Posted: March 24th, 2023
An interview involved David, a health insurance executive at an insurance company in Florida. The interview aimed to acquire in-depth information on the healthcare system in the U.S.
Interviewer: What are the major problems with the U.S. health care system today, from your perspective?
David: One problem with the U.S. health care system today is funding for the provision of adequate services, unplanned expenditures, and disaster management. The primary challenge of finance arises in the acquisition, pooling, and allocation of national funds to ensure a positive contribution towards efficient service delivery (Lehoux et al., 2017). This challenge leads to an increase in healthcare costs, unsustainable finances, and autonomy in finance.
Another problem is the reliability of the medical supply system and infrastructure, which entails poor and unavailable services, increased expenses, issues of storage and procurement. For efficient healthcare delivery, infrastructure must be available to users, well equipped and maintained, and able to adapt to the needs of the society (Lehoux et al., 2017). Hence, it is important to have a supply system that is reliable for drugs, new technologies, and other health services.
Interviewer: How effective has the Affordable Care Act (ACA) been in addressing these problems so far?
David: The costs of healthcare affect a whole spectrum of societies since it constitutes a significant proportion of the federal and household budgets. The sector regulates excellence of children in schools and productivity at work, and even enhances healthier lives for Americans. Therefore, ACA addresses the problems of healthcare costs by assuring Americans of health care access with reduced costs. The ACA has led to an increase in insurance coverage among Americans. For instance, the number of uninsured Americans declined from 16% to 9.1% (Obama, 2016). This has led to improvement in treatment access, financial security, and improved health for the insured. In addition, the ACA has enhanced access to medicine and personal physicians, especially for young adults.
Before ACA, healthcare system was subjected to the payment of fees-for-services, which was costly to providers who devised an alternative healthcare delivery. ACA has modified fees paid to providers and aligned them to the actual amounts of care provided. Besides, it has reduced fraud in healthcare through strict examination before enrolling in Medicaid and Medicare. Besides, ACA has installed value-based-payments that match the costs of services with the quality of care provided (Obama, 2016).
Interviewer: What major trends do you see occurring in the health care system in the next 5 to 10 years?
David: Amid the changes observed in the past two years, several trends are expected to continue to the next five to ten years. The first trend is the workforce revolution. It is evident that employment in areas that need more training and education is increasing; hence, workers will realize the need to upgrade their skills. In addition, healthcare organizations will incorporate various generations with advanced skills, experiences, and technical training. Notably, this population is likely to bring challenges such as technology gaps in corporate communication. Besides, physical workplaces will transform due to an increase in the “borderless” workforce, working remotely in satellite facilities or even at home (Santili & Vogenberg, 2018). Hence, to improve the overall communication of healthcare workforce, employers will need to enhance working benefits to include fitness centers, critical illness coverage, near-site clinics, and convenient clinics to provide continued care for members who are covered.
The second trend likely to be observed is consumerism in healthcare. As healthcare costs increase, consumers are likely to demand value for their money for the services acquired, which will lead to transparency in the sector. Hence, this means that healthcare providers’ success will be dependent on their capacity to achieve the needs and expectation of patients. Moreover, providers will be the primary source of information that patients require to achieve health ownership.
The third trend will be technology and transformation in the market. In the past few years, wearable sensors that monitor movements, speed, temperature, blood pressure, and muscle activity have been introduced in the market. Thus, this is an indication that innovative systems are already active in the provision of biometric gadgets. In the next 5 to 10 years, more innovations will arise, which will be sleeker and discrete to examine biometric data and levels of activity. In addition, future technology promises single gadgets that can reveal all health data of an individual. Technology will also enhance personalized medicine and genomics, which will ensure that patients receive customized therapy (Santili & Vogenberg, 2018). For this to be achieved, the government has a role to play for the various genomics through FDA, CMS and federal trade commission.
Interviewer: What changes would you like to see in the system, and how could they be brought about?
David: One of the changes would be a shift of healthcare from illness-focus to prevention and wellness-focus. The aspect involves conducting preventive and wellness evaluations, health and wellness education, and initiating health projects that address social and environmental triggers of diseases, which can be prevented. This could be enhanced if the nurses do not only focus on the immediate cause of illness but also put more emphasizes to establish what can be done to manage the patients’ health and initiate a preventive measure to reduce recurrence in the future (Echevallia & Salmond, 2017).
The second change I would like to see is a system that focuses on the patient and not provider-centric care. The approach will ensure that both the family and patient practice self-management. On the other hand, practitioners should appreciate that patients also understand their well-being, and hence integrate them and their families in the decision-making process to enhance the quality of care. In addition, nurses should partner with patients and offer client education to strengthen the capacity to achieve health goals. More so, nurses can adapt motivational interviews and action plans to help patients after a significant behavioral change (Echevallia & Salmond, 2017). Hence, the approach will guarantee that nurses offer information on treatment strategies, initiate counseling to improve self-confidence towards the newly adopted behaviors, and offer follow-up care.
Integrated healthcare is another aspect that is vital in achieving quality services while lowering the cost. The approach will ensure that healthcare providers deliver services in a way that patients receive continuous curative and preventive services throughout their lives (Echevallia & Salmond, 2017). Hence, to realize this change, healthcare providers should practice self-management, initiate families and patients’ engagement, provide relevant education, offer counseling services, and embrace advocacy in the nursing process.
Interviewer: What do you see your role as in improving health and health care?
David: As a health insurance executive, my role is to enhance equitable access to health care by reducing patients’ out of pocket payment reliance, and hence shifting the economy towards universal health care. Health insurance reduces the financial risk of unpredictable medical costs and enhances financial security. Secondly, my role is to improve other services, including primary care, ambulatory care, access to prescription medicine, and medication adherence. Hence, such improvements will ensure that patients can afford both primary and secondary care to enhance health outcomes. Thirdly, my role is to promote preventive services access, which improves and maintains health. These services are essential in healthcare since they facilitate evidence-based screening, such as diabetes, HIV, and hypercholesterolemia among other conditions (Baicker et al., 2017).
Interviewer: Thank you for your time.
David: You are welcome
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