The World Health Organization [WHO] defined healthcare policy as the branch of healthcare which specializes on the decision-making, planning, and implementing of different policies and laws that are deemed necessary to be able to achieve goals set in a particular society. It has been said that healthcare policy allows prioritization of the different goals of different communities which can bridge the gap especially when establishing consensus and informing the people (WHO, 2016). On the other hand, healthcare policy models and frameworks are different outlines or structures used by health professionals in the brainstorming, implementation, and evaluation of various health care policies and reforms.
One of the healthcare policy models and frameworks common to the people in United States is the social insurance model which is also referred to as Medicare (for the elderly) and Medicaid (for the poor). These social insurance models are funded by the Social Security taxes obtained from the employees and the employers, federal taxes, and monthly premiums funded by the recipients (Bodenheimer & Grumbach, 2009). One of the known benefits of the social insurance model is the support that it provides to its beneficiaries especially to the elderly population. Medicare greatly helped in the retirement of the elderly population because the financial support it provides allows the elderly beneficiaries to allot their monetary resources to other important necessities. Additionally, since the social insurance model is federally regulated, all of the elderly population are given the same benefits regardless of their residence. It has been acknowledged that one of the greatest strengths of Medicare is the benefits it provides to its beneficiaries. The original purpose of the social insurance model is allowing the provision of affordable health care to the elderly population. The relatively lower cost of Medicare compared to the private insurance companies proves that Medicare remains to be the better option in terms of its benefits and cost (Wiggins, 2013).
However, there are also some problems associated with the social insurance model. Some of these problems involve the deductions of the health care costs, unlimited out-of-pocket spending, and even the gap in coverage when it comes to the plan for the prescription drugs that may exist until the year 2020. Aside from these, another concern is the failure of Medicare to cover the costs for long-term care of its beneficiaries. Currently, the concern for the social insurance model is the growing number of Baby Boomers which are assumed to benefit from Medicare in the next decade. The increase in the number of Baby Boomers can be a big problem since the funds from the taxpayers may not be sufficient for the growing number of beneficiaries (Wiggins, 2013; Grabowski, 2007).
Aside from social insurance model, other models used for the evaluation of health policies include microsimulation and cell-based models. These models can be used during different circumstances. For instance, modeling which involves complex systems are ideal for microsimulations. However, the accuracy of the modeling of complex systems relies on the relatively large amount of data involving the agents, relationships, and even impacts. Microsimulations have been acknowledged as one of the strongest models ideal for the changes in health policies such as the reform in health insurance. On the other hand, the availability of large amounts of data is not necessary for cell-simulations. With this in mind, professionals have considered cell models because of their simplicity and even transparency (Ringel, Eibner, Girosi, Cordova, & McGlynn, 2010).
In totality, different health care policies and frameworks have their own strengths and weaknesses. Thus, it is important to consider these aspects in determining the best model and framework to be used for a certain health concern.
References
Bodenheimer, T.S. and Grumbach, K. (2009). Understanding Health Policy: A Clinical Approach. 5th ed. New York, NY: McGraw-Hill Companies.
Grabowski, D.C. (2007). Medicare and Medicaid: conflicting incentives for long-term care. The Milbank Quarterly 85(4): 579-610.
Ringel, J.S., Eibner, C., Girosi, F., Cordova, A., and McGlynn, E.A. (2010). Modeling Health Care Policy Alternatives. Retrieved from http://www.rwjf.org/en/library/research/2010/10/health-services-research-in-2020-/modeling-health-care-policy-alternatives.html [Accessed on 6 Jul 2016]
Wiggins, B. (2013). The Good, the Bad, and the Ugly of Medicare. Social Work Helper. Retrieved from https://www.socialworkhelper.com/2013/03/19/the-good-the-bad-and-the-ugly-of-medicare [Accessed on 6 Jul 2016]
World Health Organization [WHO]. (2016). Health Policy. World Health Organization. Retrieved from http://www.who.int/topics/health_policy/en/ [Accessed on 6 Jul 2016]
