REIMBURSEMENT PLAN

Reimbursement Plan in U.S. Healthcare Systems

Abstract

The government of United States has adopted multi payer system for funding and reimbursement of healthcare service providers. Collection and allocation of funds for healthcare is a mutual responsibility of the government and private insurance companies. The insurance companies collect premiums and other sources of payments from businesses and individuals while the government gathers funds through taxes from businesses and individuals. If the U.S citizens believe that equal healthcare to everyone is an important attribute of a healthcare system, then the present healthcare system is not appropriate. For such reasons a single payer system is a better option.

Table of Content

Abstractii

Background4

Problem Statement5

Literature review5

Overview of U.S. Healthcare5

U.S. payment reimbursement system7

Multi payer Healthcare System8

Problem analysis9

Possible solutions10

Solution and its implementation11

Cost Containment11

Improved Access12

Justification12

Conclusion12

References14

Reimbursement Plan in U.S. Healthcare Systems

Background

There is a powerful correlation between wealth and health. The position of a household's income within a society's wealth hierarchy is a strong predictor of the health of that household. Epidemiologists have observed nearly parallel gradients between wealth and health (Stuber and Bradley 2005). Wealth seems to be the most powerful of the social determinants of health, and a health gradient follows an income gradient in most developed countries (Stuber and Bradley 2005). Yet the wealth and health gradient is not perfectly linear. Health psychologists observed that mortality improves more with the increase in SES (socio-economic status) at the lower end of the hierarchy than at the upper end (Stuber and Bradley 2005). Income is highly correlated with access to health-inducing agents such as nutritious foods and safe places for exercise, as well as with limited exposure to disease-inducing agents including carcinogens, threat, and stress. Health care is likewise a health inducing agent, and access to that health care limits threat and stress (Villarruel 2004). It may be that what health reflects is not just wealth, but that wealth and health are both corollaries of social access. There appears to be a relationship between access to opportunities within a society and the health of individuals, subgroups, and populations. The pathways by which health develops include social, behavioral, psychological and biological mechanisms (Villarruel 2004).

Improving access to health care is a means by which Healthy People 2010 proposes to meet its two overarching goals of increasing quality and years of healthy life and of eliminating health disparities (Kreps 2006). It is counterintuitive that the Healthy People 2010 goals of increasing population life expectancies and eliminating health disparities are compatible. It seems that reducing health disparities would not accompany improved health for groups already enjoying better health (Kreps 2006). Historical evidence suggests, however, that health disparities are reduced during periods of the national movement toward social equality. When a nation's health disparities are reduced, the nation's overall health improves as does the health of both the healthier and less healthy population subgroups (Kreps 2006).

Problem Statement

The problem statement is to describe the problems with the U.S. multiple reimbursement systems and to discuss how single-payer system may improve access and cost containment in the ...