Healthcare Analysis: Potential Changes for Medicare Enhancement

This report examines potential changes for enhancing Medicare in the United States, addressing the current shortcomings of the healthcare system. It highlights issues such as the high cost of healthcare, lack of universal coverage, and inefficiencies in management. The report analyzes the impact of the Affordable Care Act (ACA) and suggests modifications like shifting to a value-based approach, expanding Medicaid, and implementing price controls on pharmaceutical companies. It also emphasizes the importance of health literacy and patient awareness. The analysis draws comparisons with healthcare systems in Europe, particularly the UK and Netherlands, to illustrate alternative approaches and their potential benefits. The report aims to provide a comprehensive overview of the challenges and opportunities in improving Medicare and overall healthcare management in the US.

Running head: POTENTIAL CHANGES FOR ENHANCEMENT OF MEDICARE
POTENTIAL CHANGES FOR ENHANCEMENT OF MEDICARE
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1POTENTIAL CHANGES FOR ENHANCEMENT OF MEDICARE
Advancement in heathcare facilities has significantly increased the chances of survival in
mortality-associated diseases along with reduced risks for complex surgical procedures.
Affordable Care Act or Obamacare identifies behavioral health as one of the key factors
involved in individual health and diagnostic approach taken by medical practitioner.
Multidisciplinary health professionals can cumulatively enhance the overall benefit of a
client’s health, reducing mortality and morbidity rate1. Contemporary health management
systems are considered insufficient as the cost of health services in US is significantly higher,
but the outcomes are not relatively efficient2. Several reasons include depression, stress,
anxiety, substance abuse and socioeconomic status.
Despite of all these efforts and allotment of huge amount of gross domestic income (GDP),
almost 18% of Americans of age <65 years have zero health insurance policies at their
disposal, which indicates that these endeavors were somehow lacking in reality. Inadequate
accessibility of healthcare facilities and arbitrary lifestyle are found to be major contributors
of adverse health issues. Other associated factors include lower basic income, unavailability
of a universal healthcare system, reluctance in primary and public healthcare, domestic and
criminal violence, high accidental cases, lack of fitness and poor behavioral health3.
The aforementioned data suggests, despite of initiating host of efforts from the government,
results were futile and wasted a significant amount of annual GDP. Most significant
disadvantage in healthcare management is the centralized idea of government-sponsored
health insurances, which could not deliver the expected impact on the randomized population
1 Croft, Bevin, and Susan L. Parish. "Care integration in the Patient Protection and Affordable Care Act:
Implications for behavioral health." Administration and Policy in Mental Health and Mental Health Services
Research 40.4 (2013): 258-263.
2 Davis, Karen, et al. "Mirror, mirror on the wall." How the performance of the US Health care system compares
internationally. New York: CommonWealth Fund (2014).
3 U.S. health in international perspective: shorter lives, poorer health. Washington: Institute of Medicine of the
National Academies; 2013. Available from: http://www.nationalacademies.org/hmd/~/media/Files/Report
%20Files/2013/US-Health-International-Perspective/USHealth_Intl_PerspectiveRB.pdf

2POTENTIAL CHANGES FOR ENHANCEMENT OF MEDICARE
nationwide. An inspiring approach had been replicated from the healthcare strategies of
Europe or UK, which focuses on multi-platform healthcare facility rather than concentrating
on a centralized idea, previously practiced in United States. Data suggests, 48% of health
expenditure is gathered from public taxes, 40% from private taxes and rest of the 12% is
collected directly from patients in the form of medical invoice. Medicare facilities have
provided further aid among persons with disability, individuals with an age of more than 64
years and patients with terminal renal failure (approximately 50 million in total). Other
significant health insurances include Medicaid and Children’s Health Insurance Programme
(CHIP), which covers 59 million Americans and 6 million children4. Still pharmaceutical
costs in US is 1443 dollars per capita, which is consistently higher, compared to the per
capita cost of Germany (667 dollars), Netherlands (466 dollars) and Sweden (566 dollars). In
addition, prevalence of medical procedures are genuinely high in US compared to other
countries. For instance, angioplasty rate is second highest in US, but each procedure costs
$69.20, compared to $13.10 in Netherlands. Another example of cesarean delivery, exhibits
33% prevalence of overall deliveries conducted in US each year with a per capita cost of
$61.80, compared to Netherlands, which has a cesarean prevalence rate of 16% with a per
capita cost of $8.905.
Implementation of Affordable Care Act (ACA) was a major breakthrough in healthcare
management in US. However, certain policies need to be modified to enhance the outcome of
this initiative. Shifting from volume based approach to value based approach could negotiate
the efficacy of healthcare management and provide better cost-effectiveness. Exchanging
health insurance policies tuned for individual client along with expansion of Medicaid
facilities could incorporate potential clients who are still left out of the health insurance
4 Rice, Thomas, et al. "Challenges facing the United States of America in implementing universal
coverage." Bulletin of the world health organization 92 (2014): 894-902.
5 Emanuel, Ezekiel J. "The real cost of the US health care system." Jama 319.10 (2018): 983-985.

3POTENTIAL CHANGES FOR ENHANCEMENT OF MEDICARE
policies, leading towards a comprehensive universal healthcare management for all. A
monitoring agency focused on pricing and services delivered by insurance providers, could
substantially decrease the bias faced by individual patient parties. Additionally, controlling
the expenditure marketed by pharmaceutical companies by federal or government authorities
can help reduce the huge cost related to medical procedures and assess the efficiency of the
process. Making people aware about their health conditions and risks associated with diseases
by ‘Health Literate Care Model’ could accomplish better decision-making among patient or
their respective families.6
6 Koh, Howard K., et al. "A proposed ‘health literate care model’would constitute a systems approach to
improving patients’ engagement in care." Health Affairs 32.2 (2013): 357-367.