Health Care Utilization Paper

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27 February 2016

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The health reform debate is in full swing. Millions more people will gain health insurance, coverage will be more affordable, and people will have access to the health services they need.

Health Care Reform and Access

The reason for Health Care reform is to make it easier on the citizens to be able to afford health insurance in the case they were to get sick or prevent them from getting sick. The law makes it more affordable instead of the rising cost, it is lowered so people can have insurance. The Health Care Reform act made it to be were the insurance companies will be held accountable on how much they raise their rates and how their money is spent. Plus, the new law will help lower costs through new tax credits and new marketplaces where insurers will have to compete for your business. At one time insurance companies were taking advantage of the people but now they have to make sure that everything is affordable. It was amazing how they could deny children that needed medical attention because they had prior health problems. Children that were born with asthma or born with other defects were being denied health coverage. Insurance companies were putting an amount on the coverage that would give the patient and if that failed they would find any little mistake in the paperwork to drop their health care coverage. The Affordable Care Act creates a new Patient’s Bill of Rights that protects you from these and other abusive practices. Thanks to the Affordable Care Act’s 80/20 rule, if insurance companies don’t spend at least 80 percent of your premium dollar on medical care and quality improvements rather than advertising, overhead and bonuses for executives, they will have to provide you a rebate. Things are much better now that the insurance companies have to cover many preventive services without it being any deductibles or copays required unlike before when you had to have certain screenings and were charged deductibles and co pays. Before many Americans with pre-existing conditions were locked or priced out of the health insurance market due to their pre-existing conditions which is not fair because many people have pre-existing conditions. Already, 54 million Americans with private health coverage have gotten better preventive services coverage as a result. It is good that they have made insurance companies accountable against discriminating against people with pre-existing conditions. In 2014, insurance discriminating against anyone with a pre-existing condition will be illegal.

Access and Utilization

Several factors such as proximity to health care providers, perceived quality of care, fees charged and perceived severity of illness have been shown to affect access and utilization of health services. The wellness models is focusing on the health of a person’s mind, body and spirit. If more people took time to prevent themselves from diseases this would slow the growth of health care expenditures. What people who fell to realize is that it is cheaper to go to a class and or treatment group, instead of having to use insurance to provide medications, procedures and treatments. Getting involve with a wellness consultant can also help with obesity. According to The U.S. Health System,” The increase in obesity in adults as well as children also increases the risk of chronic diseases such as diabetes and heart failure” (Barsukiewicz,Raffel &Raffel, 2010, p.12). If people start now with their children by teaching them healthy ways of eating there will be a decrease in the risk of chronic disease. The choice is in the parents hands because a child eats what a parent gives. Also as a person 65 and older gets up there in age there are more chronic diseases that they are at risk of getting and more prone to get them again or worse, which than leads to more health resources such as hospitalizations or put into a nursing facility. No, we cannot from aging but we can take care of ourselves now to avoid the risk of chronic diseases. Focusing on a wellness model can reduce healthcare costs because if a patient is given the proper information needed to recognize the signs of certain diseases and the proper information to prevent certain diseases, the patient will not always have to go to their doctor every time they sense something is wrong. Another way to reduce healthcare costs would be to educate people on how to live a healthier lifestyle. Adapting a healthier lifestyle reduces healthcare costs because if an individual is eating right and exercising daily; they can ultimately reduce their chances of become obese. Living a healthier lifestyle also reduces the cost of treatments and medications of some of the diseases that are associated with obesity, such as heart disease or diabetes.

Universal Care: Compare and Contrast

Universal health care is the belief that all citizens should have access to affordable, high-quality medical care. Universal health care is a broad concept that can be structured and funded in various ways. The common factor for all universal health care programs is that they require some form of government involvement, whether it is through legislation, mandates, or regulation. One of the key functions in a managed care is gate keeping (The Payment Process, Insurance and Third-Party Payers: A Austin PhD. Welte R.N. 20-12) which basically is a way of controlling how much health care a person can receive over a period of time. Unfortunately this means that some patients who require intense treatments mat have to get authorization prior to getting the treatment which may cause a delay in treatment that can lead to more issues for the patient. The advantages of managed cares are only for the company. Managed care plans allow doctors to be paid for each member enrolled each month which means that regardless of how many patients he treats he will only receive a certain amount of money this limits the access a patient to specialist or rehabilitation services. Since the doctor is only getting paid a certain amount he must see a certain amount of patients which cuts down the amount of time spent with each patient. This is the where disadvantage of Managed care comes in. The patient cannot receive the proper care because his/her HMO only pays a set amount.


Comparisons. (2013). Universal Health Care. Retrieved from (2013). Affordable Care Act. Retrieved from The White House. (2013). Get the Facts Straight on Health Reform. Retrieved from

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