Healthcare System




Cost,quality, and access are essential considerations in the provision ofhealthcare services. Regulatory environment jeopardizes efforts toenhance access to health services in the US. The country has severalbodies charged with accrediting institutions and professionals in theindustry. Failure to follow the recommended guidelines has adverseeffects on quality of services offered at the care facilities (Smith,Saunders, Stuckhardt, &amp McGinnis, 2013). The free market policyalso affects both medical and drug costs. The government cannotdictate the prices for the service providers. Entry of medicines frommultiple sources may contribute to substandard drugs gaining accessinto the American market. Moreover, conflicts between primary serviceproviders and specialists affect the quality of healthcare services.Each of the service providers seeks to benefit financially from thegovernment-sponsored programs. The disagreements may end upundermining the service delivery as well as create unhealthycompetition among the therapists.

Itis clear that health insurance has a significant influence ondecisions made regarding cost, access, and quality of healthcareservices by looking at the health programs initiated by the USgovernment. Health insurance links citizens to various providers. Theplan makes it possible for low-income citizens to access healthprograms appropriately. Further, it reduces the financial risksassociated with accessing quality therapy to all citizens. Throughthe scheme, out-of-pocket costs for medical care have reducedsignificantly. It also has great influence on the living standardsfor the American population (Shi &amp Singh, 2016).

Throughthe Affordable Care Act, about 40 million uninsured Americans are setto benefit. The reforms initiated by Obama’s administration havehelped to increase health access throughout the country. Medicalcosts have also reduced significantly over the years, with thegovernment engaging the private sector in improving healthcareindustry. Nonetheless, workforce shortage is likely to affect theindustry negatively in the coming days (Atlas, 2010).


Americanauthorities have over time sought to reform the healthcare industryto meet the increased needs and changes in the sector. Suchinitiatives include the introduction of Medicare and Medicaid thathave necessitated changes among the industry players, includinghealthcare and insurance providers. Medicare is an influentialprogram that has attracted the private payers. One of the majorintentions of the program is the need to shift from fee-for-serviceto value-based payments. It is also a move aimed at enhancingtransparency and accountability within the health sector. Anothersignificant milestone is the Medicare reimbursements to the serviceproviders for the services rendered.

Inthe case of Medicare reimbursements, institutions need to lower costsof non-essential services. The approach attracts more patients whosignificantly lead to enhanced profits. Nonetheless, some hospitalsavoid procedures that are costly with lower profits. Further,Medicare reimbursements have considerable influence on the provisionof quality healthcare services. Every institution intends to makemoney to support their objectives as well as meet their financialobligations. Poor reimbursement models are likely to result in poorservices. The morale of the physicians is also affected by thereimbursement rates. It is, thus, appropriate to consider models thatwill see all the essential financial obligations are considered(Smith, 2014). A well-thought model can help the authorities andhealthcare institutions to meet their financial obligations as wellas enhance business sustainability. Break-even approach needs toconsider the future risks and goals of an organization according tothe investment plans (Smith, 2014). Medicare reimbursements come withchallenges and opportunities for institutions to rethink theirfinancial planning approaches. Organizations within the sector needto ensure they meet their financial obligations to enhance thequality of healthcare services.


Atlas,S. W. (2010). ReformingAmerica`s health care system: The flawed vision of Obamacare.Stanford, Calif: Hoover Inst. Press.

Shi,L., &amp Singh, D. A. (2016). Essentialsof the U.S. health care system.Burlington, Massachusetts: Jones &amp Bartlett Learning.

Smith,D. (2014). Introductionto healthcare financial management.San Diego, CA: Bridgepoint Education, Inc.

Smith,M., Saunders, R., Stuckhardt, L., &amp McGinnis, J. M. (Eds.).(2013). Bestcare at lower cost: the path to continuously learning health care inAmerica.Washington, D.C.: National Academies Press.