Sample Sociology Research Paper on Health Care Crisis and Policy

Introduction

The issue of healthcare is very vital to society and the challenges facing the system would equivalently be passed on to the consumers. In order to provide clear ground for detailed investigations into the current state of the healthcare crisis in the United States, this research primes its study by providing an overview of the crisis in the healthcare system of the United States. The study focuses on three major issues: first, an overview of the prevailing healthcare system is given, including the institutional arrangement through which insurance on health is obtainable and/or administered. The research then examines the development of institutions of healthcare in the United States featuring the events that resulted in the current system whereby the better part of the population is dependent on their employers for their coverage on health insurance.

After conducting a deep study on the system, the current system that has the majority depending on their employers for health insurance coverage could be attributed to the result of the second world war that saw the dawn of wage and price controls, failure of the compulsory national health insurance proposal in the early twentieth century, the impact that resulted from the preferential tax treatment for fringe benefits which commenced in the mid-1950s, and the role that was played by collective bargains and unions during the early postwar period. The paper then concludes by identifying a number of disturbing trends, giving suggestions to suggest the possibility that the employer-based type of health insurance might have reached its limit. The research traces the source of the contemporary crisis in the healthcare system to the end of the post-world war period which occurred in the 1970s. This study argues that it would be unlikely for employer-based insurance coverage to remain dominant as a source of employee insurance in the next ten years to come[1].

The environment and current state of the healthcare system in the U.S.

Comparing the United States to other industrialized countries the world over, the level of healthcare insurance providers in the United States is quite low. Unlike the majority of the industrialized countries that guarantee health insurance coverage for all, the system in the United States is more focused on an institution market-based system of the patched network whereby the insured individuals obtain their coverage from their respective employers as a prerequisite for employment. However, the system also relies at times on those who purchase their own individual policies and public health programs that fund health insurance coverage such as SCHIP (State Children’s Health Insurance Program), and Medicaid on. According to a data survey on a population below 65 years of age, i.e. the non-elderly population results depicted that the better part of the surveyed group, approximately 60% of this population, relied on their employers to cover for their health insurance[2].

Further results revealed that there was a relatively lower population number comprising of those below the age of 65 years, approximately seven percent, that purchased their medical cover in the individual market, with approximately 45 million people, an equivalent of two and a half times of the compared to the first population, that was without any form of health insurance coverage[3]. It is argued that were it not for the presence of such government programs as SCHIP (State Children’s Health Insurance Program) and Medicaid, the American population that would be without any form of medical insurance would be even higher as those programs have catered for millions of families that earn low incomes, especially children. The total population of the elderly catered for by the government could be equivalent to 18 percent[4].

Public and private insurers get their supply of funds from individuals and their employers, as well as governments. These form the insurance purchase group. From the funds collected from these purchasers, insurers pay suppliers and providers use a fraction of it. The insurers and purchasers, therefore, become “payers” under such a system, which ends up creating disagreement between the payers and the recipients of these funds (Suppliers and Providers). The conflict emanates from the fact that payers desire to reduce their health care contributions while the recipients aim at increasing their receipts. This presents a warring ground in the health care cost from the opposing interests[5]. Given their position as huge purchasers of health covers, employers desire a reduction in the premiums paid to insurers, while at the same time insurers aim at maximizing their profits through maintenance of high premium payments, even as they balance this with providing competitive plans.

Employees under insurance provided for by the employer have access to several plans including the HMO (Health Maintenance Organization). HMO is an organized health care plan aside from the customary plan provided by health insurance. The HMOs are diverse with some providing collaborative coverage with stand-alone health facilities, providers, and medical practitioners. On the other hand, other HMOs restrict the provision of care by the Organization’s employees and facilities. The PPO[6] (Preferred Provider Organization) is yet another health plan, offering less prescriptive plans as patients can visit a specialist without having to be referred by a physician, and they could also visit any doctor they so please, although these are expensive since patients pay from their pockets. Another healthcare plan is the issue of traditional indemnity, also known as fee-for-service. Patients who fall within this type of plan can visit any physician they so wish, in addition to being in a position to receive reimbursement for medical expenses that are covered[7].

