We provide medical care for everyone in the United States through our comprehensive, long-term primary care foundation.
The purpose of this policy document is for the American Academy of Family Physics (AAFP) and its board to consider all options available to federal, state, and American citizens to achieve their goal of providing advocacy flexibility. Achieving Health Insurance for All – A goal based on AAFP policies.
This means that health is a fundamental human right for all human beings, and that the right to health includes universal access to timely, acceptable and affordable health care of appropriate quality.
The US health care system is uncoordinated, fragmented, and emphasizes intervention rather than prevention and comprehensive health care management. Healthcare costs continue to increase at an unsustainable rate, and quality is far from ideal. I, I, I
Over the past two decades, policies implemented through the Children's Health Insurance Program (CHIP) and the Patient Protection and Affordable Care Act (ACA) have resulted in millions of adults who were previously uninsured and ineligible for Medicare. Affordable health care is now available.
The uninsured population hit a record low of 8.8% under the implementation of these guidelines. iii The greatest increase in coverage occurred in the most vulnerable populations and young adults. However, the removal of some of the policy provisions has increased the proportion of the uninsured to 15.5%. This is pretty much the same as 10 years ago, when nearly 17% of uninsured people were uninsured and nearly 50 million uninsured.
Ensuring that everyone in the United States has affordable health insurance that provides the essential health care (EHB) services absolutely necessary to move into a healthier and more productive society. In addition, our health care system takes into account and addresses socioeconomic status, the housing and employment status, food security, the environment, and other social determinants of health that have a significant impact on individual and group health outcomes and costs.
As the Commonwealth Fund points out, the design of systems that provide health insurance for all “continuously and systematically improves access to care, equity, quality of care, efficiency and costs. This has a major impact on your ability to control. Control. "Vi
Successful health care reforms aimed at achieving universal health coverage reaffirm the centrality of primary care, revitalize the US primary care infrastructure, and provide and pay for primary care. Exciting research shows that more and more resources are being focused on professional care, leading to fragmentation, poor quality and increased costs.
Studies show that GP practices are becoming more accessible, promoting prevention, actively supporting patients with chronic diseases and reinventing the way they work to involve patients in self-management and decision-making. The design has been shown to improve quality of care and cost-effectiveness. care.vii
Family medicine and primary care are the only entities responsible for the long-term continuation of care for all patients. The relationship between GPs and patients and their inclusion have the greatest impact on outcomes and costs of long-term care. However, the current US health care system is unable to provide comprehensive primary care due to the way primary care has been and is funded.
According to the Dartmas Center for Evaluation and Clinical Science (now known as the Dartmas Institute of Health Policy and Clinical Practice), Medicare expenditures (hospital reimbursements and Part B payments) in primary care-dependent US states. Less resource expenditure (hospital beds, ICU beds, all medical work, primary care staff and healthcare professionals); reduced usage (doctor consultation, days in ICU, hospital stay number of days and patients seeing 10 or more doctors). Improves quality of care (fewer ICU deaths and higher combined quality score).
Patient-centered healthcare facilities (PCMH) are an approach to providing comprehensive aftercare primary care (APC) to children, adolescents, adults and the elderly. This is a medical model that facilitates partnerships between individual patients, their doctors and, where relevant, their families or carers.
Each patient has an ongoing relationship with a private GP who is trained to provide first contact, coordinated, ongoing and comprehensive care. Private doctors lead individual teams above the clinical level, which are jointly responsible for the ongoing care of patients. ix
A fundamental shift is needed to shift the focus of the US health care system to one that is inclusive and emphasizes inclusive and collaborative primary care. The current resource must be allocated differently and new resources must be used to achieve this desired result. All payer payment policies must change to reflect the larger investments made in primary care to fully support and sustain primary care transformation and delivery.
Staffing policies should aim to attract strong leaders from GPs and other primary care physicians who are essential to a highly functional medical team. In order to achieve these changes, the state legislature and/or state legislature must enact comprehensive legislation. Any solution is better if the law only addresses the uninsured and does not fundamentally rebuild the system to encourage and pay for better payments for primary care and primary care in other ways. We are not reaching the full potential to achieve the four goals of good care . Smarter spending. , and a more efficient and happier doctor.
Key elements of the framework
Everyone has affordable health insurance that provides equal access to age-appropriate evidence-based medical services.
