University Health Care Policy: Reimbursement Model Analysis

This report provides an in-depth analysis of the US healthcare system, particularly focusing on the Affordable Care Act (ACA) and its impact on healthcare policy. The report examines the expansion of Medicaid, the effectiveness of reimbursement models, and their influence on healthcare costs and health outcomes. It explores various factors impacting the healthcare system, including the financial burden, eligibility criteria for Medicaid, and the importance of health promotion and education. The analysis highlights the challenges and successes of the ACA, considering factors like health literacy, health behaviors, and the role of the government and financial investors in healthcare. The report concludes by emphasizing the need for comprehensive strategies to improve healthcare delivery, reduce costs, and enhance the overall well-being of the population, while also addressing the limitations of the current reimbursement methods and the importance of preventative care.

Running head: HEALTH CARE POLICY: REIMBURSEMENT MODEL
HEALTH CARE POLICY: REIMBURSEMENT MODEL
Name of the Student
Name of the University
Author Note

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HEALTH CARE POLICY: REIMBURSEMENT MODEL
Introduction
USA health care system is developed with the consideration of the subsidized care
delivery with the focus on the Affordable Care Act (ACA). This s the health care policy
developed with the reformation of the Medicaid expansion process. This care policy focuses on
helping the lower income range people with the financial help for the providing the health care
access. The ACA focuses on the expansion of the range of the people who were not eligible for
the previous rule of the Medicaid. In this context, it can be seen that there are different factors
focused on the care delivery and also there are people who are influential in terms of the
development of the policy rules and also focused on the delivery. Based on this context, it can be
found that the process of the health care policy is dependent on various aspects. It can be found
that the ACA is also focused on the reimbursement model of care. Hence, in the following
section the effectiveness of the health care policy and the reimbursement model along with the
impacting factors will be discussed in details.
Discussion
Affordable Care Act (ACA) is primarily the expansion of the previous Medicaid which
focuses on supporting the people from the group of the lower economic structure. The people
were eligible for the Medicaid obtaining would be needed to at least lie in the range of the
federal poverty level of 133 per cent (HealthCare.gov, 2020). However, the ACA has expanded
the support to the people from the 138 per cent of the federal government poverty level
(HealthCare.gov, 2020). In this context, it can be found that USA is one of the high income
countries and among all the high income countries USA spends higher for the health care system.
It has been seen that the country spends 17.8 per cent of the GDP for the health care system,
whereas, other high income countries spend 9.6 to 12.4 per cent GDP in the health care system

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(Papanicolas, Woskie & Jha, 2018). Hence, it can be stated that the health care policy of the
country is focused on the improvement of the health condition of the people despite of being in
the lower income status to reduce the disparities regarding the health condition. However, it can
be found that the insured people rate for the health care is lower than other countries in the
country as the rate is 90 per cent contrasting from other countries where the rate is 99 to 100 per
cent (Papanicolas, Woskie & Jha, 2018). The cause of this situation can be marked as the process
of the eligibility setting for the people to avail the Medicaid support. There are specific criteria
present to avail the Medicaid for people of the country such as the state of the person should
expand the Medicaid and also the person should at least lie in the range of the 138 per cent of
federal poverty level. It can be stated that the process of the care has been changed with the
effective planning of the innovative care delivery to patient to develop a cost effective care
delivery and thus reduction of the care cost. However, it has been seen that the innovation of the
biotechnology for the improved care delivery to the patients sometimes leads to higher cost.
Hence, the triple aim of the care delivery by the USA health care system has been focused on
reducing the per capita costs of health care, improving the experience of care and improving
population health (Bhavan, Agrawal & Cerise, 2016). However, it cannot be achieved due to
several factors such as the focus on the innovative care has been found with some costly factors.
On the other hand, the approach of the self-administered outpatient intravenous antibiotic
treatment is effective in terms of educating the patients with self administration processes which
can reduce the cost of the outpatient care delivery process. It has been seen that the process of
the health care investment of the country is focused on the clinical factors rather than the social
and behavioral factors which have a huge impact over the health and the life expectancy of
people. Based on this context, it can be found that the male population from the lower income

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group and 40 years age range has 14.6 years less life expectancy than the male population from
the higher income group (Adler, Glymour & Fielding, 2016). This condition is also prominent
among the female population as the life expectancy rate is 10.1 years higher among the female
population of the higher income group from the lower income group (Adler, Glymour &
Fielding, 2016). Hence, it can be stated that the process of the care delivery and the health care
finance of the country only focused on subsidizing the people from the lower income group and
there are 3 million people potentially eligible for availing the support (Papanicolas, Woskie &
Jha, 2018). However, the smoking rate and the alcohol or other substance abuse rate us high
among the people of the country which can be marked as the negative health behavior and leads
to development of the negative health issues (Adler, Glymour & Fielding, 2016). Hence, it can
be stated that the process of the care delivery or the health care finance of the country should
consider these factors of the health behavior. However, the context of the health financing in the
country can be marked as one of the higher burden over the financial or the economic structure
of the country (Moses et al., 2015). Hence, the consideration of the proper health promotion and
the health improvement strategies should be focused on the factors related to the health issue
development. Moreover, it can be stated that the financial investors for the health care of USA
should also collaborate with the federal government to reduce the health care burden of the
country and also expand the Medicaid for the people of the socially and financially unprivileged
class of people. However, the factor of the care delivery to the people of the country should be
considered with the factor of the financial support and also the health behavior improvement of
the people of the country. Based on this context it can be found that the process of the care and
the Medicaid is mainly provided by the federal government and the international health financers
and a small amount is financial support is also provided by the state government (Fuchs, 2018).

