_MHA_516 Healthcare Consumer and Provider Costs Essay: University Of Phoenix
Healthcare Consumer and Provider Costs
Baylor Healthcare System serves the communities of Dallas and its neighborhood by providing various healthcare services, including cancer care, heart, and vascular services, neuroscience, women, and children care, and trauma services. This healthcare system is affiliated with the Texas A&M Health Science Center College of Medicine and has over 20 specialty centers that provide specialized healthcare services. Currently, Baylor Healthcare System accepts various insurance plans, including Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP). As a leader of such a reputable healthcare organization, I must familiarize myself with the prevailing complexities and dynamics in the state and federal health funding systems and initiate appropriate strategies to decrease deficits.
Recent Medicaid Cuts
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The United States invests massively in the healthcare sector to address health disparities and inequalities and safeguard people’s health. The country relies on public and private insurance coverage plans as the primary models for reimbursing care services, ensuring care accessibility, and enhancing affordability. Medicaid Act of 1965 is a landmark policy that covers vulnerable people, including low-income individuals, children, pregnant women, people with disabilities, ama elderly adults through joint funding from states and the federal government (Allen et al., 2021). Although the joint fundings aim at reducing health disparities by improving insurance coverage, fluctuations in health expenditures affect service delivery in Medicaid-funded healthcare organizations.
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Medicaid cuts and discounting are common phenomena in the current US healthcare systems. Recently, states have approved reductions in Medicaid payments due to the ever-increasing costs of reimbursing care services and products, including technologies and medications. Equally, unanticipated issues like the COVID-19 pandemic force states to implement Medicaid cuts. For example, the Texas legislature approved a $350 million cut in Medicaid reimbursement rates for early childhood intervention therapists and providers. Another recent Medicaid cut is the adoption of a 1% cut in payment to Medicaid community providers and children’s and teaching hospitals by the Colorado government in 2020 (Aron-Dine et al., 2020). These Medicaid cuts affect care delivery and jeopardize care accessibility and utilization.
How Medicaid Discounting Causes Hardships
At the organizational level, Medicaid discounting and cuts affect processes and mechanisms for providing quality care to covered populations. According to Aron-Dine et al. (2020), Medicaid cuts result in increased co-payments, curtail care benefits, and contribute to delayed customer service. For healthcare systems with specialized care centers, Medicaid discounting and cuts can contribute to staff departures, compromise access to essential services, and the subsequent closure or reduction of healthcare services and programs. These issues exacerbate health disparities and affect care utilization.
Positive and Negative Impacts of Federal and State Healthcare Policies
Most of the healthcare policies in the United States focus on the three overarching goals of the US health system; improved access to quality care, affordability, and equity. Examples of these policies are Medicaid, Medicare, and the Affordable Care Act (ACA) of 2010. Shrank et al. (2021), the US health system faces various challenges, including a large and growing uninsured population, a growing national debt, strained state, and federal budgets, and widened health chasms that affect care utilization. Therefore, healthcare policies endeavor to address these challenges.
The current health policies in the US have resulted in multiple benefits, including improving care access, and affordability, and enhancing utilization. According to Shrank et al. (2021), the Medicaid expansion policy contributed to a steady decline in the number of uninsured people and enabled people to access improved healthcare services, as well as enhancing equity and financial well-being. Other advantages of health policies are advancement in home-based care, accelerated transition to value-based care, and improved affordability of therapeutics and drugs.
Although healthcare policies in the United States have significantly contributed to improved care access, affordability, and utilization, they have various limitations. According to Crowley et al. (2020), the US fares worse compared to its peers based on coverage and value benchmarks. In this sense, over-relying on federal and state insurance policies contributes to high and unsustainable expenditure per capita. Equally, Medicaid and Affordable Care Act provides states with opportunities to modify eligibility criteria, increasing the likelihood of exclusion of at-risk populations from insurance coverage.
Proposed Recommendations to Decrease Deficits and Alleviate the Negative Effects of Policy Changes
Baylor Healthcare System should implement proven interventions to reduce losses incurred in the event of Medicaid cuts and discounting. A contingency plan for avoiding financial deficits and losses includes multiple approaches, such as using data analytics to develop pathways to higher profitability, enhancing the widespread use of medical technologies, adopting of absorptive capacity policies, and talent retention policies to reduce departures (Foroughi et al., 2022). These approaches focus on reducing financial losses while maintaining care quality and staff motivation.
Conclusion
Medicaid cuts and discounting affect care quality, accessibility, and utilization by reducing organizations’ capacity to deliver healthcare services. Further, budget cuts force organizations to close or reduce service delivery and contribute to staff departures. As a leader of a reputable healthcare system in Texas, it is vital to initiate transformative, adaptive, and absorptive capacity policies to address financial deficits and maintain care quality amidst Medicaid cuts.
References
Allen, H., Gordon, S. H., Lee, D., Bhanja, A., & Sommers, B. D. (2021). Comparison of utilization, costs, and quality of Medicaid vs subsidized private health insurance for low-income adults. JAMA Network Open, 4(1), e2032669. https://doi.org/10.1001/jamanetworkopen.2020.32669
Aron-Dine, A., Hayes, K., & Broaddus, M. (2020, July 21). With the need rising, Medicaid is at risk for cuts. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/with-need-rising-medicaid-is-at-risk-for-cuts
Crowley, R., Daniel, H., Cooney, T. G., & Engel, L. S. (2020). Envisioning a better U.S. health care system for all: Coverage and cost of care. Annals of Internal Medicine, 172(2_Supplement), S7. https://doi.org/10.7326/m19-2415
Foroughi, Z., Ebrahimi, P., Aryankhesal, A., Maleki, M., & Yazdani, S. (2022). Hospitals during economic crisis: A systematic review based on resilience system capacities framework. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08316-4
Shrank, W. H., DeParle, N.-A., Gottlieb, S., Jain, S. H., Orszag, P., Powers, B. W., & Wilensky, G. R. (2021). Health costs and financing: Challenges and strategies for a new administration. Health Affairs, 40(2), 235–242. https://doi.org/10.1377/hlthaff.2020.01560
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Course Title: Operating in Structure: Health Sector Policy and Governance Competency Assessment Title: Consumer and Provider Costs Assignment Directions As demonstrated in the 2020 Census, the population of the United States continues to include greater percentages of immigrants. Many of these immigrants do not have private health insurance and thus rely on Medicaid. This has led to changes in the populations that health care organizations must serve. Assume you are the administrator of a health care organization in a Texas city bordering Mexico that accepts Medicaid as a payor. Recent Medicaid policies and discounting have contributed to the organization’s failing bottom line. Many of your clients have recently immigrated to the United States and are on Medicaid. You have been asked to prepare an executive summary to present to the board of directors detailing how Medicaid discounting causes hardships on your organization’s finances and the health populations you serve.
Write a 525- to 700-word executive summary. Include the following in your executive summary: • Clearly identify the type of facility that you are leading. • Explain specific cuts that Medicaid has made in recent years. • Describe how Medicaid discounting causes hardships on your organization. • Evaluate the impact that federal or state health care policies are having on consumers’ costs. Explore both positive and negative effects. • Recommend changes you propose to help decrease the deficit from the perspective of your organization. • Recommend actions the organization can take to alleviate the negative effects of these changes but still meet the needs of various populations.
Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
Format your assignment according to APA guidelines.
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