Everyone has a family doctor and health facility.
Insurance reforms that introduce consumer protection and non-discrimination policies will continue and will require proposals and options to be considered to achieve universal health insurance. These reforms and safeguards include, but are not limited to, continued issuance warranties.
Prohibition of buying insurance based on health status, age, gender, or socioeconomic criteria. Prohibition of annual and/or lifetime interest and limitation of coverage. The coverage required for the specified EMS. Compensation is required for certain preventive and vaccine services without co-patient payments.
Each proposal reflects at least twice the percentage of medical costs invested in primary care. • These investments should provide a primary care payment model that supports and sustains the transformation of primary health care facilities and closes the current income gap between primary and subspecialty care. Take care to ensure that general practitioners have a sufficient workforce.
Federal, state, and private funding for medical education will be reformed to establish and achieve national physician staff policies that produce sufficient primary care workers to meet state medical needs. ... In addition, US medical schools have been raised to a higher standard in creating the workforce needed by family doctors across the country.
A series of visits and certain services by your GP is free of charge.
Every universal health system protects the ability of patients and physicians to directly and voluntarily contract a specified or negotiated set of services (eg, direct primary care [DPC]). In addition, individuals can purchase additional or additional private health insurance at any time.
To achieve universal health insurance, the AAFP, following the principles above and with the support of the majority of Americans, combines one or more of the following approaches and recognizes that each has its strengths and challenges. Advocating for partisan solutions.
The multidimensional approach to funding, organization, and delivery of healthcare is aimed at achieving affordable healthcare with competition on the basis of quality, cost, and service. One such approach involves several non-profit and non-profit private organizations and government agencies in providing health insurance coverage.
Such a universal healthcare approach should ensure that everyone has access to affordable medical care.
The Bismarck model approach is a multi-payer non-profit public health insurance policy that includes a government-defined benefit package and must cover all legal residents. Doctors and other physicians work independently in a mixed public and private setting.
The single-payer model approach, which is well defined in terms of organizational, funding, and coverage models, is publicly funded and controlled by the public or private, and government provided by physicians and other health care professionals. Raise and provide funds to pay for medical expenses. It works independently or in a private health system.
The public options approach, which is a publicly administered plan that competes directly with private insurance plans for customers, can be statewide or regional. Doctors and other doctors will continue to work independently.
The Medicare/Medicaid purchasing approach builds on existing public programs by allowing individuals to purchase health insurance through those programs. In such a scenario, at a minimum, parity of Medicaid-to-Medicare payments for the services provided by the primary care physician to the patient is required.
Each option to achieve full health coverage has its own strengths and challenges, as outlined in the AAFP Discussion Paper on Health Insurance and Funding Models, commissioned in 2017 by the AAFP Board of Directors, USA and its elected officers and representatives. These include the following important points:
Scope of administrative and regulatory burden on physicians, physicians and other healthcare providers, and patients/consumers
Impact on total healthcare costs for governments, employers and individuals
Satisfaction of patients, consumers, doctors and clinicians tax rate
Impact on on-time delivery (waiting time) of healthcare services and delays in selected healthcare service plans
Clarity of funding model and level of payments to physicians, clinicians and other healthcare providers
Pay, childbirth, and participation of primary care physicians in other health decision-making committees
Description and clarity of the core set of essential health services available to all, particularly primary care and prevention, management of chronic diseases, and protection against catastrophic health care costs.
Impact on the availability and fair delivery of medical services
Impact on Quality and Access
Determine if there are global budget and price/payment negotiations
The need for a clear and consistent definition of the “one-off healthcare system”
Comprehensive basic care
Advanced primary care embodies the principle that patient-centred primary care is comprehensive, continuous, coordinated, connected and accessible to patients for their first contact with the healthcare system. APC aims to improve clinical quality by providing coordinated long-term care that improves patient outcomes and reduces medical costs. AAFP believes that APC is best achieved through a home care model.
