Health Care Utilization Essay
Health Care Utilization
Health care reform is not a recently devised concept. The government and health professionals have studied and tried to establish legislation that would assist the general population with a means of accessing adequate health care for decades. The task has proven itself as a daunting one although studied the world over. Individuals struggle with disease and illness that they cannot afford medical attention and treatment. Insurance companies price gouge or drop individuals from their insurance coverage. Reform has to be implemented to protect the public and provide across the board health care for every situation.
Ronald Andersen wrote in the Journal of Health and Social Behavior there is a model of behavior that determines the seeking out of health services (Anderson, 1995). Anderson collaborated with Odin Anderson and wrote The Initial Behavioral Model in 1968 to assist in the analysis of national survey data collected by the Center for Health Administration Studies and the National Opinion Research Center at the University of Chicago (Andersen & Anderson, 1967). The model explains that there are elements that may determine if an individual will access health services.
Anderson explained, “I want to stress that the model was initially designed to explain the use of formal personal health services rather than to focus on the important interactions that take place as people receive care, or on health outcomes”(Andersen, 1968, p. 1). The Initial Behavioral Model (1960s) PREDISPOSING ENABLING USE OF CHARACTERISTICS RESOURCES NEED HEALTH SERVICES Demographic Personal/Family Perceived Social Structure Community (Evaluated) Health Beliefs (Revisiting The Behavioral Model and Access to Medical Care: Does it Matter?, 1995)
The president had legislation passed in 2010 to implement the Affordable Care Act. Today, more than 45 million Americans lack access to affordable health insurance. Additionally, many individuals who do have health insurance have incomplete coverage that may include exclusions for pre-existing conditions, or they may be one-step away from losing coverage because of a change in employment. Individuals with health insurance face increasingly high premiums and medical costs that drive some to bankruptcy or force choices between maintaining health insurance coverage and paying for other household essentials (HHS, 2013). These new regulations will provide consumer protections and the developing of a competitive market. Insurance companies will be required to spend a specific percentage on health care and not excessive administrative costs.
There have been major changes to the accessibility of insurance coverage for individuals which have been diagnosed with a pre-existing medical condition. Insurance companies will no longer be allowed to deny insurance coverage for individuals, such as children born with life-threatening illnesses. This will also address lifetime limits on medical care. There has been a health insurance exchange in an effort to pool millions of people and allow them to examine various insurance coverage policies to determine the best policy for them and their families. Health and Human Services has implemented a website for the comparison of the insurance coverage options (HHS, 2013).
There have been conversations for decades about the implementation of universal health coverage. The World Health Organization defines it as a goal to ensure that people obtain the health services they need without suffering financial hardship when paying for them. It goes on explaining, access to health services enables people to be more productive and active contributors to their families and communities….financial risk protection prevents people from being pushed into poverty when they have to pay for health services out of their own pockets (WHO, 2012). There is a definite similarity with the concepts of universal health care and the Affordable Care Act now in place in this country.
Attempts are being made to ensure that all citizens can access health care and increase their wellbeing in the process. The expansion of Medicaid will benefit multiple low-income citizens who, through no fault of their own, are working at a minimum wage job. They are barely earning too much money to be eligible for assistance and are not making enough of a salary to afford health insurance coverage. It turns into a viscous cycle. The individual has to decide whether it is better to quit work and get assistance for medical care or to continue struggling and still not make the grade.
There have been no major issues personally with the implementation of the health care expansion. The insurances that I carry are both the Medicare and Medicaid. Medicaid has changed in that they are requiring that there is a primary care physician (PCP) established to oversee medical services provided. The initial visit would be to the PCP where any examination and testing would be performed for the determination of the necessity of a referral.
The PCP’s office would organize all medical records and coordinate with the specialist’s staff to establish a consultation. I consider myself an extremely fortunate individual because I have been able to have multiple medical issues addressed and corrected because of the medical coverage. The Medicare coverage is not as restrictive as Medicaid. Medicare allows the individual to access any physician or facility that the patient desires for treatment as long as their insurance is accepted.
There has not been any specific positive or negative effect with this coverage. Medicare has provided successfully for preventive measures in my health services such as yearly mammograms, colonoscopy testing every two years (if deemed necessary through findings during prior examination), and comprehensive yearly physical examinations. Unfortunately, there is minimal dental coverage and no eye examinations available.
There has been major skepticism with the Affordable Care Act being voted on and implemented in the governmental realm. It is exhibiting a number of positive actions implemented with the creation of this act. It is time that this country gives thought to the individuals which are suffering because of
no fault of their own other than being on the lower end of the income scale. Also citizens are pleased with the inclusion of the poor souls battling daily with an affliction that requires more attention and treatment than they could ever afford. It is in this new light that people are viewing the creation of the Affordable Care Act and see that this should prove to be beneficial to every citizen within the national borders.
Andersen, R. M. (1995). Revisiting The Behavioral Model and Access to Medical Care: Does it Matter? Journal of Health and Social Behavior, 36, 1-10, retrieved from: http://www.jstor.org/stable/2137284
Andersen, R.M., Anderson, O.W. (1967), A Decade of Health Services, retrieved from:
Health and Human Services (2013), Strengthen Health Care, retrieved from:
World Health Organization (2012), What is Universal Health Coverage, retrieved from: