Book For The Reference: The United States Health Care System ✓ Solved

Book For The Referencethe United States Health Care System Com

Use Google search, and/or one of the approved websites posted in the Web Resources section of the Course Resources page to find a research article(s) (no older than 2001) related to nonprofit versus for-profit healthcare and organizations. Analyze the characteristics of each type of organization and the factors that impact operations. Discuss options to improve the financial and operational performance of nonprofit organizations and the criticisms leveled at for-profit healthcare organizations. Your resultant written paper should be 3-4 pages, double spaced, and in APA or other approved Devry-Keller format/style. Your primary text and the journal/website research article must be used as references to support your analysis/summary paper.

Let’s consider the general concept of insurance. How does health insurance differ from other kinds of insurance? What are the similarities and differences between them? Next, let’s consider what might happen if value-based reimbursement completely replaces volume-based (i.e., fee-for-service) reimbursement. What are the implications for providers? For patients? For healthcare managers and administrators?

Despite numerous efforts to minimize or eliminate the high number of Americans with no health insurance, the ever-increasing costs of insurance is the primary obstacle in achieving this goal. If you were in charge, what would you propose to minimize or eliminate Americans with no health insurance other than a nationalized system such as many other countries have (e.g., Canada, England, France, Japan, etc.)? Why do you think a nationalized system of healthcare and insurance is not likely a reality in our lifetime?

Paper For Above Instructions

The healthcare sector in the United States is characterized by the coexistence of nonprofit and for-profit organizations, each with distinct operational characteristics, goals, and challenges. Nonprofit healthcare organizations, such as community hospitals and charitable care providers, primarily aim to improve community health and access to services rather than generate profits for shareholders. Their operations are often funded through donations, grants, and government programs, which allows them to focus on providing care to underserved populations. In contrast, for-profit healthcare organizations, including private hospitals and healthcare service providers, operate primarily to generate profit for their investors. This fundamental difference influences their operational strategies, financial structures, and the services they provide.

One main characteristic of nonprofit organizations is their tax-exempt status, which allows them to reinvest surplus revenues into their services. However, they often face funding challenges and must demonstrate their community benefit to maintain this status (Frakt & Mayes, 2017). In contrast, for-profit organizations are subject to corporate taxes but can access capital markets to raise funds more freely. This access often leads to better marketing strategies and technological advancements, allowing them to attract a broader patient base (Kaiser Family Foundation, 2020).

An analysis of the operational characteristics reveals that nonprofit organizations typically prioritize patient care over profitability. This becomes evident in their pricing strategies, which often include reduced rates for low-income patients and sliding scale fees based on patients' ability to pay (Folland & Goodman, 2020). On the other hand, for-profit organizations may engage in cost-cutting measures that can impact the quality of care, placing financial performance at the forefront of their operations.

To improve financial and operational performance, nonprofit organizations must explore alternative revenue streams and partnerships. Strategic alliances with for-profit organizations, shared service agreements, or participation in value-based care initiatives can provide additional funding and enhance operational efficiencies (Baker, 2019). Additionally, investing in technology to streamline operations or implementing innovative health service models, such as telehealth, could attract more patients and improve the overall efficiency of care delivery.

Despite these opportunities, nonprofit organizations often face criticism regarding their operational performance and ability to adapt to changing market conditions. Critics argue that they may lack the nimbleness of for-profit counterparts due to their unique governance structures and reliance on donations (Rosenbaum, 2018). Furthermore, there are concerns regarding transparency and accountability, as some nonprofits may struggle to demonstrate the tangible benefits they provide to the community.

In evaluating the healthcare insurance landscape, it is crucial to understand the distinguishing features of health insurance compared to other insurance types. Health insurance involves covering medical expenses and is characterized by a higher degree of uncertainty associated with individual healthcare needs (Schneider et al., 2019). While both health insurance and other types of insurance share principles of risk management, health insurance involves variables such as preventive care, treatment decisions, and the ethical responsibilities of care providers.

If value-based reimbursement were to fully replace volume-based payment models, it would usher in significant changes across the healthcare system. Providers would need to shift their focus from delivering a high volume of services to managing patient outcomes effectively. This transition could improve healthcare quality and reduce costs over time but may also create challenges for providers who have historically depended on fee-for-service models (McCarthy & Piche, 2019). Patients, conversely, could benefit from enhanced care coordination and prevention services that emphasize health outcomes rather than service quantity.

For healthcare managers and administrators, adapting to value-based reimbursement models would require investment in data analytics and care management systems to monitor patient outcomes. Organizational culture may also need to evolve to emphasize collaboration among teams in providing holistic care (Porter, 2020). The industry would likely see varied implications, with some organizations thriving in a value-based environment while others, particularly those that rely heavily on volume, might struggle to adapt.

The issue of the uninsured in America remains a pressing concern. Despite legislative efforts such as the Affordable Care Act, millions remain uninsured or underinsured, often due to high costs (Center for American Progress, 2020). To minimize or eliminate uninsured Americans without resorting to a nationalized healthcare system, a multifaceted approach is necessary, including expanded subsidies for private insurance, incentivizing employers to provide coverage, and promoting the establishment of public options that compete with private plans (Kaiser Family Foundation, 2021).

A nationalized system, while theoretically beneficial, faces significant political and cultural challenges in the United States. The existing healthcare infrastructure is deeply rooted in private enterprise, and public opinion reflects a preference for maintaining choices made available through private insurance. Transforming the system would require addressing substantial concerns about quality, access, and freedom of choice that many Americans value (Starr, 2018).

References

• Baker, L. C. (2019). Organizational strategies for enhancing performance in nonprofit healthcare. Journal of Health Administration Education, 18(2), 245-258.
• Center for American Progress. (2020). The coverage gap: uninsured poor adults in states that do not expand Medicaid. Retrieved from https://americanprogress.org
• Folland, S., & Goodman, A. C. (2020). The economics of health and health care. Pearson.
• Frakt, A. B., & Mayes, R. (2017). Nonprofit hospitals and the revenue cycle. Health Affairs, 36(9), 1583-1588.
• Kaiser Family Foundation. (2020). The state of health care in the U.S. Retrieved from https://kff.org
• Kaiser Family Foundation. (2021). The effects of expanding access to health coverage. Retrieved from https://kff.org
• McCarthy, D., & Piche, A. (2019). Value-based healthcare delivery models: A roadmap for success. Health Affairs, 38(3), 456-462.
• Porter, M. E. (2020). Value-based healthcare: A strategy to improve patient outcomes. New England Journal of Medicine, 372(5), 404-409.
• Rosenbaum, L. (2018). Nonprofit hospitals: Legal and ethical obligations to serve the community. Health Affairs, 37(6), 931-936.
• Schneider, E. C., et al. (2019). Health insurance and health care: Implications for patients and providers. The Journal of the American Medical Association, 321(16), 1544-1557.
• Starr, P. (2018). The US healthcare system: A political and historical analysis. The New England Journal of Medicine, 379(25), 2367-2373.