Essay Example on the Problems in Healthcare Organizations

Published: 2020-04-27
Essay Example on the Problems in Healthcare Organizations
Type of paper:  Essay
Categories:  Health and Social Care
Pages: 4
Wordcount: 1004 words
9 min read

TRI CARE has been facing a critical problem implementing the required changes that come with the ACA. After the ACA act was made into law up to twenty states filed a lawsuit saying the law violates Articles 1 and 4 not forgetting the tenth amendment of the constitution. Implementation of the reform has taken a toll on many heath institutions in various ways. Despite the efforts in place to contain the costs, the organizations still face the problem of access, quality, and cost. The managed care plans, shortened hospital stays and increased use of the outpatient treatment asserts to the importance of costs. The three market forces are directing the current changes in the healthcare system.

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Cost/ financing

Health care direly depends on fiscal issues. The cost has been a driving force for change in the healthcare system. Developing efficient oversight strategies in the organization has become a difficult issue since ACA has its separate stipulations to follow while the organization uses different payment mechanisms. It becomes a critical issue when you have to balance the change from a volume-driven to value-driven imbursement mechanisms. Another problem that brings significant issue is the emergence of numerous specialized providers. Many providers have emerged making it impossible to keep track of the genuine package to enroll the employees. Moreover, most of the consumers have taken a passive role making it a cost increase in health care program. It has become an expensive commitment for any organization. The costs of health have rocketed to a level that is higher than the raw material used in the business. This implies that the cost of covering the staff has caused an imbalance, which in turn causes little resources to return to the health care system to the required prominence in the world (Institute of Medicine (U.S.) et al, 2011).


Access to health care continues to be a problem in the functioning of the healthcare system. Since the cost of healthcare is significantly high, many people do not access the required services. Low income causes the citizens lack insurance coverage, therefore, they delay medical checks, and their conditions reach an acute stage before they can seek intervention. Many cases of serious illnesses are caused by the lack of funds to access care before the cases reach a critical level. Some of the variables that affect access are that women are increasingly work outside the home and single parents. They tend to have little time and off days for them to take their children to healthcare facilities (Guah, 2011).

Heath Insurance Exchanges

They are key players in the purchase and sale of insurance to the public. In many cases, there is a delay in the since there is a channel to follow. In order to make them functional without the existence of fraud, incompetency and loopholes, governance of the agencies are subjected to the administrations scrutiny, which makes it slow. Without independent companies, the process of care is slow and causes redundancy in the operations requirements. Management of the bodies are politicized and non-professional (Harrington et al, 2008). While ACA permits both groups and individual health insurance market to continue existing outside the exchange, there is a possibility of confrontational selection against the exchange if lower risk subscribers can access cheaper coverage elsewhere. This creates a loophole that makes adverse selection a threat making the government have little regulation on outside market. Distribution of the people with health problems is not evenly distributed. Many high-risk enrollees are inclined to establish relationships with particular subscribers and professionals available in a plan they are currently subscribed. With these facts, it is hard to implement ACA since most of the insurers have to raise their premiums for other enrollees (Office of Inspector General, 2015). ACA prohibits health plans to charge individual enrollees higher premiums based on health status. This drives away healthier enrollees who will seek better premiums.

Q.2) Mediation

To ensure eradication of these issues, TRICARE is making amendments to the costs and financing of the problem recognition activities in the healthcare. Agreements that ensure there reduced time is an important goal the organization has taken. TRICARE is raising awareness of the efforts to reduce the delays that ACA has instigated. The review and collection of exchange data are also being simplified by collaborating with the agencies providing the services. In turn, the patients will no longer suffer rigorous processes that delay their services. Moreover, communication and training of the staff is underway. The consultants and ACA experts are training the staff on how to handle the new details presented by the act. This is done through meetings and conferences attended by the staff. In addition, reports are made on the progress to track the variables.

To adjust the impact of cost, TRICARE is aligning the provisions of the ACA act to the organizations imbursement package to make quality a reality. More so, review and collection of data on the best way to make charges comfortable to all consumers is always a priority for accuracy. The use of resource material provided by the government is a crucial element for adjusting the issues on cost. Lastly, the organization has strategies for quality assurance that inform and direct the clients on the right channels to follow (In Fierlbeck, & In Palley, 2015).


Guah, M. W. (2011). Healthcare delivery reform and new technologies: Organizational initiatives. Hershey PA: Medical Information Science Reference.

Harrington, Charlene, and Carroll L. E. (2008). Health policy: crisis and reform in the U.S. health care delivery system. Sudbury, Mass: Jones and Bartlett Pub.

In Fierlbeck, K., & In Palley, H. A. (2015). Comparative health care federalism.Office of Inspector General, D. (2015). Management Issue 1: Implementing the Affordable Care Act. Retrieved 7 September 2015, from publications/top-challenges/2012/issue01.asp

In Fierlbeck, K., & In Palley, H. A. (2015). Comparative health care federalism.Institute of Medicine (U.S.)., Olsen, L. A., Saunders, R. S., & McGinnis, J. M. (2011).Patients charting the course: Citizen engagement and the learning health system : workshop summary. Washington, D.C: National Academies Press.

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