Research Paper Abstract
The U.S. healthcare service is the most expensive as compared to other developed countries in the world. The high cost of healthcare is a result of huge salaries paid to the physicians and high research cost which are passed on to the patients. The expense of healthcare often keeps many people from seeking treatment for non-life threatening illnesses. When in serious need, patients will overflow the emergency room with requirements that would be better served by a primary care physician. The insured also cannot afford the co-pays that follow the service, and they see the use of the emergency room as more cost-effective.
Obamacare, or the Affordable Care Act (ACA), was implemented to aid with the overall cost of insurance coverage for people with small salaries or no incomes. ACA’s intention was to end what the administration declared as health insurance companies’ abuses and exploitations, to make medical coverage less expensive, and to outspread its scope to those who could not acquire the insurance. Primary caregivers offer pre-emptive care and can detect and treat most disorders and sicknesses of the patients.
Evidence shows that there is reduced medical care cost when individuals have a primary caregiver managing their health and harmonizing all the examinations, processes, and development care. When necessary, the primary caregiver coordinates and offers care for patients and makes referrals for expert care. The emergency department could transfer several patients to consultations at primary care services.
Keywords: emergency room use, life-threatening illness, medical bills, primary care services, Affordable Care Act
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Research Paper Introduction
There have been numerous debates concerning American citizens’ access to affordable health care since the launch of the Affordable Care Act known as Obamacare, which aimed at reforming the health care system. Healthcare in the United States is very expensive compared to other countries in the world. Although regular visits to primary care services may prevent serious illnesses from occurring, many individuals prefer using the emergency room (ER) as a source for care. The study analyzes the reason those now have the ability to obtain coverage, and those who have the option of a primary care provider prefer using an emergency room for care. In addition, the paper explores the impact of the Affordable Care Act on the citizens it was meant to provide against the private insurance companies.
Thesis Statement for Research Paper
The Affordable Care Act was implemented to assist both the insured and uninsured patients, who due to the high cost of healthcare avoid seeking treatment for non-life threatening illnesses; which cause overcrowding in the emergency room with needs that would be better served by a primary care physician.
Costs That Make Healthcare an Expensive Business
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Training Value for Doctors
Medics are amongst the highly respected careers, and the majority of the uppermost-paying occupation lists comprise members of the health career. Although doctors receive the uppermost average annual pays, they have an extremely great investment and opportunity costs, as they forego about 0.5 million dollars in order to become doctors (Ogle, 2013). All staff inside a certain career are not made equally. Certain doctors receive more or less pay than others as it is for employees in other professions. A study demonstrated that in 2012, 79 percent of medical institute graduates stated learning debt of over $ 100,000; averagely, the medical institute liability was approximately $ 166,750 (Ogle, 2013).
Additionally, doctors spend at least four or five years in medical training; hence, they miss payments of about $57,000 annually (the average incomes for somebody who has a bachelor’s degree). This implies a doctor sacrifice an additional $ 228,000 value of after-school earnings to complete supplementary, post-graduate education (Ogle, 2013). For these reasons, doctors require to be paid considerable salaries to compensate for the resources and time they spent in order to become professionals, which in turn increases the total costs of healthcare.
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High Cost of Research on Diseases and Illnesses
The cost of disease research establishes the expenses related to having a particular disorder on an individual and to the community in general. Various stakeholders use the statistics obtained from the research in several ways. The researchers use the data to validate the reason their research needs to be financed comparative to the investigation into another illness. The data collected are also used by drug development firms to explain why an insurance firm should repay afresh developed medication.
Other organizations use the data to foyer the administration for the provision of more funds to lessen the expenditures absorbed by persons who live with a certain ailment. The research is important since it helps in quantifying the influence of illness and enables that effect to be compared to other sicknesses (Sarriera, & Salvucci, 2016).
The research findings are exceptionally vital in the allocation of the scarce resources available. In addition, the statistics from the research of illnesses can help in facilitating the fight against certain diseases (Sarriera, & Salvucci, 2016). Conducting research on an ailment requires a substantial amount of resources which ultimately increase the cost of health care.
The Costs Delegated to the Patient
Each time someone increases the likelihood of anything that would increase producers’ expenses, the possibility of the charges being transferred to consumers rises. The same case happens in the health care system. The high salaries demanded by doctors and other medical staff raise the cost of medical care (Ogle, 2013). These costs are passed on to the patients; thus, they are faced with the huge burden of medical bills. Similarly, the high costs of research conducted on illnesses are also passed on to the patients (Sarriera, & Salvucci, 2016).
