Health reform initiatives essay

Health Reform Initiatives

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Table of Contents
  1. Difference between Prospective and Retrospective Payment Plans 2

  2. Payment Reform Initiatives 2

  3. Health Insurance for All 3

  4. Expansion of Medicaid 3

  5. Importance and Structure of Patient Education 4

References  5



1. Difference between Prospective and Retrospective Payment Plans

Cost plays a critical role in the healthcare system and there are two primary types of payment plans: Prospective and Retrospective Payment Plans. Prospective Payment Plans refers to a fixed payment for certain treatments. It helps the healthcare service providers and insurers estimate costs and manage them. However, the providers may offer less personalized service since they receive a fixed amount. On the contrary, retrospective payment plans pay the health care providers for the actual charges incurred. The healthcare provider receives a full payment after submitting an itemized bill detailing the services rendered. It allows the providers to adjust their services according to the patient’s needs (Geruso & McGuire, 2016).

2. Payment Reform Initiatives

According to the Patient Protection and Affordable Care Act, the initiatives are stated as follows:

            Global Payment- This reform model consists of a monthly payment to a single member for all the services rendered to the patient, measuring performance and patient risk. It assesses negative consequences of patients and identifies opportunities for quality improvement (, 2016).

ACO Shared Savings Program- The accountable care organizations (ACOs) voluntarily assume responsibility and payer savings if the service providers meet quality and cost performance benchmarks.

Medical Home- A healthcare provider shall receive additional payments if medical home criteria are met. The payment shall be calculated by evaluating quality, multiple tiers of achievement and resource use.

3. Health Insurance for All

In my opinion, there could be affordable health insurance coverage for all the people using a pragmatic approach. The healthcare providers have to stop their urge of radical restructuring. America has abundant financial and intellectual resources to provide health insurance for all. Any proposal for expanding health insurance coverage shall consist of advantages to consumers. Also, with good communication, the reform in health sector is possible. Moreover, if an efficient leader plans and gives a definite time frame for completion, the health reform can successfully be established (Glasgow, 2013).

4. Expansion of Medicaid

The expansion of Medicaid has clearly created a divide between the people who have insurance and those who do not. Under the Affordable Care Act, the gains of expansion of Medicaid outweigh the ‘have nots’ (Cross-Call, 2015). The expansion of Medicaid is savings people money and the savings shall increase over time. For the countries who have large number of non-insured people shall be stuck in the coverage gap as they have too low income for subsidies and too high for Medicaid. However, the hospitals that did not expand generally experienced a drop in the volume of treating uninsured patients (Cross-Call, 2015). Therefore, the Medicaid must be expanded across the States.

5. Importance and Structure of Patient Education

It is necessary for the patients to receive education regarding insurance, regardless of private and government coverage as it shall provide an improved understanding of the medical condition, informed consent, lower risk of malpractice and higher amount of satisfaction. The structured education helps in self-management of the diseases and it shall consist of nature of disease, special problems associated with it, and the ways to live with it. It should be delivered to the patients as it forms a basis of their lifestyle change. The structure shall be delivered as soon as the health problems are recognized covering all relevant details (Christie et al., 2016).

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