Factors Driving Changes in American Healthcare System
The American healthcare system is one of the best in the world. One unique aspect of the American healthcare model is its drastic changes over the years to support the country’s goal to “ensure an opportunity for life, liberty, and the pursuit of a happy life” (Knickman & Elbel, 2018). One of the most important factors that influence these changes is cost since a larger part of the American economic budget caters to health-related issues. In a capitalist economy, the American healthcare system has, for the longest time, encouraged profitability through payment for healthcare services (Abrams et al., 2015). The country has been unable to attain health goals when compared to other rich countries, influencing the need to reform how healthcare services are paid for.
For the longest time, the American healthcare system adopted the fee-for-service model (FFS). This model advocates for those healthcare providers to be paid based on the number of services they provide. The individuals, or the government, or the insurance company are expected to pay for every medical procedure (treatment, testing, consultation, and hospitalization) the healthcare provider performs (Knickman & Elbel, 2018). Thus, it is more rewarding to the provider instead of the patient outcome. This challenge has prompted the American healthcare system to transition to a value-based care model that limits the healthcare providers from turning healthcare services into the business. The value-based care model focuses on the positive outcome of ensuring that patients do not seek medical services more often (Knickman & Elbel, 2018). An excellent example is the Affordable Care Act (ACA) that has provided many provisions that reform the FFS model. For example, ACA has lowered the annual Medicare payment rates, limiting the FFS power to allow healthcare providers to adopt the incentive model, where they are rewarded for quality care and good patient outcome instead of the quantity of services they have provided (Abrams et al., 2015).
References
Abrams, K. M. et al. (2015). The Affordable Care Act’s Payment and Delivery System Reforms: A Progress Report at Five Years. The Commonwealth Fund. https://www.commonwealthfund.org/pulications/issue-briefs/2015/may/affordale-care-acts-payment-and-delivery-sytem-reforms
Knickman, R. J. & Elbel, B. (Eds). (2018). Healthcare Delivery in the United States, 12th Edition. New York: Springer Publishing Company.