There is are also such types of plans that blend together the elements of the Preferred Provider Organization, and the Health Maintenance Organization plans such as the POS (Point-of-Service) plan which calls for the designation of in-network physicians by enrollees though it provides room for patients to look for out-of-network healthcare provided they are willing to part with a higher amount of cash for the expenses. There is also another type of plan in operation known as the CDH (Consumer Directed Health) plan. The plan was evolved from the accounts of health reimbursement (HRAs) and health savings accounts that call for every single individual to cough huge sums of money in order to cover for their medical expenses, however, it also caters for a traditional type of insurance for non-routine care.

The New York Times featured the deteriorating state and crisis of the United States healthcare system in March last year, addressing the challenges that were facing thee, physicians, within the system as they began to regulate the number of Medicare patients to attend to due to limitation of facilities and Medicare reimbursement[8]. It was argued that the decision that was taken by the doctors to regulate the number of Medicare patients was without their control as much as they would be willing to assist due to the heavy cost of taking care of the elderly as the government did not provide for reimbursement to cater for the same. If the situation persists, and medical physicians decline to take in more patients, the results could be catastrophic as there would be limitations to medical care access to a population that would be so much in need of the services[9].

Other than the declining ratio of coverage and increasing premiums in health insurance, also other forces conspire to weaken the system of healthcare in the United States[10]. To begin with, a very high number of the American population, accounting for 80 percent raised concerns on their level of satisfaction with the system in place, complaining about the high costs of national health care.[11]Other issues include the extremely high number of Americans that are uninsured, amounting to a total of 45 million, with 8 million among them being children. The number of the underinsured is also high being at 15.6 million people[12].

Insurance premiums sponsored by the employers have also been on the rise ever since the year 2000, rising at a rapid rate than the earnings of the workers by four times[13]. There has been a 143 percent increase in the average contribution of employees to the employer-sponsored plan, with a 115 percent average increase in co-insurance for physicians, out-of-pocket costs for deductibles, hospital visits, and co-payments for medication since the year 2000. The United States personal spending in healthcare, as a share of their GDP, has increased by 200 percent in the last 30 years,[14] with an expected increase in the total expenditure for national health to four trillion U.S. dollars by 2015 as they are projected to take care of a fifth of the GDP by then[15].

Comparing America to other industrialized nations, the American citizens pay more, both as a share of their GDP and based on per-capita for health services. Ranking far behind most of its international competitors with respect to health outcomes including infant mortality and longevity, in spite of its significant increase of expenditures on health care, the United States has had most of its citizens raising issues concerning their worries about the huge amounts of cash that they have to part with in order to payfor their health care insurance[16]. Himmelstein et al. argue that half of all the cases of bankruptcy that were filed were as a result of medical expenses[17].

The National Coalition of Healthcare argues that for every thirty seconds, there is a bankruptcy case reported in the United States attributed to serious health issues[18]. Collins et al. also record cases of approximately 50 percent of the workers in the middle and low range compensation jobs, with 25 percent of those in the higher compensation jobs being included, reporting problems with huge accruals of medical debts or having to pay[19]. More than one-quarter of the surveyed population, in a survey conducted by the Access Project, reported financial issues such as being unable in the past to take care of their rental or mortgage payments due to huge medical debts that they were struggling with to settle[20]. Considering the fact that the healthcare system in the United States has been under stress, there has been mounting pressure that calls for immediate effective action to be taken. For instance, the increasing cost of medical care has to be addressed as if the increase continues without being controlled, more burden would be shifted to the employees as the employers would not be in a position to cater for their employees’ medical insurance coverage. This will result in an increase in the uninsured population that will thus translate to deterioration in the standards of health, dissolving of families, increased cases of bankruptcy worsening the health outcomes in general[21].

Conclusion

This research has brought forth some of the critical issues affecting the healthcare system in the United States outlining the causes that have resulted in such situations. The research introduces the current state of the healthcare system in the United States majoring on the weaknesses/challenges facing the system. There are quite a number of challenges facing the healthcare system including lack of support from the government, increasing cost of medical insurance, dependence on employer-based medical cover, and other Medicare plans such as the SCHIP (State Children’s Health Insurance Program), and Medicaid among other challenges. There is a need to address these challenges as the general population that is most in need of these services looks up to the Medicare system. The government should also increase its support and funding as the current system is at a higher risk of failing in the near future due to the burden left on employers who might give in due to increased costs in health insurance coverage.

