Sample Nursing Paper on Health Care Delivery Systems

Access to quality and affordable healthcare is a fundamental right of individuals in modern democracies. The provision of quality healthcare in the U.S. is expensive; hence, most families cannot finance their treatment programs without external assistance. In the U.S., there are several forms of health care payment methods that ensure that Americans are provided with quality and affordable health care services. The healthcare payment methods are grouped into Medicare and private health care insurance. Medicare is a government-sponsored method of health care payment while private health insurance involves payment of premiums by individuals to medical insurance companies. Although Medicare and private health insurance aimed at subsidizing medical costs, they are quite different methods of healthcare payment.

Medicare and private health insurance rely on the concept of the common good to subsidize health care payment in America. Provision of quality health care is an expensive affair in America. Thus, it can only be made accessible to all individuals through the concept of the common good (Blumenthal, Davis, & Guterman, 2015). The concept of common good involves the collective participation of all individuals for the achievement of what is beneficial to all (Blumenthal et al., 2015). Both Medicare and private health insurance utilize the concept of the common good to ensure that quality healthcare is affordable and can be accessed by all individuals. Medicare pools resources of the entire nation to ensure that the aged and those living with disability can access free or affordable quality health care (Conesa et al., 2018). Private health insurance also pools the resources from like-minded individuals who require medical insurance cover to ensure that in case of an illness or injury once can access quality healthcare without worrying over the finances involved (Conesa et al., 2018). Under Medicare, all citizens are taxed to create a financial pool big enough to cater for the financial costs of providing quality health care services for the aged and those people living with disabilities. For private health insurance, premiums of those insured are pooled to cater for the costs of treatment of any insured individual who gets sick.

Medicare and private health insurance are different in their respective mandates, funding, and operations. The mandate of Medicare is limited to providing quality health care to individuals who are 65 years of age and above and those living with disabilities in America (Clemens & Gottlieb, 2017). On the other hand, the mandate of private health insurance is to provide affordable health care services to any insured individual while protecting its business interests (Clemens & Gottlieb, 2017). At the center of private health insurance is the business interest of profit creation which dictates all actions of private health insurance companies. Medicare is funded through federal taxes derived from the American people while private health insurance is funded through premiums paid by insured individuals (Selden et al., 2015). The fact that Medicare is funded by American’s taxes makes it a public initiative. Private health insurance is only a preserve of the few individuals who pay premiums to the health insurance companies. The operations of Medicare are more cost-effective compared to those of private health insurance. Since Medicare has a wider coverage pool compared to private health insurance companies, it possesses a higher bargaining power thereby incurring fewer costs.

Medicare and private health insurance play a vital role in the provision of affordable quality healthcare in America. Without Medicare and private health insurance, the constitutional concept of the right to quality healthcare would have been a pipe dream. Although there are fundamental differences in the mandates, operations, and funding of both Medicare and private health insurance, their operations can be harmonized to further increase the provision of affordable health care services.

 

References

Blumenthal, D., Davis, K., & Guterman, S. (2015). Medicare at 50—origins and evolution. N Engl J Med372(5), 479-486. https://doi.org/10.1056/nejmhpr1411701

Clemens, J., & Gottlieb, J. D. (2017). In the shadow of a giant: Medicare’s influence on private physician payments. Journal of Political Economy125(1), 1-39. https://doi.org/10.1086/689772

Conesa, J. C., Costa, D., Kamali, P., Kehoe, T. J., Nygard, V. M., Raveendranathan, G., & Saxena, A. (2018). Macroeconomic effects of Medicare. The Journal of the Economics of Ageing11, 27-40. https://www.nber.org/papers/w23389.pdf

Selden, T. M., Karaca, Z., Keenan, P., White, C., & Kronick, R. (2015). The growing difference between public and private payment rates for inpatient hospital care. Health Affairs34(12), 2147-2150. https://doi.org/10.1377/hlthaff.2015.0706