How does Health Insurance Status Impact Treatment Intensity and Health Outcomes?
Having a good healthcare plan in the United States is essential as we do not receive free healthcare like Canada. In that, the type of health insurance an individual has determines his or her health outcome. So, it is agreeable that if one pays more for the services that he receives, that he should get better treatment and better outcomes as opposed to those uninsured or those who have Medicare or Medicaid, which are federally-funded health insurances. With a privately funded insurance, a patient can get better services but how does that affect his health outcome? By paying hospitals and doctors in the United States more than what other countries do, privately insured individuals can have costly specialists who overuse technologies, like CT scans and M.R.I. machines (The New York Times). Though these options may be perverse insurance incentives to entice doctors and patients to use expensive medical services more than what is needed, the fact that the option is immediately available to the privately insured patient and not to the uninsured patient shows that the type of health insurance does have a big say in one’s health care (The New York Times).
For example, if one is a low-income individual who does not get preventative care and does not have enough money for regular doctor visits to update on one’s health, his health may not be in the best shape. A prime model of this is the difference between primary and quaternary practices. Primary practices consist of quality doctor offices with experienced doctors that accept a greater amount of private insurances than federal; however quaternary practices are doctor offices where the patient is not able to pay his copay, resulting in built up debt as doctors cannot decline patients who need care. The difference in care here is that the primary doctor will give full attention to the patient but, the quaternary doctor will not because his full compensation is not fulfilled. So, the doctor will just work in completing his civic duty towards the patient. Even if the doctor is fully helping the patient, he or she may not be able to provide other expensive services to the patient as the patient cannot afford the current one. This model shows that healthcare determines the type of care and services one receives. However, most of the literature addressing this topic does not accurately assess the grounds of positive health outcomes as many low-income individuals are probably in a state of bad health, whereas high-income individuals generally start at a state of good health. In this way, data cannot realistically be collected as there is prior bias that fogs the results of the outcomes of an individuals’ health statuses.
The underlying discrepancy of health insurances will be discussed through analysis of how all health insurance is not the same, the inequality seen in healthcare, and how a different healthcare payment plan can be implemented as an option to increase treatment intensity and provide indiscriminate access to quality health services for all patients. As a result, the outcome of my research can evaluate the root of the inequality in healthcare and explore options that can be integrated to better the healthcare system.
All health insurance is not the same
Ostensibly, there is a general thinking that having any type of health insurance leads to having good healthcare and thus one must have an overall good health if one is following the doctor’s orders correctly but, that is not the case. In “Measuring the Quality of Healthcare in the U.S.”, Claxton, a researcher with the Kaiser Foundation, states that a way to measure healthcare system quality, apart from looking at health outcomes, is to focus on mortality rates (Measuring the Quality of Healthcare in the U.S.). In the study conducted, Claxton displays a graph that has decreasing mortality rates over the past 30 years. With a negative trend, The Kaiser foundation assumes that health care has improved; however, they overlook the bias in their calculations. The Kaiser foundation is a private insurance. This means that those who are not provided quality care or are uninsured are not included in the data. Also, mortality is not only caused by bad health, but also unfortunate accidents. These outliers are not considered in the data as well so, one cannot say that positive health outcomes are increasing for all individuals, insured and uninsured. On the other hand, the author of Care Without Coverage: Too Little, Too Late, Katherine Bond, disputes Claxton’s statistics. Bond claims that uninsured and federally funded insurance holders have poorer health and shorter lives as federally funded adults are less likely than highly insured adults to receive recommended health screening services like mammograms, clinical breast exams, and colorectal screenings (Bond). And when they do receive these preventive services, it’s not recommended often (Bond). Additionally, in the cancer care observational data conducted by Bond, it is shown that federally insured cancer patients generally have poorer health outcomes and die sooner than persons with better insurance (Bond). Without timely screenings diagnosis is delayed so, when cancer is found it is advanced and probably more fatal. Bond states the evident differences that can be seen in the quality of care received by patients in both private and federal insurances but Claxton does not bring up the differences in insurance type that affects the intensity of aggressively attacking the health problem. With better insurance, catching a health problem is incentive to providing better quality of care and allow physicians to progressively help patients better their health outcome.
