Introduction
Vermont, Minnesota and Colorado have introduced transformative healthcare payment and delivery system reforms. The three regions have introduced deliberate measures to coordinate the healthcare insurance providers and health facilities to improve disease prevention and management. The reforms in the regions have the aims to lower the basic costs and enhance the desired healthcare results. The healthcare models in Colorado and Minnesota have introduced transformative, accountability and transparent approaches for the patients under the Medicaid program. On the other hand, Vermont has introduced the multi-payer programs with the objective of a consolidated healthcare financial system. This article focuses on the healthcare payment and delivery system reforms being carried out by the state of Georgia in collaboration with the federal government (Cohen & Martinez, 2016). The discussion centers on the reforms and initiatives regarding payment and delivery systems to inform the federal government measures to improve healthcare for all.
Georgia is the 9th most populous state in the US with a population of 9.6 million. The state had a GDP of $425 billion by 2013 and an unemployment rate of 8.1% which implies that an adequate health payment and delivery system is necessary (Vetter, et al 2014). Medicaid and children health insurance program (CHIP) have shown the greatest positive impacts in the state of Georgia as they provide a flexible plan for the adults and the children. The two payments and healthcare system complement each other to make healthcare affordable to the majority. The two payment systems offer private healthcare options for the children and the adults in the lower income bracket and hence the positive impacts.
The health insurance marketplace is another payment and health delivery system that has been active in the state of Georgia. Figures indicate that by 2014, about 85,000 people had enrolled in the program. 87% of those registered at the time received government premium subsidies. 35% of those enrolled in the program are aged below the age of 35 years. The payment and the delivery system have had such a positive impact on the low-income earners who would otherwise not afford the health care insurance covers (Cohen & Martinez, 2016). The insurance has been some kind of an affirmative action to enable the people in the lower income groups to access healthcare, which in turn has made them productive in their endeavors.
Challenges in Healthcare Reform
Despite the elaborate payment and the health delivery system through Medicaid and CHIP, there is quite a substantial proportion of the population that is not covered by the program. Evidence shows that the state has one the highest uninsured rates in the country with more than 1.8 million people in the non-elderly group being under no payment plan. The challenge is attributed to the high levels of unemployment in the state which implies that the majority of population aged 54 years has no stable sources of income and hence cannot contribute to the payment plan. Data from 2014 indicate that the number of the uninsured individuals has been increasing in comparison to other states in the USA (Cohen & Martinez, 2016). The majority of the uninsured people are in the low-income households. The major challenge, therefore, is a lack of reliable sources of income which implies that the federal government should make the environment conducive for investments and therefore employment creation. Such a measure would raise the level of revenues for the low-income households and hence enable them to contribute fully to the Medicaid program.
The federal government could also introduce a special tax on the high-income earners so that the amounts cater for the health requirements of the most vulnerable individuals in the lower brackets. The federal government should also explore more ways to ensure that the black and Hispanic populations who consist of more than 55% of the uninsured residents are gainfully engaged in income-generating activities. The federal government should create other avenues to ensure the coverage through the expansion of the Medicaid cover to make sure that majority of the non-elderly adults in the state access the program (Silow-Carroll, Edwards, & Rodin, 2013). The federal government also has the direct responsibility to provide financial assistance to the low-income earners to enable them to enroll through the health insurance marketplace. The health premium subsidies have particularly been crucial in enabling the low-income earners access quality medical care. The government should also simplify the eligibility and the enrollment process so that more individuals are absorbed into the payment and the healthcare delivery system.
Major Lessons
The major lessons from the Georgian experience are that there should be a collaborative effort of all the stakeholders in the achievement of a comprehensive healthcare reform. The contribution of the governments, especially the federal government, is not enough in the availability of the affordable healthcare to the citizens (Keehan et. al, 2011). The responsibility of the healthcare reforms rests with all the people in a given area as low levels of healthcare will ultimately affect everyone. Although the federal government contributes about 67% to fund the Medicaid, it is still not sufficient to cater to the targeted segment of the population (Cohen, & Martinez, 2016). The implication is that the government should continue exploring other avenues to ensure that the payment and health care reform impacts majority if not all of the targeted groups.
As such, there should be a deliberate attempt by the federal government to make sure that the majority of the population across the country is gainfully engaged so that they can fully contribute to the health insurance covers. Ensuring the elevation of the incomes among the majority in the low-income brackets would be crucial in reducing the financial burden on the government (Keehan, et al, 2011). The government has also demonstrated that it is possible to empower the moderate-income members of the society through the provision of the health premium subsidies and therefore enable them to access quality healthcare (Brunt, & Jensen, 2014). Another lesson is that the health of the children, the elderly and the people with disability is critical and it is significant that the state and federal governments have the definite plans to cater for the health of the most vulnerable members of the communities.
Conclusion
The Georgia healthcare, payment and delivery reform system have been relatively successful in the midst of the myriad challenges in the state and the country at large. The Medicaid and the health insurance market have served the exact role in the healthcare reform agenda within the state. However, a lot needs to be done to ensure that the healthcare system is all inclusive and cater for the low-income earners as well as the most vulnerable segments of the population.
References
Brunt, C. S., & Jensen, G. A. (2014). Payment generosity and physician acceptance of Medicare and Medicaid patients. International journal of health care finance and economics, 14(4), 289-310.
Cohen, R. A., & Martinez, M. E. (2016). Health Insurance Coverage, Early Release of Estimates from the National Health Interview Survey, 2011. National Center for Health Statistics.
Keehan, S. P., Sisko, A. M., Truffer, C. J., Poisal, J. A., Cuckler, G. A., Madison, A. J., & Smith, S. D. (2011). National health spending projections through 2020: economic recovery and reform drive faster spending growth. Health Affairs, 10-1377.
Silow-Carroll, Sharon. Edwards, J. N., & Rodin, Diana (2013). How Colorado, Minnesota, and Vermont are reforming care delivery and payment to improve health and lower costs. Issue Brief (Commonw Fund), 10, 1-9.
Vetter, T. R., Boudreaux, A. M., Jones, K. A., Hunter Jr, J. M., & Pittet, J. F. (2014). The perioperative surgical home: how anesthesiology can collaboratively achieve and leverage the triple aim in health care. Anesthesia & Analgesia, 118(5), 1131-1136.
