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There are many problems with the healthcare system in America that the government has been trying to fix the problems for decades. Currently, the one of the barriers that many people face is an inability to access to health care because of its high cost. In the 1940s, many men were in overseas during the war, and US employers needed workers. In order to attract the employees, they added a health insurance plan to the benefit package. This was the beginning of employer-based health insurance.

However, healthy people started having to pay the health care costs for sick. In the 1950s, the health care system became more complicated because of a host of newly available medications, including antibiotics. The cost of health care rose as a result, and many unemployed people were unable to see a doctor, or had to for their treatment in cash. In response to the rising costs of health care, many US companies began providing health care plans during the 1960s. At this time, Medicare and Medicaid were implemented to help the poor and elderly.

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Due to a rapid increase in healthcare costs in the1980s, most of employee-sponsored healthcare plans were changed to managed care from a pay-as-needed plan. The managed care plan was implemented to set up the fee structure and manage the costs. By the1990s, the most popular health plan was the managed care plan, which is still commonly used in today’s health care system. Some presidents have tried to create a near universal healthcare system in past decades, yet many people are still unable to obtain medical coverage because of the high cost (“A Brief History,” 1999).

The expense of medical care coverage has been a long-term problem in the United States. Estes and Harrington claimed that the reason for higher medical care costs is due to higher prices for services than in other countries (2008, p. 250). There are many uninsured people seeking treatments despite the financial burden. The government has implemented various cost effective programs for uninsured patients. However, there are still many people who are unable to seek medical care. Bodenheimer (2008) provide a few explanations for high medical care costs. First, there is no free market in healthcare.

Patients simply do not have options to choose hospitals or physicians for healthcare services because of a lack of transparency in healthcare system in the U. S. Another contributing factor the high cost is the growth of the aging population (p. 269). Cunningham (2008) conducted a study to examine how the burden of high medical costs contributes to self-reported measures of patient trust and perceived quality of care. He concluded that: “Exposing patients to more of the costs could lead to greater skepticism and less trust of physicians’ decision-making, thereby making health-care delivery less effective”(Cunningham, 2008, p.415).

In this study, patients with high cost burdens perceived the physicians as financial transactions rather than care providers. Self-pay medical costs are one of the factors contributing to dissatisfaction with the US healthcare system and, in consequence, self-payers have to face making difficult choices. Doty, Collins, Rustgi, and Kriss (2008) believed that 72million people had trouble with paying medical bills in 2007(2008, p. 1). Their study showed that both the insured and uninsured suffered from financial burden, especially in low-income, uninsured population.

Furthermore, Doty et al (2008) pointed out that medical insurance does not guarantee financial protection because of insufficient coverage for items such as prescriptions, dental care, preventative care, and long-term facilities coverage. The ineffective means for providing healthcare paired with the fact that some cannot access health care due to high costs should provide enough reasons to change the healthcare system in America. In 2010, the Patient Protection and Affordable Care Act (PPACA) was signed in an effort to make medical care accessible for all Americans at affordable prices.

There are several benefits to the PPACA law. At first, health plans cannot deny coverage based on pre- existing medical conditions. Also, insurance companies cannot drop an individual’s coverage when they develop illness. Furthermore, as a result of health care reform, the cost of insurance policies will be decreased because the insurance companies will have to compete with each other to provide the best plans at a low costs. Lastly, there will be increased in access to health care in starting in 2014. However, the PPACA law also contains inevitable flaws.

One example is that there may be reductions in Medicare spending, which means that senior citizens will receive less advantages and benefits from the program. This may concern baby boomers who are soon to join the aging population. Also, we may face a shortage of primary care providers as the PPACA takes effect. Even though services may be affordable for patients, there may be a longer waiting time for patients. Furthermore, many patients may be affected by higher cost professional fees due to lack of primary health care professional incentive.

The government does not appear to have evaluated additional responses the increase in patient demand before passing the bill. Making the healthcare system cost-effective through the PPACA may also affect the nursing profession. Before the government passed the bill, the ways of meeting increase in patients demand have been evaluated. Currently, there is already a shortage in primary care physicians. Sherman, Moscou, and Dang-Vu claime “We do not have enough health care professionals to bring comprehensive primary care services” (2009, p 944-945).

To make it worse, many physicians are leaving primary care for other subspecialties. Without a plan to fill in the gap, this increase in demand will be detrimental for patient care. For instance, after Massachusetts’s health care reform initiated in 2006, new enrollees overwhelmed primary care physicians. Advanced nurse practitioners end up playing an important role in healthcare reform to meet the rising demand. Buerhaus, DesRoches, Applebaum, Hess, Norman, and Donelan (2012) reported that the delivery care system will be shift as a result of expansion of medical care coverage and enhanced coverage for preventative care (p. 318).

Moreover, advanced nurse practitioners will be able to administer the health care in under-served areas. Yet, recruiting the primary physicians and advanced nurse practitioners will be a challenge; the government must create more programs in addition to a loan forgiveness program in order to attract more physicians and nurse practitioners. Health care reform may also provide opportunities for registered nurses (RNs). For example, current RNs will have a training opportunities learn more about of in-depth preventative care for patients.

This will allow nurse practitioners and RNs can work more closely in collaboration. Sherman et al agreed that “a nationwide nurse shortage currently exists and, by 2020, it has been estimated that there will be more than one million vacancies for registered nurses” (2009, p. 945). However, in order to obtain adequate nursing staff, there should be an increase in federal funding to educate RNs and nursing students. For many people, the high cost of medical care in the US has been a hindrance for seeking appropriate treatments. The implication of the ACA is that it will help people to seek medical care at a lower prices.

Nonetheless, there will be inevitable problems that arise as a result of the PPACA legislation. Health care reform will require the collaboration of researchers, institutions, and policy-makers working together to make the healthcare system better in the United States. References A Brief History : Universal Health Care Efforts in the US. (2006). Retrieved from September 8, 2013 from http://www. pnhp. org/facts/a-brief-history-universal-health-care-efforts-in-the- us Bodenheimer, T. (2005). High and Rising Health Care Costs: Part 1: Seeking an Explanation.

In Harrington, C. (Ed. ), Health Policy:Crisis Reform and in the U. S. Health Care Delivery System. ( 5th ed. , pp. 266-274). MA:Jones and Bartlett Publishers. Buerhaus, P. I. , DesRoches, C. , Applebaum, S. , Hess, R. , Norman, L. D. , & Donelan, K. (2012). Are Nurses Ready for Health Care Reform? A Decade of Survey Research. Nursing Economics, 30 (6), 318-329. Retrieved from http://www. nursingeconomics. net/ce/2014/article3006318329. pdf Cunningham, P. (2009). High Medical Cost Burdens, Patient Trust, and Perceived Quality of Care. Journal of General Internal Medicine.

24(3), 415-420. doi: 10. 1007/s11606-008- 0879-3 Doty, M. M. , Collins, S. R. , Rustig, S. D. , & Kriss, J. L. (2008). Seeing Red: The Growing Burden of Medical Bills and Debt Face by U. S. Families. Issues Brief, 42, 1-22. Retrieved from http://www. commonwealthfund. org/usr_doc/doty_seeingred_1164_ib. pdf? section=4039 Sherman, P. , Moscou, S. , & Dang-Vu, C. (2009). The Primary Care Crisis and Health Care Reform. Journal of Health Care for the Poor and Underserved, 20, 944-950. Retrieved from http://www. clinicians. org/images/upload/Primary_Care_Crisis. pdf

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