Policy Analysis - Free Paper

Health policy is a course of action as well as an inaction that impacts sets of funding arrangements, services, organizations, and institutions of the health system. The policy can be made both in the private sector and in the public sector. Since health is influenced by different factors outside the system of health, the analysts of health policy have an interest in the intended actions of the external systems of the health of an organization, which affects health (Maroulis & Mackey, 2019).

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The health system reform has been increasing over time, which is an advantage to those individuals who have an interest in healthcare innovation. Some of the state health policy reform innovations that had been identified include; insurance market reform, the single-payer system, and the managed competition. The paper will dwell much on one policy reform innovation which is the single-payer system.

The policies that lead to the advancement of the reform goals are most likely to move resources away from specialists, hospitals, and expensive procedures toward primary care where innovation might result in great improvements in health. Health care reform policy tends to cause changes in some health incentives and put larger value for the health care expenditures (Oberlander, 2019).

Even though many changes caused by the health care reform policy are already working, the payers have greatly reduced the spending for the treatment of inpatient. They have employed shifting care to home and ambulatory settings. Insurers have also increased coverage of dentistry, pharmaceuticals, and preventive services. The consumers and providers have formed the integrated delivery system largely. The strategies are put in place to train fewer specialists' physicians and more generalists. The employers and government jointly assess the quality and cost of care and availing information to the public (Maroulis & Mackey, 2019).

Though the developments mentioned above predate the health care reform policy currently, they tend to respond to similar underlying pressures. It does not matter the kind of shape that health reform policy is taking; there will still be a continuation of pressures to regulate spending, causing a change in the market for innovations. Thus, the state health policy reform innovation selected is discussed below;

1. The Single-Payer System

The single-payer system consolidated the health insurance provision into the public system that is administered by the state. The single-payer system tends to remove some state programs, Medicaid and Medicare and incorporate their beneficiaries into the national system. The single-payer system government ensures that there is universal coverage for standard benefits (Angerer-Fuenzalida, 2018).

The system assigns the state agency the responsibility for the whole policy, like setting the health care budget and managing benefit package. The state health care budget issues the mechanism for regulatory expenditure, through paying providers directly or each state allocation.

The single-payer system advocates that state governments to pay for care regarding the set rates respectively such as; the current Medicare's diagnosis-related group approach for hospitals, payment capitation to care organizations that are comprehensive same as health maintenance organizations and schedule fees for individual practitioners (Mason et al., 2020). Therefore, the single-payer system promotes primary care via the expanded training and higher rate of payments that manages the supply of capital through restrictions that are explicit on the purchase of equipment.

There are several reasons why the innovation of a single-payer system should be enacted in the health system. Some of the reasons are discussed below (Angerer-Fuenzalida, 2018);

The system ensures that nobody is left out everybody is in. It advocates for universal healthcare where everyone has access to health.

A single-payer system is portable in that it allows one to access health coverage even if one changes or loses his job or is unemployed.

It enhances uniform benefits. The single-payer system discourages premium plans for the wealthy individuals and minor plans for everyone else, with limited services, lack of protection in the catastrophe event, and with more deductibles. Thus, care service is provided uniformly, no matter the size of one's wallet.

There is a prevention benefit when a single-payer system is embraced. By eliminating the roadblocks of finances, a single-payer system promotes the preventive care that reduces the ultimate pain and cost of an individual as well as suffering when there is spread of communicable diseases and when problems are neglected.

It encourages the choice of a physician. Several private plans have been restricting what hospitals, caregivers, and doctors an individual can use. The single-payer system, therefore, enables patients to make a choice and assuring the provider a fair reimbursement.

Stopping the insurance industry that interferes with care. A single-payer system enables patients and caregivers to regain autonomy in making decisions on the best thing for the health of a patient, but not what the billing department dictates. And there is no coverage denial as a result of pre-existing conditions or policy cancellation for the minor health problems that are not reported.

The single-payer system ensures that administrative waste is minimized.

Saving the cost. The single-payer system produces the needed savings widely to cover everyone by utilizing the existing resources without waste.

Common sense budgeting is encouraged. Fair reimbursements are set by the public system, which applies to all providers equally while issuing an assurance to all appropriate and comprehensive health care is delivered. The clout is also used to negotiate huge discounts for medical equipment and drug prescription.

It enhances public oversight. The public puts in place the policies and monitors the system, and making decisions concerning the inflation of the compensation packages or company profits.

Therefore, there is a need for health reform to build appropriate measures to balance and check such changes. For instance, the state government should come up with a system to evaluate innovations, and the evaluation responsibility should not be combined with that of an agency that is responsible for the health care budget. Various changes that are anticipated due to health care reform innovation are underway already. They include; wide coverage of preventive services in the plans for insurance, primary care encouragement through the higher payment rates, and growing the share of the market for the integrated system delivery. All these are causing a change in the historical incentives for innovation (Mayka, 2019).

The main effect of health care reform on innovation might arise from containment of market-wide cost and competition-based or regulatory. The containment cost, however, relies critically on the political goals to alter incentives and restrain payments. Thus, the health care reform policies affect innovation indirectly by altering the extent and composition of health coverage insurance and by containing costs (Angerer-Fuenzalida, 2018)

Reference

Angerer-Fuenzalida, F. M. (2018). Quality and Importance of Health Policy, Reform, and Public Health Topics: A Study in Physician Assistant Education. The Journal of Physician Assistant Education, 29(2), 89-98. https://pubmed.ncbi.nlm.nih.gov/29727431/

Maroulis, J., & Mackey, T. K. (2019). State Health Care Reform: Waivers, Single-Payer, and the Need for Alternative Pathways. Annals of Internal Medicine, 171(4), 281-282. https://doi.org/10.7326/M19-0509

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O'Grady, E. T. (2020). Policy & Politics in Nursing and Health Care-E-Book. Elsevier Health Sciences.

Mayka, L. (2019). The origins of strong institutional design: Policy reform and participatory institutions in Brazil's health sector. Comparative Politics, 51(2), 275-294.
https://doi.org/10.5129/001041519X15647434969830

Oberlander, J. (2019). Navigating the shifting terrain of US health care reform—Medicare for All, single-payer, and the public option. The Milbank Quarterly, 97(4). https://www.milbank.org/quarterly/articles/navigating-the-shifting-terrain-of-us-health-care-reform-medicare-for-all-single-payer-and-the-public-option/