QUESTION # 1: Analyze Why Is It Important For Health Care Managers and Policy-Makers To Understand The Intricacies of The Health Care Delivery System

Lenie G.
Manayam #64126 September 26, 2015

HCA 501 Health Care in America
Unit #1
QUESTION # 1: Analyze why is it important for health care managers and policy-makers
to understand the intricacies of the health care delivery system.
The provision of adequate and quality health care poses a tremendous and continuing
challenge to countries all over the world. There has been an ever increasing pressure and clamor
of governments, policy makers, managers and other participants in health care to make health
care delivery more efficient, affordable, accessible and better with positive health outcomes. But
with health care getting more complex, it is becoming more evident that health care practitioners
and policymakers need an understanding of the health care delivery system and the new
complexities arising from such. It is common for well-trained and skilled health professionals to
remain incognizant to the various forces that can create a significant impact on their clinical
practice. It is also not unusual to see policymakers and managers as clueless to the in-goings and
interrelationships in a health care environment. A drafted health policy or an approved legislative
health bill can have desirable and undesirable effects on the health needs of a nation and its
people. It can severely affect the multiple key players involved with the delivery of health care
services.
For the past decade, health care has been consistently among the top issues that U.S. citizens
want their policymakers to address. Concerns with cost, access and quality of health care
entwined with the increasing anxieties of economic insecurity result in periodic changes in
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Lenie G. Manayam #64126 September 26, 2015
Unit #1
health policies, decision-makings and implementation of various health programs.
To understand the significance of knowing the intricacies of the health care delivery system by
policymakers and health managers, consider the Patient Protection and Affordable Care Act as
an example. Before this bill came into fruition and made into a law, an analysis of the American
health care delivery system revealed certain complexities. The U.S. health care system differs
from the health care systems of other industrialized nations. In reality, the U.S. does not have a
uniform health system and it does not provide a universal health care coverage for its citizens.
(Leiyu & Singh 2008). It does not have a national health insurance program or a multi-payer
universal health insurance funds similar to Germany, Canada or the U.K. (Leiyu & Singh). Data
obtained in 2012 showed that a great percentage of U.S. health care expenditures came from
private funds. Only 38% of health care spending came from the federal government, while 12%
came from local and state funds, respectively. Furthermore, only 84.6 percent of the U.S.
population had health insurance, while a mere 63.9 percent of the working population procure a
private health insurance plan. Among those insured, 32.6 percent of the population, received
coverage through the U.S. government through VA or other military care, Medicaid and
Medicare. (http://dpeaflcio.org/the-u-s-health-care-system-an-international-perspective/)
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Unit #1
Developments in modern health technologies, information systems and the pharmaceutical
industry, coupled with the rising incidence of chronic, debilitating illnesses and high
administrative costs, contributed to the rising costs of health care in the U.S. With health care
costs rising, public expenditures on health care, likewise, spiraled up. As a consequence,
Americans who earn below average incomes and had no health insurance coverage found health
care services expensive and inaccessible. More and more are getting into medical debt and
bankruptcy. The lack of health insurance in the U.S. by some of its citizens costs billions of
dollars in annual losses, thereby creating a humongous impact on U.S. economy.
Aware of the complexities of the American health care system and equipped with statistical
data and health indicators at hand, U.S. legislators, in consultation and debates with key players
of health services delivery: health managers, managed care providers, employers, institutional
representative and health professionals, formulated and enacted the Patient Protection and
Affordable Care Act (ACA). The act, signed into law by President Barack Obama in 2010, aims
to initiate reforms in the American health care industry. (http://obamacarefacts.com/obamacare-
facts/)
Five years after Congress enacted the Affordable Care Act, the Commonwealth Fund reported
the following on January 2015:
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Unit #1
a) There was a reduction in the number of uninsured Americans and an increase in
affordability and access to care under the Affordable Care Act; b) Health care spending in
2014 grew at a slowest rate on record since 1960’s due to the law’s cost curbing provisions; c)
8.2 million seniors have saved more than $11.5 billion on their prescription drugs since 2010
– an average of $1,407 per beneficiary; d) The ACA’s provisions have helped save $19.2
billion in fraud – about a $10 million increase from the five years before that ; e) Medicaid
expansion and increased coverage has combined to reduced unpaid medical bills, resulting in
less medical debt for consumers and fewer unpaid hospital bills, which hurt hospitals and
state tax payers. Hospitals’ uncompensated care costs are estimated to be $7.4 billion (21%)
lower in 2014 than they would have been in the absence of coverage expansions.
(http://obamacarefacts.com/obamacare-facts/)
The implementation of the Affordable Care Act (ACA) is critically vital to shape the future
direction of the U.S. health care delivery. Its success or failure is dependent on the cooperation
of the multiple key players in health care services and on the support it will receive from the
Americans. ACA’s success will bring an improvement in the lives of US citizens and a creation
of a health care system that will truly cater to the health needs of its people. But a failure in its
implementation will tender repercussions and serious consequences in American society, and
possibly, create deterioration in health care services and tremendous suffering in the lives of the
American people.
Lenie Manayam #64126 September 26, 2015
Unit #1
References
Shi, Leiyu and Singh, Douglas: Delivering Health Care in America, 2008, 4th.ed.
Jones and Bartlett Publishers, LLC
Rise in Health Care Coverage and Affordability. (2015). Retrieved from:

http://obamacarefacts.com/2015/01/15/rise-in-healthcare-coverage-and-affordablity/
The U.S. Health Care System: An International Perspective (Fact Sheet 2014). Retrieved from:
http://dpeaflcio.org/the-u-s-health-care-system-an-international-perspective/

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Lenie G.

Manayam #64126 September 26, 2015

interrelationships in a health care environment. A drafted health policy or an approved legislative

health policies, decision-makings and implementation of various health programs.

Developments in modern health technologies, information systems and the pharmaceutical

dollars in annual losses, thereby creating a humongous impact on U.S. economy.

to initiate reforms in the American health care industry. (http://obamacarefacts.com/obamacare-

the following on January 2015:

a) There was a reduction in the number of uninsured Americans and an increase in

Rise in Health Care Coverage and Affordability. (2015). Retrieved from:

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