taken under consideration during the ass’s when the private healthcare industry was initiated in the United States and now our healthcare industry is in turmoil. According to Presumptuousness’s, a Health Research Institute, the United States Supreme Court ruling upholding the Affordable Care Act re-injects a sense of urgency into the transformation of an industry that represents nearly one-fifth of the US economy. This is because the healthcare industry is with challenges and opportunities that so many other US industries do not encounter.
The healthcare industry is a 2. 5 trillion dollar business and the market for more innovative technologies is on the horizon. The healthcare market consist of a multitude of sectors such as but not limited to global drug & prescriptions, laboratory, research & development, medical equipment, investment, medical personal, and IT. There are also many different specialties such as but not limited to continuity care, pediatrics, geriatrics, internal medicine, ophthalmology, cancer research, genetics and surgery; he market is plentiful for financial gain in the healthcare industry.
This is where the insurance industry comes into play because of the high cost of healthcare and prescription drugs; the insurance industry sets the insurance premiums at a cost that most Americans cannot afford. This causes the healthcare industry to also further increase the cost of medical services; this is where the industry becomes a vicious circle and the American tax payers get to handed the bill.
Rising cost in the healthcare industry is not limited to the US market this impact the industry on a global level as well. The global market share of services in the healthcare industry is worth $ 50 billion US dollars. The global market in healthcare is soon expected to witness a hike in coming years. (The Medical, Global Healthcare Marketplace, 2009). Although the Healthcare industry has seen its share of crisis, the American people are hoping a transformation to the healthcare system is close at hand.
With the presidential election coming up, the focus is centered on the healthcare industry and how each candidate proposes to correct the problem or at least minimize the financial impact to all players involved. The U. S. Latherer industry encompasses a wide range of participants and in order to ensure there is order, an even playing field if you will between all sectors private / non for profit our government established regulations to ensure compliance. When we think about regulations within the healthcare industry most people automatically think of HIPPO.
The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HAIFA, Title II) require the Department of Health and Human Services (HUSH) to adopt national standards for electronic health care transactions and national identifiers for providers, health plans, and employers (SMS, 2012) . To date, the implementation of HAIFA standards has increased the use of electronic data interchange. The government has created a plethora of regulations to incorporate all segments within the industry; one that has grabbed the attention of participants in the industry is Meaningful Use.
Meaningful Use (MO) of information technology is an umbrella term for rules and regulations that hospitals / physicians must meet to Act of 2009. RARE allows the Centers for Medicare / Medicaid to provide articulating providers incentive reimbursement for providing data via an Electronic Medical Record (EMMER). The goal of MI-J is to improve 1) quality, safety, and efficiency of patient care 2) engage patients and families, 3) improve care coordination, 4) ensure adequate privacy and security of patient health information and 5) improve population and family health (SMS, 2012).
As you can deduce our government is collecting data in order to benchmark data. Our government will continue to implement regulations to ensure that quality care and positive outcomes improve in the healthcare industry as a whole. One of our most forefront and prevalent hot button topics in the media today has been healthcare reform. The American healthcare system of today faces many issues and problems. The growing population of elderly and high rate of unemployment has left many Americans without any type of healthcare at all.
To reform healthcare that has to first the infrastructure established that is sustainable for doctors, suitable for members, and costly enough to be sponsored. Hospitals are bulking up into huge systems, merging with one another and building extensive new doctor work forces. They are exploring insurance-like setups, including direct approaches to employers that cut out the health-plan middleman. Wow’s Anna Mathews Joins the News Hub to discuss the changing face of health care in the U. S. As a result of pressure to cut costs. AP Photo.
On the other side, insurers are buying health-care providers, or seeking to work with them on new cooperative deals and payment models that share the risks of health coverage. And employers are starting to take a far more active role in their workers’ care. (Wiled-Matthews, 2011) This new and innovative plan does seem to be valid ND more cost-efficient. The main issue with current health care plan and especially government mandated health care plan are the doctor’s reimbursement rates for procedures. Doctors argue that current reimbursement rates are too low, causes them to lose money, and force sub-par healthcare to members.
Many argue that current health care reform also known as “Beamer” is a budgetary disaster will only lead to worsen the debt crisis that we already face. Experts say Over the next five years, deficit reduction will total only $7 billion, which does not include the $5 lion to $10 billion the IRS will spend to implement key provisions of Beamer, or the $8 billion the Administration is spending on a supposed “demonstration” in the Medicare Advantage program that representatives of the Government Accountability Office have testified has no clear purpose and should be terminated. 2] The Administration has also requested nearly $1 billion to set up exchanges in states that decline to do so. This additional spending wipes out all of the near-term deficit reduction and reduces the 10-year estimate to inconsequential amounts. (Capacitate, 2012). Experts question whether healthcare reform is sustainable and if the advantages actually outweigh the cost. Other options on the table consist of continuing without current healthcare situation leaving millions of adults and children without a valid health care plan or the more recent prevarication of government mandated plan.
The Balanced Budget Act of 1997 gave Medicare beneficiaries the option of receiving their benefits through private health plans, a program called “Medicare+Choice” or “Part C. ” Upon passage of the Medicare known as Medicare Advantage, and prescription drug coverage was added. Continuously research has been used to refine and make the system of senior health better and more efficient but based on the uproar of unhappy scrutiny in the media it seems that more research needs to be done. (“Families Usa”, 2012).
The UN- staggering success of the Medicare part C plan has led our legislature to look at healthcare reform from a different perspective. Prevarication of healthcare means that companies can compete for members of government mandated plans. This in turn leads to lower rates, higher reimbursement rates for doctors and broader coverage for procedures and drugs. In addition to advantages of members and doctors taxpayers can share less of the costs that it would take for a fully of government mandated plan.