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In this context it can also be stated that the process of the care delivery is subsidized by the
federal government. Thus, there are presence of several innovative care procedures to reduce the
health care cost as well. However, the factor of the behavioral development of the people of the
country regarding the health improvement should be considered with higher priority. Hence, it
can be stated that the process of the Medicaid expansion should be considered by the state
governments as there are a large number of people cannot avail the Medicaid opportunities as the
state government did not expanded the care Medicaid.
Moreover, the Medicaid expansion and the new rules of the ACA is focused on the
subsidizing a large number of people from the lower economic group to reduce the burden of
health issue in the country. However, it has been seen that the process has faced several barriers.
On the other hand, lack of health literacy is one of the negative factors which develops the
negative health beliefs impacting over the health outcome of people. Hence, it has been seen that
the ACA has also implemented the reimbursement model method to reduce the cost of the care
and also developing the quality f care. The reimbursement would be provided to the providers to
reduce the cost of the organizations. However, the subsidized or insured care would be provided
to the people who have bought a health insurance or at least have the eligibility to avail the
health insurance facilities (HealthCare.gov, 2020). On the other hand, the factor of the subsidized
care procedure and the Medicare along with the Medicaid it has been seen that the process of the
care delivery is effectively almost free for the people of the lower income groups of the country.
However, this factor leads to the health cost increase for the federal government rather than
reducing the health issue burden of the country. This reimbursement method of the financial
support providence to the health insurance companies and also the development of more
innovative processes of care delivery is costly for the federal government and it also affects the

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GDP of the country (Moses et al., 2015). However, this process helped in the improvement of the
life expectancy rate among the socio-economically imbalanced population. On the other hand,
the education and empowerment should be provided as well to the population in order to reduce
the malpractices and develop the healthy habits which can reduce the health burden of the
country and subsequently reduce the cost of the health care as well. Thus, it can be stated that the
ACA is very much effective in the Medicaid expansion process and included a large number of
people from the lower economic income group or rather from the poverty level which effectively
helped in the improvement of the health care providence factors for these people. It has been
seen that the improvement in the health care policy for the people of the lower income group that
is subsidizing the care procedure financially would lead to the reduce the health issues among
these people. However, the eligibility criteria of the Medicaid expansion process are also
responsible for a large number of people to not avail the opportunity of the subsidized care.
Conclusion
Based on the above discussion it can be concluded that the care delivery process of the
USA health care system is subsidized for a large number of people. However, the process of the
health care subsidization cost affects the financial sector of the country. The factor of the health
insurance development and including a large number of lower income group people is effective
in the quality of life and the health outcome improvement. However, it is recommended that the
people of the country should be provided with proper education regarding the health care and the
self management factors in order to reduce the health care burden reduction from the federal
government of the country. Thus, it can be stated that the ACA has developed the health care
facility of the country and also effectively reduce the negative health outcome for a large number
of people. Although the improvement of the health promotion strategies and also identifying the

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alternative process and elimination of the reimbursement method should also be considered as it
also puts burden on the health finance sector of the country.

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References
Adler, N. E., Glymour, M. M., & Fielding, J. (2016). Addressing social determinants of health
and health inequalities. Jama, 316(16), 1641-1642.
Bhavan, K. P., Agrawal, D., & Cerise, F. (2016). Achieving the triple aim through disruptive
innovations in self-care. Jama, 316(20), 2081-2082.
Fuchs, V. R. (2018). Who Really Pays for Health Care? The Myth of “Shared Responsibility”.
World Scientific Book Chapters, 365-371.
HealthCare.gov. (2020). Affordable Care Act (ACA) - HealthCare.gov Glossary. Retrieved 16
March 2020, from https://www.healthcare.gov/glossary/affordable-care-act/
HealthCare.gov. (2020). How Medicaid Health Care Expansion Affects You. Retrieved 16
March 2020, from https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-
you/
Moses, H., Matheson, D. H., Cairns-Smith, S., George, B. P., Palisch, C., & Dorsey, E. R.
(2015). The anatomy of medical research: US and international comparisons. Jama,
313(2), 174-189.
Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health care spending in the United States
and other high-income countries. Jama, 319(10), 1024-1039.