Five key features of the Comprehensive Primary Care Plus (CPC+) initiative, which defines primary care facilities as homes based on the shared principles of the patient-centric Homeix and establishes physician offices that provide comprehensive care and partnerships. Between patient and doctor. A payment system that recognizes primary care members and other healthcare teams and extensive work in delivering primary care. The main tasks of primary health care are:
Any proposal or option to provide health insurance for all should cover a defined set of basic health services. This includes at least products and services in the following performance categories:
outpatient service
emergency service
hospitalized patient
Care of pregnant women and newborns
Mental health and substance use disorders services, including behavioral medicine
Prescription drugs
rehabilitation and rehabilitation services and apparatus
laboratory service
Prevention and health services and treatment of chronic diseases
Pediatric services including oral and vision care
In addition to applying for EHB reimbursement, any proposal or option will ensure that primary care is provided through the establishment of primary care for the patient. When services are provided by the patient's nominated GP to foster a long-term relationship with the GP, any suggestions or options relate to financial limitations (ie, deductions and expenses). the following services.
A. Rating and Administration Services
B. Evidence-based prevention services
C. Population Based Management
D. Good parenting
e. vaccination
F. Mental Health Care
Payable
To achieve the goal proposed in this paper, "Providing Health Coverage to All in the United States Through a Comprehensive and Long-Term Basic Care Foundation" focuses solely on health and primary care. It's not enough. Efforts should be made to identify and reduce healthcare costs, including the administrative costs of providing these services.
A comprehensive health system that prioritizes primary care should also emphasize the cost and affordability of care. This is important not only for consumers, but also for physicians, clinicians, payers and government decision-makers. Affordability is an important element of the US healthcare reform effort.
Prevention and Public Health - There is a need for increased investment in prevention, particularly in prevention services that have been shown to reduce the spread of preventable diseases, such as: B. Access to free vaccines and screening programs. Focusing on reducing preventable diseases can reduce, or at least delay, future costly spend on preventable diseases. In addition, more attention needs to be paid to identifying the social and environmental factors that contribute to the increase in healthcare costs.
Transparency – With increased investment in primary care and healthcare facilities, healthcare plans can not only reduce the cost of treating high-risk patients, but also improve the quality of care. xi This increase in investment must be accompanied by aggressive pricing efforts. Transparency of all supported medical services. Such transparency can help reduce excess health care costs by informing the general public about health care costs and intensifying competition in the health industry.
Integration – Integrative medicine systems are a problem in terms of affordability.
Integration between medical systems can reduce internal costs such as operating costs, but it also reduces market competitiveness and increases medical and premium costs. xii
Location-independent payment policies – For many medical services, current payment policies often vary significantly depending on the location of the service (for example, hospitals, outpatient surgery centers, and clinics pay more for the same service). This was not the case, and there were significant differences in the quality and outcome of treatment. Such payment policies contribute to overspending in current systems. In addition, these payment policies facilitate integration, reduce competition between providers, and promote overconsumption of expensive medical services. This issue can be effectively addressed by site-independent payment policies and the elimination of some setup fees.
Administration Costs-Part of the total health care costs in the US healthcare system are due to high administration costs. Most of these high management costs are due to the complexity of billing and are exacerbated by many payers. In countries with fixed budgets and few medical plans, administrative costs are low. xiii Of all hospital spending in the United States, 25% is administrative expenses, which is about $ 200 billion. By comparison, Canada spends only 12% of hospital costs on administration, while the UK spends 16% on administration.
In addition, there was no link between higher management costs and higher quality of care.
Pharmacy and Biology – Advances in pharmacy and biology have improved the health of millions of people, reduced the prevalence of preventable illnesses, and enabled long-term maintenance of chronic illnesses. These advances have increased the life expectancy of millions of people, especially those with chronic illnesses and certain types of cancer. This progress should be celebrated for its positive impact on millions of people.
However, rising costs of medicines and biologics have made these interventions and treatments out of reach for too many people. Policies need to be implemented to allow health care buyers, including Medicare, to negotiate the cost of prescription drugs. In addition, greater flexibility is needed in the design of formulations that can increase the use of generics and biosimilars.
payment
The AAFP believes that all practitioners should be compensated according to the Advanced Primary Care Alternative Payment Model (APC-APM), AAFP's comprehensive payment model for practitioners and primary care treatment. AAFP believes that APC-APM is a fundamental element of a larger investment in essential services that are essential to a better care system in the United States.
This model is based on years of program and research demonstrating the benefits of increasing support for population-based care away from service costs (FFS). This provides better support for small, independent practices and reduces the administrative burden on the medical department.
Tidak ada komentar:
Posting Komentar