HEALTH CARE FINANCING AND ACCESS TO SERVICES
Managing and offering health care to the patients has become among the most controversial and problematic issues in the United States of America presently. The major problem is arising as a result of conflicts between the health care providers and the interests of the patients. The problem entails access to quality health care and cost of the health care. The costs are abnormally high while the quality is substandard, hence resulting to an economy with unhealthy population. Many health care providers have included some high costs on cost of medication. Others like health maintenance organizations have been able to restrict the patients’ access to the health care besides offering their services selectively. This paper evaluates how the a physician can manage the patients access to medical services without any restrictions as witnessed in the case of health maintenance organizations (HMO).
Among the major problem affecting Medicare is the problem of insurance issues that have become very complex and thus making the cost of medical services to high while adversely affecting the quality of the problem. This problem will be solved in future because of the introduction of the Accountable Care Organizations that are a product of the Obamacare. There have been fundamental flaws that have made the policy makers to try to implement policies to address the flaws such as on overutilization, sustained growth rate and physical fee schedule. This problem will continue to influence the Medicare in future because the sustained growth rate is cumulative physicians have limited control over the expenditure on drugs. The other problem is the rate of reimbursement on the physicians.
The physicians can manage the access to patients’ health services by employing a well coordinated care that requires each patient to be assigned a respective physician. Through that, there will limited chances of patients developing health complications and thereby reduce the chances of using high cost on medication in the future. In an exceptional way, the physician should ensure that the specialists, primary care, hospitals, and health care providers among other health care stakeholders work in harmony to enhance efficient and effective delivery of health services to patients. Among the key factor that physicians should focus on is maintaining a high quality of theory service and not saving resources at the expense of the patients as it happens in the case of the HMO (Wolper, 2004).
According to Coombs (2008), HMO limits the patient restriction to health care and thereby saving the cost of medical care at the expense of the health of the patients. In some cases, the HMOs are profit making organization hence increase their charges on health services and thereby limiting the number of patients who can access their services. The HMO further restricts the inpatient access to referrals through structural features that make the patients to have limited alternatives of accessing medical care. That means HMO has control over the health of a patient. The physicians should limit the chances of health care consolidation and hospital mergers that can limit the number of independent doctors and hospitals. If such a situation arises, them the cost of medical care could end increasing hence making it too costly for some citizens (Sweet, Wisconsin, & Wisconsin, 1983).
The physicians have a key role in ensuring efficiency in the operation of the health care in the United States of America. The physicians should ensure that patients receive quality and affordable health care to all citizens. They should ensure that there are no hidden costs that make the cost of medical care high. Restrictions that characterize HMO should be eliminated. They should ensure the performance and quality of the service offered to patients is a key tool to guarantying a healthy nation. For the physicians to succeed in quality accessible health care, they should work with all the stakeholders and implement strategic policies that will guide the future of medical care.
Coombs, J. (2004). The rise and fall of HMOs: An American health care revolution. Madison, Wis: University of Wisconsin Press.
Powell, S. K., Tahan, H. A., & Case Management Society of America. (2008). CMSA core curriculum for case management. Philadelpia: Lippincott Williams & Wilkins.
Sweet, R. N., Wisconsin., & Wisconsin. (1983). Legislation relating to health maintenance organization services. Madison: Wisconsin Legislative Council.
Wolper, L. F. (2004). Health care administration: Planning, implementing, and managing organized delivery systems. Sudbury, MA: Jones and Bartlett Publishers.