Healthcare Funding In The U.S Discussion
One of the most important determinants of a country’s or nation’s economy is the population’s health. As the adage goes, “a healthy nation is a wealthy nation,” so the health sector must remain operational regardless of a country’s current situation. The reasons that an effective and flawless health financing system has not been established anywhere in the world are that (1) developed countries are having difficulty containing the costs of care and (2) some developing countries are having difficulty maintaining health spending and achieving the health for all initiative (Papanicolas et al., 2018)Healthcare Funding In The U.S Discussion. To recap, health financing was a recurring topic at the World Health Organization’s Executive Board Meeting in 1986 and the World Health Assembly and the Commonwealth Health Ministers Conference in 1986, leading to the definition of the term ‘health financing.’ According to Papanicolas et al. (2018), health financing is defined as the mobilization of funds for healthcare, the allocation of those funds to specific regions and populations, and the specific mechanisms for sourcing those funds (Papanicolas et al., 2018). Find a discussion of acceptable funding sources in my healthcare facilities, as well as the characteristics and benefits of a funding source advocated for the uninsured and underinsured population, below.
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Current Funding Sources Acceptable in my Healthcare Setting
My healthcare organization accepts a variety of public and private funding sources. Taxation and social insurance are acceptable public funding sources, whereas private insurance and out-of-pocket arrangements are acceptable private funding sources. Individuals contribute to the provision of health services through taxes on income, property, purchases, capital gains, and various other items (Greener, 2020). Taxation has the advantage of pooling risks for the entire population, relying on a variety of revenues, and having the potential for administrative efficiency and cost control through a single centralized governance system (Greener, 2020). A few flaws of taxation that may limit its effectiveness, as evidenced in my healthcare setting, include variations in the annual budget causing unstable funding, inefficiency due to a lack of incentives and effective public sector management, and, finally, the fact that it disproportionately benefits the wealthy (Greener, 2020)Healthcare Funding In The U.S Discussion.
In the case of social insurance, which is also a viable source of funding for my healthcare organization, everyone in the eligible group enrolls and pays a set premium in exchange for a set of benefits (Gu & Page-Jarrett, 2018). The benefit is that it gives the covered population access to a wide range of services; however, the fact that the poor may be excluded due to high premiums and it provides inadequate coverage for preventive and chronic conditions may limit its wide use (Gu & Page-Jarrett, 2018)Healthcare Funding In The U.S Discussion. Out of pocket schemes, a private funding system in which payments are made directly at the point of care is the most common method of payment in the healthcare setting I am affiliated with. As a result, my facility’s funding sources and reimbursement systems are diverse, recognizing various private and public funding mechanisms.
Features and Benefits of a Private/Public Funding Source Selected
The realization that most funding sources disproportionately benefit the wealthy while leaving low-income people out necessitates the need for a more viable option. Considering the options available, community-based health insurance (CBHI) appears to be a viable option that primarily targets low-income people. The CBHI is a type of micro health insurance that is based on three principles: community cooperation, local self-reliance, and pre-payment (WHO, 2022). The features, as laid out by the WHO (2022), include the following: a community, or people with common characteristics, such as a shared geographical location or community, pool funds together to finance their health needs; membership is voluntary; membership premiums are set at a flat rate and are independent of an individual’s health risk; the scheme is a not-for-profit venture. The main advantage of a CBHI is that low-income people are integrated into the programs because they can afford the membership premiums, which are often affordable (Likka et al., 2018)Healthcare Funding In The U.S Discussion. This financing method will increase access to care for the low-income population, thereby improving their health.
Why the Funding Source Selected has more Advantages: Explanation in Relation to the Affordable Care Act
In its modus operandi, a healthcare institution outlines its acceptable funding or reimbursement sources. To accommodate more people, both socioeconomic groups, those with high income and those with low to moderate income, must be considered. Otherwise, access to health care will be a privilege reserved for the wealthy, while the poor will continue to face barriers to care. The CBHI was chosen as the funding source because of its ability to accommodate low-income individuals while also maintaining high-income individuals, thereby promoting diversity in access to care. The Affordable Care Act (ACA) and the CBHI schemes have similar goals to increase access to care among the low and middle socioeconomic groups. ACA, as enacted by President Obama, increased health insurance coverage for low and middle-income people, a health milestone that resulted in massive utilization of care among that population (Buchmueller & Levy, 2020)Healthcare Funding In The U.S Discussion. This funding system, if accepted by my healthcare setting, will thus improve care to the surrounding population while increasing the hospital’s revenue.
Conclusion
Population health must be maintained and preserved at all costs as an essential determinant of a country’s economy. Countries and nations have various ways of funding the health sector, including public and private schemes. While most funding schemes disproportionately benefit the wealthy, the poor have been overlooked. This realization necessitates the implementation of a funding system, such as CBHIs, that includes low- and middle-income populations in the plan. While some may argue that a CBHI is an outmoded funding strategy, it benefits both the community and the hospital.
References
Buchmueller, T. C., & Levy, H. G. (2020). The ACA’s impact on racial and ethnic disparities in health insurance coverage and access to care: An examination of how the insurance coverage expansions of the Affordable Care Act have affected disparities related to race and ethnicity. Health Affairs (Project Hope), 39(3), 395–402. https://doi.org/10.1377/hlthaff.2019.01394
Greener, I. (2020). Healthcare funding and its relationship to equity and outcomes: A QCA analysis of Commonwealth Fund and OECD data. Journal of European Social Policy, 30(4), 480–494. https://doi.org/10.1177/0958928720905290
Gu, E., & Page-Jarrett, I. (2018). The top-level design of social health insurance reforms in China: towards universal coverage, improved benefit design, and smart payment methods. Journal of Chinese Governance, 3(3), 331–350. https://doi.org/10.1080/23812346.2018.1491112 Healthcare Funding In The U.S Discussion
Likka, M. H., Handalo, D. M., Weldsilase, Y. A., & Sinkie, S. O. (2018). The effect of community-based health insurance schemes on utilization of healthcare services in low- and middle-income countries: a systematic review protocol of quantitative evidence: A systematic review protocol of quantitative evidence. JBI Database of Systematic Reviews and Implementation Reports, 16(3), 653–661. https://doi.org/10.11124/JBISRIR-2017-003381
Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health care spending in the United States and other high-income countries. JAMA: The Journal of the American Medical Association, 319(10), 1024. https://doi.org/10.1001/jama.2018.1150
World Health Organization. (2022). Community-based health insurance. Who. Int. https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-2020 Healthcare Funding In The U.S Discussion
