The challenges of health insurance and benefits are rising alarmingly. However, with proper solutions, we can expect a healthier and happier America.

Health Insurance in the US includes any program that bears the cost of medical expenses. The medical expenses may be paid through privately purchased insurance, social insurance, or government-funded social welfare program. No doubt, Health Insurance and benefits are synonymous with each other. However, there is still a wide gap in the access to quality healthcare. In this article, you will understand the challenges that are contributing to the gap, what statistics suggest and the potential solutions.

Facts about Health insurance and Healthcare Spending in the US

The US government spends trillions of dollars annually on its healthcare system. In fact, the enormity of the expense can be gauged by the fact that in 2012, US healthcare spending was 17% of its GDP. Interestingly, this amount is more than the entire GDP of the UK.

Among the OECD (Organization for Economic Co-operation and Development) countries, per capita healthcare expenditure of the US is the highest. However, even such huge investment does not seem to improve health conditions for many Americans. Regrettably, statistics suggest that the US has poorer health conditions compared to other high-income countries. According to a WHO report, at least 18% of US residents younger than 65 years had no any form of insurance till 2014.

The major drivers of poor health outcomes in the US are gaps in health coverage, unhealthy lifestyle and lack of appropriate access to health care.

Currently, in the US, public payers are the biggest contributor accounting for 48% of total healthcare expenditure. Likewise, 40% comes from private payers and 12% from the patients as out-of-pocket payments. Almost 30% of the total population is covered by Medicare and Medicaid.

What are Health Insurance Exchanges?

Also called Obamacare’s insurance marketplaces, the exchanges are the websites that help you buy health insurance coverage. In some cases, you can also get financial aid from the federal government.

The basic idea behind creating the exchanges is to facilitate shopping for coverage. The exchanges provide a one-stop solution where you can compare different insurance policies
Typically, an exchange helps to compare a number of insurance plans that have common components such as premiums quality rating of plans, enforcement of insurance mandates, compensation payments to insurers with high-cost enrollees and regulatory oversight.

What Challenges are Affecting Health Insurance and Benefits?

According to a WHO report, the major challenges that the US healthcare system is currently facing are:
Challenges in Health insurance coverage

When Obamacare was first introduced, it was believed to cover nearly all Americans. However, the current situation is nowhere near. Unfortunately, an estimated 35 million Americans have no health insurance. Even worse, many more are underinsured.

It is a positive thing that more than half of private-sector workers have two or more health insurance options. Also, Medicare offers veterans to choose from traditional coverage or other Medicare-approved plans from private insurers (Medicare Advantage). But the choice of the most appropriate health insurance plan is often marred by insurance illiteracy and lack of information. Consequently, they end up paying for what they actually may not need.

Challenges in expenditures

Well, it might sound like we are repeating the same thing time and again. But, yes, the US government is spending far more than what it should spend. Regrettably, the results are not something anyone proud of. Looking at the current trend in healthcare expenditure, it seems quite unlikely that any change in the expenditure will occur if no reform in the policy takes effect shortly.

The major driver of rising healthcare expenditure is theadoption of new medical technologies. For instance, if a new blockbuster drug enters the market, it will surely push the cost-curve upwards. In some cases, the benefits of any of these technologies fall well below the amount you pay for them. Moreover, overspending on ineffective new technologies can affect spending on necessary things. For example, preventive care, health education, and others.

Health Insurance and Benefits: What Measures Can maximize the Outcomes?

The most critical factor to address the current crisis in US healthcare system is a reform which can include:

• Personal health insurance. It should always be the individual’s authority to choose which insurance policy they like. But in a system where the employer chooses your policy, it is very less likely that the selected insurance will solve all your ailments. Moreover, if you leave the job, your insurance coverage might go off the air as well.
• More competitive insurance market. More competition means the consumers can expect to have more choices and most probably pay less for their choice. As a matter of fact, the insurance market is dominated by a handful of companies that drive the fate of the market. If it was possible for the consumer to choose from a number of options, it would have been a different scenario now.
• A wider range of practice authority to non-physician medical professionals. Like in the insurance market, competition is a good thing even when among the healthcare professionals. All non-physician professionals such as Nurse practitioners, physician assistants, midwives, naturopaths, and chiropractors should have a greater flexibility in practicing what they have learned.

Want To Know More?

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