Transition from the Fee-for-Service Payment to Value-Based System

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Transition from the Fee-for-Service Payment to Value-Based System

Affordable Care Act (ACA) has played a critical role in ensuring that people from

different socioeconomic levels can access quality care. The higher healthcare costs and the

expensive health insurance premiums had made it difficult for a majority of American

households to afford quality care. However, the ACA ended up transforming the situation and

ensuring that a significant number of Americans can get quality treatment. Efficiency,

affordability, and convenience have been crucial aspects in illustrating the benefits of ACA in

helping more households. Unfortunately, ACA has also experienced various challenges that have

undermined its credibility and the ability to help patients effectively. In this case, the fee-for-

service payment approach has resulted in some negative implications. For instance, insurers

insist that some physicians and providers have increased the volume of services by introducing

unnecessary treatments in order to maximize their profits. Such an initiative has resulted in cost

escalation, which portrays the higher hospital expenses that the administrators have incurred.

However, an introduction of the value-based system will reject the use of the volume of services

to determine the amount of payment that the providers require. Instead, ACA will come up with

a list of quality indicators that can determine the extent of positive patient outcomes that the

providers have achieved. In the process, providers and insurers will get an opportunity to work

together in lowering the costlier healthcare expenses that the US has strived to address in recent

years. The intervention can ensure that most Americans can afford health insurance and patients

do not have to spend a huge part of their disposable income to address any medical expenses that

they might incur. This essay evaluates how the transition from the fee-for-service payment to the

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value-based system will foster consensus, cooperation, and continuation of the ACA in order to

assist patients in accessing quality treatment that they deserve.

Overall Challenges That the ACA Is Facing

Higher Number of Uninsured Americans

Although ACA has strived to create affordable healthcare, the number of uninsured

households is still high, which shows the need for appropriate measures. For instance, nearly 37

million individuals do not have any health insurance, and the number is the highest among some

of the existing industrialized nations (Cooper & Taylor, 2011). The higher number of uninsured

individuals can create a huge burden for the health system that might struggle to support such

persons. Evidently, nurses still have to come up with a number of initiatives that can help the

group of uninsured patients. In the process, it can be difficult to utilize the insufficient resources

and facilities to ensure that uninsured patients receive quality treatment. Although the federal and

state agencies have created the hospitals to help uninsured patients, most of them usually have

larger crowds and it can be difficult for the providers to access quality care. Furthermore, the

incidences of underpayment and understaffing might lower the commitment of the providers as

they handle their clinical responsibilities and assist patients recover from different conditions.

Such circumstances highlight how uninsured patients might struggle before they access the

quality care that they need. Instead, they have to deal with the poor medication that does not

prioritize their interests and specific needs, too.

Higher Quality of Healthcare Facilities

Even if the number of uninsured households is high, the hospitals have strived to improve

the healthcare facilities and other essential factors. Most importantly, American hospitals tend to

offer quality health care due to the technological advancement, competent clinical practitioners,

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and intensive clinical research on different illnesses (Cooper & Taylor, 2011). Hence, hospitals

have the potential of offering quality treatment and assist patients in recovering from different

illnesses that they are experiencing. The presence of advanced facilities and qualified specialists

can ensure that the patients end up accessing quality treatment that can enhance their recovery

progress. Technological advancement and vast scientific research have resulted in better

healthcare systems that can handle different conditions more effectively. The situation reveals

how the US healthcare system has the potential to offer affordable care if the stakeholders decide

to address all the concerns that have been common in recent years. An improvement of the

reimbursement procedures and the prices of different forms of treatment or medications can

make it favorable for the patients to afford the necessary expenses.

Higher Healthcare Costs

Most patients have even paid a quite high amount of funds in order to settle their health

expenses. Evidently, most Americans even have to incur higher health care costs in comparison

to the other industrialized countries (Cooper & Taylor, 2011). The situation might create a

serious issue due to the higher number of uninsured patients that are struggling to get quality

treatment. Even the hospitals are struggling to help the uninsured patients that might require the

help of the hospitals. In the process, similar hospitals might end up overcharging other smaller

payers as a way of recovering the expenses that they have lost due to treating the uninsured

patients (Cooper & Taylor, 2011). Although such an approach might seem charitable and

favorable, it is also unfavorable to charge the wealthier patients a higher amount in order to settle

the expenses of the poor ones. Evidently, most of them also have other financial requirements

and they might benefit from such income. However, the fact that they have to pay higher medical

expenses highlights how it might be difficult for poor people to afford quality healthcare.

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An analysis of the healthcare expenses in America portrays how it is quite high while

other countries have way lower levels. The comparison portrays the difficulties that American

hospitals might experience as they try to assist patients to attain positive outcomes. Most

importantly, in 2013, the US had even spent a higher amount of healthcare costs in comparison

to 13 of the high-income countries (Squires & Anderson, 2015). The amount portrays how

Americans have to deal with the higher medical expenses that might undermine the disposable

income that they have. For instance, it can be difficult to address all the household requirements

if people have to set aside such a huge amount of funds for the medical purposes.

Even the private and out-of-pocket systems have not encountered any positive outcomes

that patients are hoping to achieve. As a result, the improvement of the situation is quite