Healthcare inequality
Next, there are federally-funded insurances that are just one step superior in better health care in comparison to being uninsured. Medicaid and Medicare are big name federal health insurances; the first is for low-income individuals and the latter is for people 65 years and older. In “What Is Medicaid’s Impact on Access to Care, Health Outcomes, and Quality of Care?”, Julia Paradise believes that having any health insurance is much better than being uninsured, which I agree with as having insurance increases the access to better care and resources. However, Paradise also claims that Medicaid beneficiaries and privately insured individuals have comparable access to preventative and primary care (Paradise). After analyzing her claim, it may be easy to bring in people with Medicare for well checkups but, if all required tests or vaccinations aren’t checked and ensured up-to-date, quality of care and treatment outcome still lacks in the care provided. On the other hand, in “Multigroup Path Analysis of the Influence of Healthcare Quality, by Different Health Insurance Types”, the author, Yong-Rock Hong, does not believe in the healthcare equality that Paradise assumes. His study examines differences between individuals covered by different types of insurance. In the study, multi-group path analysis models were used to examine the moderating effects of health insurance on direct and indirect associations with general health status and satisfaction with care (Hong). Data was obtained from the 2012 Medical Expenditure Panel Survey and analyzed according to the types of insurance: private, public, and military (Hong). As a result, higher healthcare quality was positively associated with better health status and greater satisfaction. Hong supports my argument, where the motto, “you get what you pay for”, makes a true point. This can be related to Medicaid’s impact on access to care as Paradise shows that a low-income based health coverage provides good care but, Hong suggests that better healthcare insurance is positively associated with better health status and higher satisfaction. In that, insurance that one individually pays for stands as a greater option for better healthcare treatment and better health outcomes than federal insurances.
Implementation of a new healthcare payment plan
Incidentally, in an article written by Jeroen Struijis, a senior researcher at the National Insititute of Public Health in the Netherlands, called “How Bundled Health Care Payments Are Working in the Netherlands” describes a possible answer to the inequality of healthcare cost on healthcare quality. This idea may be implemented in the United States to better our current healthcare system. Struijis is experimenting with bundled-payment models, “whereby a single prospective payment is made for all services for a patient with a given condition, even when multiple providers deliver that care” to pay healthcare providers (Struijis). This means that the patient would not be paying to see a specific doctor but, would be paying for the care that he or she receives to treat a condition. This system allows doctors and nurses to focus on the value of care provided and not the volume of care, as in the number of patients seen in a day by the doctor. In turn, this would enable doctors to better help their patients, rather than trying to get through numerous patients. This system is a great way that quality can be ensured and in turn lead to better outcomes for the patients. Though this payment method has only been used by one-third of U.S healthcare insurances, that is still less that fifty percent of insured people that are using this insurance method. There is also a challenge that the bundled healthcare plan faces in the United States. It is that this method has only been limited to primary care because this plan gives general physicians leeway to refer their patients to specialists when patients’ situations are more complex and costly to them (Struijis). In result, this benefits the general physician as he or she is basically “throwing” the patient to a specialist to take care of. Thus, the bundle system can’t work in this situation as the quality and outcome of the care would decrease; however, if this plan is used correctly, by not allowing situations like transferring physician’s patients to another specialist for the physician’s own benefit, then this system may be adapted within U.S. healthcare insurances. Additionally, this system may work if more accountability is added on the physician and medical team’s part by including financial and performance accountability contracts for patient care. This may lead to higher treatment intensity and higher quality of health outcome for the patient.
Conclusion
Altogether, there is no silver bullet to fix healthcare costs or maintain equality in the system. There is a wide range of contributing factors that need to currently be addressed in healthcare; even if there is no guarantee they will impact the field anytime soon. Through analysis, insurance coverage does have a significant causal effect on treatment intensity and health outcomes. Uninsured patients receive less intensive treatment and are more likely to be discharged rather than transferred to another hospital for continued care. Additionally, healthcare providers increase their use of hospital services when a more generous insurance coverage is available, and therefore these highly accessible services produce better health outcomes for the patient. As for changing the healthcare insurance system, implementing a new insurance plan to better health intensity and outcomes are still being discussed. In sum, this issue affects high and low-income individuals, as well as people who strive to maintain equality in the medical field. So, people should care about this topic because access to not only healthcare but good healthcare, where an individual is promptly able to have an aggressive treatment plan should be required and is vital to all citizens of the United States.