Today’s health care system is complex and totally different from what it used to be. This coursework reviews the major driving factors that have led to this change and its impact on consumers.
Today’s health care is not only complex, but also very different from what it used to be. These changes represent the major shifts in moving from the plan based on just satisfying what the needs of the patient, to a managed care system. The American health care system has not only undergone rapid changes but also continues to evolve. Socially amoral economic factors now drive the health system change. This piece of coursework is going to focus on theemployers, health plans & market systems, healthcare providers, the government, and the consumers as the major drivers of the change.
The employers in the private sector have become the major drivers of health system change. They have achieved this by shifting their purchasing power from paying for the open-ended, fee-for-service health insurance benefits Hence, employers can now save on the amount they spend on health care without reducing the quality of care. Employers now expect that the managed care premiums will fall and hence will replace the annual double-digit at is increasing each year. This strategy has succeeded in bringing down the costs of national health (Raphael, D., Riox, M. H., & Bryant, T. 2010)
As health plans compete in the health market for managed care, price competition determines their business strategies.Pressure and uncertainties in the market that are a little bit lower offered today. The price discipline will be determined by both the competitors and the employers. Because the new health plans use aggressive pricing to get started in the market, it means that existing insurers must respond to hold on to the market. A considerable market share is necessary as it enhances negotiations with providers, and it is also an indicator whether the plan will fail or succeed. Price competition among health plans seeking to gain market is getting tougher day by dayservice insurers have started giving way to the market fight among managed care plans for a diminishing number of privately insured individuals. Other factors that enhance market share are acquisition and mergers among health plans.
Price competition for contacts from the health plans is also one of the primary drivers for health care providers. The suppliers take advantage of the fact that they are in excess supplyin a market with aggressive purchasers, and with limited knowledge on how to differentiate between the quality of their services from those of their competitors. Therefore, as managed health care took hold, the expectations of the providers shifted to a future of tightened pressure on pricing and for downsizing. Whereas physicians were rejecting offers of Medicare fees plus ten a few years back, they are now accepting Medicare schedules of minus twenty or even thirty percent. Fear is now said to be the main driver of change among health care providers, and particularly an influential one.
Consumers drive health care market trends today majorly through their willingness to buy health plans on the basis of price comparisons. Individuals tend to prefer lower price plans from the available employers’ offerings and that even a small disparity in premium differences can drive a shift in enrollment among health plans. Thus, the choice made by a consumer and the employer purchasing are both drivers in price-based competition in the health plan market. Research has revealed that with healthcare providers and the managed care plans, customers have a higher degree of overall satisfaction. At the same time, some experts portray consumers as being relatively uninformed purchasers in the health care market who most of the times are confused in choosing among plans and providers. As with employers, consumers would limited basis to enable them to make valid comparisons(Pol, L. G., & Thomas, R. K. 2002).
For along time, the federal government had no major roles in influencing the forces that drive health system change. However in the recent past, the actions of the government have been particularly influential. For example, the implications of Medicare’s shift towards managed care have been felt in the entire health care system. the standards in Medicare’s health plan, the market rules, quality assurance, complaints procedures, consumer information, and the national consumer choice system has provided models for national reforms. Both the federal and the state governments have had a great influence in the regulation of health plans.
From the factors discussed, we can see that the American medical system has tremendously developed over the year is more, patient oriented. There has also risen stiff competition among the service providers which has led to better service delivery. With the rapid technological progress, we expect the system to advance even more.
RAPHAEL, D., RIOUX, M. H., & BRYANT, T. (2010).Staying alive: critical perspectives on health, illness, and health care. Toronto, CSPI.
Health Care in the United States: An Evolving System. (n.d.). Retrieved from http://quod.lib.umich.edu/m/mfr/4919087.0007.102/–health-care-in-the-united-states-an-evolving-system?rgn=main;view=fulltext
POL, L. G., & THOMAS, R. K. (2002).The demography of health and health care.New York, Kluwer Academic Publishers.