Health Care Utilization
This paper will describe the ways in which recent health care reforms have enhanced or restricted access to care and how changes in access may influence utilization. It will also explore the concept of universal health care and similarities and differences of current care to this concept as well as my experience with health care expansion.
The Patient Protection Expanded and Affordable Care Act (ACA) which was signed into law in 2010 and other similar legislations enacted at state levels have expanded access to preventive and emergency care to people who could not afford such services previously. These acts enhance access through various ways; some acts provide state-subsidized medical insurance cover to the uninsured whilst others make it mandatory for employers to enroll their employees in medical insurance schemes. In essence, therefore, these legislations ensure that that more people have medical insurance and in effect, they can access preventive and curative health care services.
The Health Information Technology for Economic and Clinical Health (HITECH) Act has also enhanced access to care for patients. This act requires all hospitals and other health care settings to implement electronic health records by the year 2015 and provides financial incentives for health care organizations to implement such systems. This requirement has enhanced access to care for patients because health care professionals can now access patient records from various settings and geographical locations. As a result, patients can now seek health services from providers other than their primary physicians. For instance, school nurses can monitor and provide due immunizations to their students reducing their need to visit hospitals. However, the benefits of increased access to patient information are offset to some degree by HIPAA which delineates provisions that restrict the sharing of patient identifiable information to a need to know basis. The act has been criticized for failing to delineate parameters for disclosure and non-disclosure of patient information. As a result, anecdotal reports indicate that health care providers wary of breaching the provisions of the act fail to disclose information crucial to care of patients. Therefore, the HIPAA act restricts access of health care providers to patient information and in effect, it may inhibit patient access to care.
Changes to access of health care may increase utilization of routine health care services through various ways. Firstly, groups that could not access preventive and curative health care services on account of financial limitations would be able to afford these services and thus increase their utilization. On the other hand, increased access to health care services may also encourage misuse of such services whereby persons may consume more of these services needlessly. For instance, increased employer-sponsored or government provided insurance coverage can foster more unnecessary emergency department or hospital visits because patients are immune to the care costs. Decreased access to health care services due to either unavailability of physicians or increased care costs, on the other hand, may decrease utilization because people may not be able to afford medical fees or the services may be unavailable. Notably, findings from various studies seem to suggest that increased access to care does not result in increased utilization of emergency care, hospitalization services, and specialized care (Kempe et al., 2005).
The concept of Universal health care is defined as a basic guarantee to health care for all citizens. Access to health care is seen to be a basic right under universal health care systems. The universal health care system is funded by a single-payer who is usually financed by the government through taxes or social insurance. In contrast, the current US health care system utilizes a mixed system of financing where employment based insurance predominates. Due to the different modes of funding, citizens under universal health care systems have guaranteed access to health care whilst citizens in the US can only access care if their employers enroll them in an insurance scheme or if they belong to government funded insurance programs such as Medicare and Medicaid. As a result, a significant proportion of US citizens (approximately 45%) do not have medical insurance or are underinsured. Due to practical constraints, universal health care systems lead to the rationing of care and delays in treatments. In contrast, access to the US health care system is influenced by availability of the health care services and one’s ability to pay. Unlike the US health care system, universal health care systems are characterized by a high degree of governmental control (Ham, 2005).
My experience with recent health care expansions was mainly positive. They have led to an increase in the number of patients utilizing preventive care services. As a result, we have to attend to an increased number of patient. I derive professional satisfaction though from the knowledge that patients who could not access preventive care services are now able to.
In summary, recent health reforms have enhanced access to care by increasing the number of citizens eligible for medical insurance and access to patient medical records. Depending on the underlying factors, changes in access to care may increase or decrease utilization. The concept of universal health coverage guarantees access to care to all citizens. It differs from current care in terms of financing and coverage. Lastly, my experience with health expansion has been positive.
References
Ham, C. (2005). Money can’t buy you satisfaction. BMJ, 330(7491), 597-599.
Kempe, A., Beaty, B. L., Crane, L. A., Stoksad, J., Barrow, J., Belman, S., & Steiner, J. F. (2005). Changes in access, utilization, and quality of care after enrollment into a state child health insurance plan. Pediatrics, 115(2), 364-371.