This makes accessibility to healthcare very expensive, and some people end up bankrupt when they get ill. Due to the high cost of healthcare, many people avoid seeking medical care for non-life threatening illnesses in case of any illnesses or symptoms since they could not pay for treatment or are worried about possible costs, albeit they have insurance cover. Consequently, when in terrible need, patients will normally overcrowd the emergency room with requirements that would be better served by a primary care physician.
Roles of Primary Care Physicians
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Maintaining Personal Health
Primary care physicians offer preliminary contact for an individual with an undiagnosed medical issue and ongoing care of various health conditions. They offer pre-emptive care and can detect as well as treat most disorders and sicknesses of the patients. The primary care physicians are the first line of defense in fighting disease. They can identify and treat a wide range of conditions while assisting people to remain healthy and prevent illness (Xu, Rohrer, & Borders, 2002). They treat common diseases and detect minor medical concerns before they turn into serious problems. Primary care doctors provide preventive facilities such as cancer screening, flu shots, and advising on diet and smoking, as well as assist in handling the care of chronically ill patients.
It would be very problematic for people to acquire all the healthcare they need to stay fit without a primary caregiver. When individuals lack access to frequent primary caregivers, they find themselves in emergency rooms more frequently, and they are more often admitted to hospitals. Without frequent screening, a manageable disorder such as high cholesterol can ultimately cause a life-threatening heart attack.
It is reported that proper access to primary care can enable people to live longer, feel healthier, and evade incapacity and lengthy absenteeism from work. Additionally, evidence shows that there is reduced medical care cost when individuals have a primary caregiver managing their health and harmonizing all the examinations, processes, and development care (Xu, Rohrer, & Borders, 2002). Thus, regular visits to primary caregivers reduce the use of emergency rooms as well as medical costs.
Referring the Patient to a Specialist
Health referral is the act of directing a patient by a skilled care provider to another, who could be an expert and thus be more well-informed in the diagnosing and additional supervision of the patient (Xu, Rohrer, & Borders, 2002). Referral of patients is normally practiced for appropriate diagnosis, satisfactory examinations, and their correct treatment by the receiving professionals. The necessity for a transfer, its suitability, scheduling, and to whom the transfer is made usually relies on the attending physician (Xu, Rohrer, & Borders, 2002). Referral ought to be done only after discussion with the patient’s relatives and appropriate approval is gotten. When necessary, primary caregiver coordinates and offers care for patients and makes referrals for expert care.
Insurance Firms and Obamacare
Insurance Company Exploitation Before the Obamacare Implementation
Before the Affordable Care Act was implemented, the health insurance industry was fragmented for the reason that cost of coverage was rapidly increasing, and finding insurance was the difficulty. Instead of supplementing the high costs of acquiring healthcare, the private insurance companies exploited the patients by setting too high premium rates that many people were unable to afford. President Obama’s government maintained that medical insurance firms had excessive freedom as they were not subjective to a federal mandate, and thus required to be controlled (Dey, 2014).
Although the Affordable Care Act essentially impacts all sectors of the health system, it was mainly concerned about health cover, since the government was convinced that the private medical cover business unfairly profits from patients requiring health care (Dey, 2014). Therefore, the law was to end what the administration professed as health insurance firms’ abuses and exploitations.
Impacts of the Affordable Care Act on Low-Income Earners
Obamacare’s main objective was to make medical coverage less expensive and to outspread its scope to those who could not acquire the insurance. To attain this goal, the novel law made health cover compulsory, and those without it were subjected to possible penalties. The government offered subsidies to aid the citizens who had insufficient money to pay for the new compulsory insurance cover (Dey, 2014).
In addition, the Act prohibits insurance firms from repudiating cover or charging greater premiums to those with prevailing situations. The ACA generates state-founded markets called ‘exchanges’ for persons and small enterprises to buy cover for their personnel. Elements such as higher registration, more inclusive welfares, and price-sharing restrictions will impact medical costs and sequentially medical cover premiums in diverse ways. There will be a major impact on the discrete medical cover market. Ultimately, the aim of the Affordable Care Act was to spread medical welfares to all American citizens at a reasonable price (Dey, 2014).