Bibliography

Bodenheimer, Thomas. “High and rising health care costs. Part 1: seeking an explanation.”Annals of Internal Medicine 142, no. 10 (2005): 847-854.

Borger, Christine, Sheila Smith, Christopher Truffer, Sean Keehan, Andrea Sisko, John Poisal, and M. Kent Clemens. “Health spending projections through 2015: changes on the horizon.” Health Affairs 25, no. 2 (2006): w61-w73.

Ginsburg, Paul B., and Len M. Nichols. The health care cost-coverage conundrum: the care we want vs. the care we can afford. Center for Studying Health System Change, 2003.

Harrington, Charlene, and Carroll Estes, eds. Health policy: crisis and reform in the US health care delivery system. Jones & Bartlett Publishers, 2008.

“Health Care in America Survey.” ABC News/Kaiser Family Foundation/USA Today. 17th October 2006. Accessed 2nd April 2014.http://www.kff.org/kaiserpolls/upload/7572.pdf

Hellander, Ida. “A review of data on the US health sector: spring 2006.”International Journal of Health Services 36, no. 4 (2006): 787-802.

Himmelstein, D. U. “Warren, e. Thorne, d., & Woolhandler, S. Market watch: Illness and injury as contributors to bankruptcy.” Health Affairs 24 (2005): 63-73.

Setness, Peter A., M.D. “The Looming Crisis in Geriatric Care; as Baby Boomers Age, Healthcare Policy Fallout Seems Inevitable.” Postgraduate Medicine 111, no. 6 (Jun 20, 2002): 17. http://search.proquest.com/docview/203974965?accountid=1611

[1]Harrington, Charlene, and Carroll Estes, eds. Health policy: crisis and reform in the US health care delivery system. Jones & Bartlett Publishers, 2008.

[2]Charlene Harrington, and Carroll Estes, eds. Health policy: crisis and reform in the US health care delivery system. Jones & Bartlett Publishers, 2008.

[3]Bill Bryson, and William Roberts. A short history of nearly everything. Vol. 33. New York: Broadway Books, 2003.

[4] Ibid., 15

[5] Thomas Bodenheimer. “High and rising health care costs. Part 1: seeking an explanation.” Annals of Internal Medicine 142, no. 10 (2005): 847.

[6] Ibid., 848.

[7] Ibid., 848.

[8]Peter Setness A., M.D. “The Looming Crisis in Geriatric Care; as Baby Boomers Age, Healthcare Policy Fallout Seems Inevitable.” Postgraduate Medicine 111, no. 6 (Jun 20, 2002): 17. http://search.proquest.com/docview/203974965?accountid=1611.

[9] Ibid., 17.

[10] Ibid., 17.

[11]“Health Care in America Survey.” ABC News/Kaiser Family Foundation/USA Today. 17th October 2006. Accessed 2nd April 2014. http://www.kff.org/kaiserpolls/upload/7572.pdf

[12] Ida Hellander. “A review of data on the US health sector: spring 2006.”International Journal of Health Services 36, no. 4 (2006): 787.

[13] Ibid., 789.

[14]Paul B.Ginsburg and Len M. Nichols. The health care cost-coverage conundrum: the care we want vs. the care we can afford. Center for Studying Health System Change. 2003.

[15]Christine Borger, Sheila Smith, Christopher Truffer, Sean Keehan, Andrea Sisko, John Poisal, and M. Kent Clemens. “Health spending projections through 2015: changes on the horizon.” Health Affairs 25, no. 2 (2006): w61

[16] Ibid., w65

[17]Himmelstein, D. U. “Warren, e. Thorne, d., & Woolhandler, S. (2005). Market watch: Illness and injury as contributors to bankruptcy.” Health Affairs24: 64.

[18] Ibid., 65.

[19]Wages, health benefits, and workers’ health. New York: Commonwealth Fund, 2004.

[20]Wages, health benefits, and workers’ health. New York: Commonwealth Fund, 2004

[21]Paul B. Ginsburg and Len M. Nichols. The health care cost-coverage conundrum: the care we want vs. the care we can afford. Center for Studying Health System Change, 2003.