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How to Boost Healthcare Accessibility

Big Picture 


While insurance coverage provides access to healthcare services, there can still be barriers to timely and appropriate care. Continued efforts to address this concern are highly important to ensure all Americans have access to affordable and comprehensive health insurance coverage. 



Operative Definitions


  1. Health insurance coverage: Legal entitlement to payment or reimbursement for your health care costs, generally under a contract with a health insurance company, a group health plan offered in connection with employment or a government program like Medicare, Medicaid or the Children’s Health Insurance Program (CHIP). 

  2. Affordable Care Act (ACA): The name for the comprehensive healthcare reform law (passed in 2010) and its amendments. The law addresses health insurance coverage, costs and preventive care. 

  3. Copays (or copayment): A set fee you pay for a doctor's visit or prescription. You typically pay for it at your appointment or when you pick up a prescription.

  4. Health insurance premium: An upfront payment to maintain health insurance, often monthly for individual market plans or via payroll deductions for employer-based plans. Consumers may also face out-of-pocket costs for medical care, like deductibles and copays.


Important Facts and Statistics


  1. An estimated 112 million (44%) American adults are struggling to pay for healthcare, and more than double that number (93%) feel that what they do spend is not worth the cost. 

  2. The ACA moved us closer to universal coverage, but the U.S. remains one of the few countries without it. Despite spending the most on healthcare as a percentage of GDP, our health outcomes are worse than other advanced nations like Australia, Canada, the UK, Germany, France and Japan. 


Five-Point Plan


(1) Reduce administrative costs to redirect excess US health spending and focus more on improving health outcomes. 

US administrative spending accounts for 15-30% of healthcare spending and many costs do not correspond to specific lines in cost reports or budgets. As much as administrative costs in healthcare can be significant, involving paperwork, billing, and processing claims, reducing unnecessary initiatives can free up resources. This allows healthcare providers to focus more on patient care alongside improving efficiency to ensure that resources are directed toward delivering necessary medical services and treatments. 


(2) Adequate funding to expand outreach efforts to raise public awareness of financial assistance. 

This helps keep coverage plans such as Medicaid premiums and cost-sharing requirements affordable for beneficiaries. It allows the program to subsidize premiums or eliminate them altogether for those who cannot afford to pay. Furthermore, the correct funding helps minimize out-of-pocket costs, such as deductibles and copays, making healthcare services more accessible and affordable for low-income individuals and families. 


(3) Guarantee comprehensive healthcare plans and appropriation in terms (patients get what they pay for, nothing less). 

Comprehensive health plans contribute to equity and fairness in healthcare access. By covering a broad range of services, they help ensure that individuals have equal opportunities to receive necessary care regardless of their income level or health status. Comprehensive coverage reduces disparities in access to essential services and helps address health inequities among different populations. We need to streamline health insurance plans by simplifying options and improving transparency: enhancing the clarity of each, standardizing benefits and terminology and providing information that is easy to understand.


(4) Emphasize that patients’ well-being and access to quality healthcare services are above the pursuit of financial gain in the healthcare industry. 

This will encourage patient-centered care delivery models that promote care coordination, empower patients in decision-making and foster a healthcare system that prioritizes quality outcomes and patient satisfaction. This can kickstart an integration of patient feedback in insurance plan design and delivery. 


(5) Invest in initiatives that encourage education on population health. 

Among the 11 nations surveyed, the U.S. is the only one without universal health insurance coverage. Other research suggests that the U.S. spends less than other high-income countries on social services, such as child care, education, paid sick leave and unemployment insurance, which could improve population health. These areas need to be fully funded by the government and can lead to stress and root causes of not being able to afford health insurance. When awareness has risen, healthy lifestyles, preventive screenings and chronic disease management ultimately reduce the burden of illness and lower long-term healthcare costs. 


Why This Initiative Is Important


This initiative tries to improve access to care, provide financial protection, lead to better health outcomes, promote health equity and contribute to the sustainability of the healthcare system. These reforms aim to create a more inclusive and efficient healthcare system that meets the needs of individuals and communities. 


Economic Impact 


Enhancing healthcare efficiency by controlling costs, particularly through the reduction of unnecessary procedures, leads to lower healthcare expenditures for individuals, businesses and the government. 


Healthcare insurance reforms that expand coverage and improve access to care can lead to increased use of healthcare services, thereby stimulating economic activity within the healthcare sector including increased demand for healthcare professionals, medical facilities and pharmaceutical products. 


The opinions expressed in this article are those of the individual author.


Sources


Buchholz, Katharina. “Infographic: Number of U.S. Uninsured Falls Once More.” Statista, 7 Feb. 2023, https://www.statista.com/chart/8441/number-of-americans-without-healthcare-insurance/

“112 Million Americans Struggle to Afford Healthcare - westhealth.org.” West Health, 31 March 2022, https://www.westhealth.org/press-release/112-million-americans-struggle-to-afford-healthcare/

“3 Reasons the U.S. Doesn't Have Universal Health Coverage.” USNews.com, 26 Oct. 2016, https://www.usnews.com/news/national-news/articles/2016-10-26/3-reasons-the-us-doesnt-have-universal-health-coverage

Velasquez, Vikki. “Health Insurance Premium: Meaning, Overview, FAQ.” Investopedia, https://www.investopedia.com/health-insurance-premium-4773146

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