Is System Wide Incentives Encourage Delivery Of High Quality, Prevention Orientated Programs?

Because the rate all payers pay are generally the same (by categories of procedure), providers have no incentive to compete and provide better service. Providers who provide higher quality care are rewarded just as much as those who provide lesser quality care. Even though an all-payer system would shift provider's focus from the patient's socio-economic status, it would eliminate the incentive to improve the quality of service as the reward for quality is limited to morality, not money. A possible solution of this is to have an all-payer system, with adjustment to rates based on the quality of health care provided (rather than inflating some payers to cover the discounts of payers who pay

Through the history of health care, the standard of care changed from protecting our patient from injury and illness to a systemic entity to make money for insurance companies. Access to services and clinical outcomes are dependent on what health insurance providers will “pay” for in a clinical or community setting; as a result, patient safety, care and satisfaction has been negatively impacted.

The current health care sector is too costly and too fragmented with a lot of variation in care even with established evidence based guidelines. Providers lack the tools, support and information they need to offer the coordinated health management that can reduce cost and improve outcomes. Primary Care Physicians are constrained in their abilities to perform any proactive care that involves avoiding Hospital or ER visits, and influencing healthy lifestyles.

Research shows that healthcare is not equal among all demographics and it is evident that throughout time, various groups of people have been taken advantage of by the medical community.

It is commonly believed that the method of physician remunerations affects their professional behavior. As a result, payment systems are therefore manipulated in attempts to achieve policy objectives with the primary aim to improve quality of care, contain cost and maintain recruitment of human resources in underserved areas. (2,1)

For anyone who has kept up with the news, the US healthcare system has undergone major changes in recent years. Insurance providers are no longer able to deny someone coverage based on pre-existing conditions. The advent of healthcare marketplaces has changed the way people purchase health insurance. Children can stay on their parents' health insurance plans until 26. Leading the healthcare revolution is InnovaCare Health. This organization is a leading provider of Medicaid and Medicare Advantage plans. InnovaCare Health recently announced it would partner with the Health Care Payment Learning and Action Network. This is a significant private-public partnership that seeks to change compensation models to reflect the quality of care instead of quantity. This new partnership reflects InnovaCare Health's to affect change in compensation sooner rather than later. The current healthcare model focuses on reimbursing physicians based on the number of patients seen or procedures performed. This encourages "treadmill medicine," or a model that focuses on rapid turnover. This can often lead to detrimental effects on patient health. The new quality model would reward physicians based on practice targets. Potential goals include HbA1c goals for patients with diabetes, the percentage of patients who smoke, and hospital stay after surgical procedures.

Health System Reform in the United States: Impact of Rising Premiums and Opportunities for System Improvements to Enhance Access to Healthcare Services

The single most important impetus for healthcare reform throughout recent history has been rising costs (Sultz, 2006). In the book called The healing of America: a global quest for better, cheaper, and fairer health care, Reid wrote that the nation’s health care system has become excessively expensive, ineffective, and unjust. Among the world’s developed nations, the US ranks near the bottom for healthcare access and quality. However, the US ranks at the top for health expenditure as a percentage of the Gross Domestic Product (GDP) and average of $7,400 per person (Reid, 2010). Therefore, Americans are spending

The United States, as a developed, wealthy nation, possesses the largest disparity between social classes in relation to health care and access to health care services (Wright & Boorse, 2014). Because of this disproportion and regardless of spending the most health care dollars per person, the United States ranks lowest amongst developed nations in life expectancy, has the most children living in poverty, and the most people in prison (Wright & Boorse, 2014, p. 200). President Obama’s Patient Protection and Affordable Care Act, passed by the U.S. Congress and the Senate in 2010, sought to correct the imbalances that exist between the classes in relation to both health care and health insurance with socialized medicine. While the Affordable Care Act has contributed to cost savings, reductions in fraud, abuse, and misuse of health care resources, along with health insurance for all, the Affordable Care Act has had an untoward, negative effect on the delivery of primary care (Mori, 2016). Hence, decision-making authority over primary care has shifted from the physician and into the hands of Accountable Care Organizations (ACO’s) created by the government, insurance companies, and private health care systems (Mori, 2016).

The dysfunction of the American health care system implies that not everyone has access to the right medication and medical treatment. Middle-class families and chronically ill patients do not always have access to health care, and when they do they do not receive adequate treatment with regards to hospitalization and medical services or quality of service. The lack of payment reform results in

After years of schooling and hundreds of thousands of dollars in debt, doctors aren’t even able to work on their own terms. “Consumers allegedly have a “right” to what health care providers provide, a “right” to say what will be provided, when, and at what price” (Salsman 2012). Consumers shouldn’t have a “right” to what is provided to them or how much it costs. The government controls pricing and controls who can receive care and what kind. It’s not right that those who are actually working in the medical profession that they have lost control of their businesses.

The Issue is that physician payments in Medicare and Medicaid, are already well below the prevailing rates in the private sector. On the average, physicians who take Medicare are paid 81 percent of private payment. Doctors who take Medicaid are paid 56 percent of private payment. This type of payment plan (Obamacare) has resulted in access problems for Medicare patients, and the even lower Medicaid payments have already caused serious access problems for lower-income people and made hospital emergency room overcrowded. During recent research study on the The Affordable Care Act they found that 67 percent of primary care physicians said that under current laws and conditions new Medicaid enrollees will not be able to find “suitable primary care

There are two prime issues that arise from this discrepancy. Firstly, the performance of providers that treat patient populations with low socioeconomic status might be mis-measured. Secondly, even after addressing mis-measurement, disadvantaged patients are generally disproportionately served by low-performing performers that are under-resourced and require additional resources to improve quality for disadvantaged patients. Therefore the redistribution of resources way from the providers, who care for disadvantaged population, requires changes in the payment policy. Ideally, a pay-for performance

Primary care is considered by many countries as a backbone of the medical health system that is effective and efficient and satisfies the demands of patients and families (Sebo, 2015). The enhancement of primary care practices’ quality improvement (QI) orientation is essential in strengthening the primary care practices (U.S. Department of Health and Human Services Agency for Healthcare Research and Quality, 2013). In addition, external supports such as feedback and benchmarking, coaching, expert consultation, and shared learning can help primary care practices with quality improvement and enhancing QI orientation. There are different organizations that provide quality supports to primary care practices. One of this is the North Carolina Area Health Education Centers (AHECs) Practice Support Program. The aim of the program is to support primary care practices in North Carolina by providing primary care practices with onsite QI consultants, tools, and resources that help primary care practices’ transformational efforts (U.S. Department of Health and Human Services Agency for Healthcare Research and Quality, 2014).The aim of this paper is to summarize two articles related to primary care.

Primary health care is a term used to describe a system where a patient’s health care needs are attended to by the most appropriately trained individual. This method of health care delivery has been called a “team based approach” (Health Canada, 2006). Instead of seeing the doctor for every health concern, other health professionals such as nurse practitioners, pharmacists, dieticians or physiotherapists may be called upon to take care of your concerns. In this paper I will discuss the issues in primary health care from the literature review/article Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health (2010). I will once