RESEARCH TOPIC: ADVANTAGES AND DISADVANTAGES OF OBAMA CARE
Research Topic: Advantages and Disadvantages of Obama Care
Annotated Bibliography:
1. McWilliams JM, Chernew ME, Dalton JB, Landon BE. (2014). Outpatient care patterns and organizational accountability in Medicare. JAMA Intern Med; 174:938-45.
The paper intends to reveal the challenges that one might come up during fostering accountability in medical accountable care organizations which are referred as ACOs. This occurs due to the fact that unrestricted choice of healthcare providers is available to medical beneficiaries whose attributes directly relate to the ACOs. These ACOs are at times, subjected to fragmented care. The paper intends to measure three of the constructs that are related to and also relevant in terms of the incentives suggested by ACOs and whether how capable they are in terms of managing the care system. In the broad domain of care related facilities, the stability of assignments relating to patients, outpatient care leakage and the phenomenon of contract penetration is investigated. The studies reveal that there have been distinct challenges that one needs to overcome in order to achieve organizational accountability with respect to Medicare. This has been revealed by obtaining the care patterns revealed by means of beneficiaries who have been served by ACO. However, these patterns need to be monitored continuously in order to reveal the needs for enhancements in ACO in order to improve the patient care system they desire to set. The paper has utilized the Medicare system claims and rosters published by physicians, who had remained a part of ACOs in 2010-2011 in order to reveal the results.
2. Fronstin P. (2012). Private health insurance exchanges and defined contribution health plans: is it deja vu all over again? Employee Benefit Research Institute. www.ebri.org/pdf/briefspdf/EBRI_IB_07-2012_No373_Exchgs2.pdf
In this paper, the issues relating to that of private health insurance exchange, the possible structures of exchange, the fund related aspects, the advantages, disadvantages and the uncertainties that an employer might have to face at its expense for adopting it. The paper utilizes a summary of the attitudes of employers and how the changes they have made have contributed in betterment towards the health care system. The employer’s health care cost exposure has been limited by means of insurance market reforms and change in the exchange structure in terms of PPACA. The paper highlights how employers always deprived the employees from their basic rights to avail a specific amount in order to purchase healthcare related plans and insurances. They regarded it as a risk preferring individual coverage over the group coverage, which was also accompanied by the risk of individuals not being able to secure coverage for themselves in the individual market. The paper suggests that issues relating to these employers which may include the design for plan, the decision regarding fix contribution setting, adverse selection implications and similar must be discussed in detail to overcome the issue. The surveys that the papers include suggest that significant number of employers have expressed their interest in defined contribution health benefits whereas the private health insurance companies may serve as vehicle to accomplish this concept. The paper regards that the concept if accommodated within the organizational structure would benefit both the organization as well as the individuals employed within. Health illiteracy as well as technological advancement may continue to raise the cost of this initiative.
3. McCue, M., Hall, M., and Liu, X. (2013). Impact of medical loss regulation on the financial performance of health insurers. Health Aff. 32(9):1546–1551.
The profit Insurance people who had been operating in the individual market have invested more on the medical related claims and increased the quality of the products they are offering along with offering reduced premiums, which collectively resulted in rising of the medical loss ratio. This ratio can be defined as the actual amount that has been spent on improvement of quality of products being offered and the premiums, in the year 2010 to 2011. The Affordable Care Act has resulted in imposing a must spent of 80 percent of premiums that have been collected for individuals as well as small groups by of health providers. This spend has been insisted to be invested upon the healthcare and quality improvement plans rather than to gain further profit from the amount. For all those insurers that intend to not spend this money on improving the quality of healthcare must involve into the phenomenon of rebating with customers, whereas for those who deal in non-profit domains might also suffer, getting their hands off the favoured tax status. A study, conducted by means of Common Wealth Fund tracked as to what are the effects of medical loss ratio regulations on those who operate in the insurance providence industry by means of analysing the changes that prevailed in financial performance of these players in the year 2010-2011. This study was conducted before the rule went operation to compare and contrast its effects. The three indicators which included the medical loss ratio, administrative cost ratio and operative margin were essential part of the research aspect.