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Use of Triage in Hospitals
Nowadays, most hospitals have emergency departments that provide preliminary treatment for a comprehensive variety of sicknesses and injuries. Some of them could be life-endangering and necessitate instant attention. Sometimes, most emergency rooms get so overcrowded that they become hazardous. It is problematic that on many occasions, in every emergency room, there is only one doctor expected to attend lots of people. The ratio of doctor-to-patient is normally about one to fifty (1:50) (Parenti, Serventi, Miglio, Masi, & Sarli, 2011), including those in the waiting room.
Therefore, it is not conceivable to attend to every patient without making others wait for some hours hence the need for triage services where an evaluation is conducted to identify the level of urgency of the patients’ needs for clinical intervention (Parenti, Serventi, Miglio, Masi, & Sarli, 2011). The persons with life-threatening illnesses are served first as their survival is determined by how quickly and correctly the caregivers detect and treat their illnesses.
The emergency department prioritizes the cases on the basis of medical need as patients arrive at any time. Triage is an arrangement of medical risk management applied in emergency departments to carefully control patient flow when medical needs surpass capacity. Triage is considered a vital function during huge entry of patients in case of tragedies, epidemics, and plagues, as well as in normal emergency care departments (Parenti, Serventi, Miglio, Masi, & Sarli, 2011). The majority of emergency departments have a devoted segment where triage processes take place as well as personnel committed to performing a triage task. Normally, patients are initially examined at triage and handed to another segment of the department.
Reducing of the Emergency Room Use for Non-life Threatening Issues
Grumbach, Keane, and Bindman’s (1993) study involved 700 patients at a government hospital waiting for emergency department (ED) service. It aimed at assessing if transfer to primary care settings would be medically suitable for and satisfactory to patients waiting for ED services for conditions that are not urgent. The scientists conducted an evaluation and comparison on the accessibility to other sources of health facilities, medical suitability of ED utilization, and readiness of patients to utilize nonemergency facilities among patients with a consistent source of care and those without it. The findings revealed that almost half of the patients claimed that they used the ED due to barriers that hindered access to primary care (Grumbach, Keane, & Bindman, 1993).
According to Grumbach, Keane, and Bindman (1993), only one out of six patients had illnesses that were medically suitable for ED services. Patients with a consistent source of medical services utilized the ED more suitably than patients lacking a consistent source of health care. About 38% of the patients were ready to exchange their ED visit for a consultation with a doctor in 3 days (Grumbach, Keane, & Bindman, 1993). Therefore, ED could transfer several patients to consultations at primary care services, which would be only practical when the accessibility and harmonization of primary care facilities were improved for low-earner people.
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The Insured Challenges in Accessing Primary Care Services
In their study, to find out whether people, excluding the senior and the uninsured, face challenges in getting access to primary healthcare, Hayward, Shapiro, Freeman, and Corey (1988) examined 7633 grown-ups nationally. They expected that the insured had considerably better access compared to the uninsured; however, there were considerable differences in obtainability of care amongst the covered. The finding showed that working-age people who were insured were 3.5 times as probable as the seniors to have required back up medical facilities but did not obtain them, and 3.4 times likelihood of having had great financial challenges due to sickness (Hayward, Shapiro, Freeman, & Corey, 1988).
According to Hayward, Shapiro, Freeman, and Corey (1988), amongst the insured adults, the humble were 4.4 times more likely than the rich to have required back up health services though they did not get them, and 5.2 times likely to have experienced huge financial difficulties owing to disease (Hayward, Shapiro, Freeman, & Corey, 1988). It is evident that the insured adults who are in working age have less accessibility to primary healthcare than the senior, and the poor in this group have a higher risk for greater financial challenges to obtain care. Therefore, even the insured people cannot afford the co-pays that go with the primary care service, and using the emergency room is more cost-saving on the front end as they do not need payment at the time of service.
Research Paper Conclusion
There is no doubt that American healthcare is very costly for both insured and uninsured. For this reason, people are avoiding seeking treatment for non-life threatening conditions; hence, they overcrowd the emergency room when in serious needs. The reason healthcare has become too expensive is high salaries paid to the physicians and the high costs of researches on diseases, which are passed on to the patients. Primary care physicians play an important role in the prevention of some diseases by assisting people to stay healthy as well as referring patients to experts for further diagnosis when necessary.
Regular visits to primary care physicians reduce medical care costs for individuals as well as overcrowding of people in emergency departments. Thus, people are encouraged to regularly visit the primary care providers even for non-life threatening diseases or symptoms. Obama’s government endorsed the Affordable Care Act to help with the overall cost of insurance coverage for citizens with low wages or no income as the insurance firms used to abuse and exploit patients.