Essays, poems and Stories of an African-American

Tuesday, 8 December 2015

The "Insurancization" Culture: What America can teach Africa: From a Public Health Perspective


The 2010 Patient Protection and Affordable Care Act (PPACA) and its modifier The 2010 Health Care and Education Reconciliation Act are also called the Affordable Care Act. They are good examples to emulate by African countries engaged in implementing sweeping health care delivery Laws, initiatives and systems if they want to be relevant in this post globalization era. In essence, they enable government to generate and direct funding means for a universal coverage initiative.

The United States of America is increasingly investing in global health. It is imperative that say, African countries, study what has made the US stand at par with older developed countries of Europe. One way to do this is by identifying historical events or circumstances that brought about the need for impacting legislation and examining the positive and/or negative consequences that followed the implementation of the acts.

Health delivery in the US is complex and fragmented into functional components: financing, insurance, delivery and payment.

Health delivery is changing to accommodate concerns of educational and research institutes, medical suppliers, insurers, payers, claims processors, healthcare providers and many integrated networks providing a continuum of care and covering many of the service components. The changes are mainly in response to concerns regarding costs, access and quality (Shi, L. & Singh, D. A., 2015).

How much have African countries empowered their communities to look at health as a commodity of value? 

Health is an outcome of individual behavior, inclination, opportunity to participate in healthy behavior in relation to  family, community, environment and social conventions on a backdrop of systems through which health services can be provided (Turnock, 2016). Three institutions: government (e.g., legislature, judiciary, executive, federal and state); private sector (e.g, foundations, research institutes and lobby groups) and businesses (e.g., military, media, law, finance, manufacturing, industry and non-governmental organizations) influence the delivery of health, allocate values and shape the lives of all Americans (Dye and Ziegler, (2006). US government is distinct from the private sector and business spheres. This was emphasized by many presidents, e.g., President Coolidge Calvin,1923-1929. This distinction is maintained further between Federal and State governments by court rulings too, e.g., the  US Supreme Court ruling of 2012.

The 2010 Patient Protection and Affordable Care Act (PPACA) is a comprehensive measure tying together comprehensive coverage, care and costs in order to deliver health services. PPACA is also tied to other acts such as the Sunshine Act (Sarah Freymann Fontenot, 2013) which mandates that any transaction between a physician (or teaching hospital) and the pharmaceutical or device industries more than $10 in value must be publicly disclosed. The government’s intention is to end what it labels covert activity, unnecessary drug prescription and potential conflicts of interest between physicians and the pharmaceutical and device manufacturing industries. PPACA also calls for comprehensive service provisions addressing the needs of elderly, disabled, women, men, youths, children, refugees, poor, special population groups and the uninsured. Enrollment is on-going. The PPACA has three features: expanded coverage; cost friendliness; and expanded care for different populations payable at different health provision facilities (e.g., local hospitals, dental clinics, and chosen network of Doctors within states and in some cases across states). It is  given different names in different states, e.g., Azcentral for Arizona, MassHealth in Massachusetts or Covered California in California.

PPACA is a summation and culmination of all other piecemeal tried and tested Acts since 1912. To arrive at it, one has to trace it from the beginnings of America. However, according to History of Health Reform in The USA (www.kff.org) concerted effort towards the present PPACA is traced from developments that transpired between 1912 to 1932 when major events such the 1921 Sheppard-Towner Act, 1929 Baylor Hospital Pre-paid Insurance and the National Health Insurance/New Deal; then the outcomes of events between 1933-1953 e.g., Economic Security Commission to address old-age, unemployment, medical care and insurance and  the report on risks to economic  security arising out of illness; the events of 1954-1974 that included: Military medicare and Civil Rights Act; 1975-1940 events that addressed the high inflation, high costs for health care; and 1991-2011 events that saw the appearance of the National Committee on Quality Assurance (NCQA) Forms to accredit managed care health plans and the eventual passing of the 2010 Patient Protection And Affordable Care Act (P.L. 111-148). 

The positive side of PPACA according to the NCBW 100 brochure  are:
Ending arbitrary withdrawals of insurance coverage.
Guarantees right to appeal.
Ends Pre-existing condition exclusion
Keeps young adults covered.
Covers preventive care at no cost to patients.
Ends lifetime limits on coverage
low monthly premium

The negative side of PPCA are:
It was not sold well to scared undocumented immigrants who thought it was a ruse to identify and have them rounded up.
The PPACA has added to the already fragmented systems that are loosely held together. This makes it hard for overall planning, direction and coordination from a central agency. There is a likelihood of inconsistencies and waste. 
PPACA and the Sunshine Act are interpreted as instruments to deter the medical and pharmaceutical world from prescribing large numbers of dangerous, inappropriate or unnecessary drugs allegedly because of industry influences. This depicts these professions as irresponsible which is not the case.

However, the above three can be addressed through continued awareness drives, involving communities in health delivery and engaging in proactive equitable interventions. The take back home lesson for African countries is to consider establishing mechanisms to generate insurance funds, consolidate a health care delivery system and develop policies that ensure financing, insurance, payments and delivery of health. This will be one way of improving on the general welfare of the populations.

REFERENCES:
1. Dye and Ziegler, (2006). Irony of Democracy. Belmont, CA: Thomson Higher Education).
2. History of Health Reform in The USA. https://kaiserfamilyfoundation.files.wordpress.com/2011/03/5-02-13-history-of-health-reform.pdf. Retrieved on December 3rd 2015.
3. NCBW 100. National Coalition of 100 Black Women-San Francisco Chapter 
4. Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett
5. Shi, L., & Singh, D. A. (2015). Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett.
6. President Coolidge Calvin (1823-1933): Washington D.C: The White House Historical Association. 
7.Sarah Freymann Fontenot, (2013).Understanding the Affordable Care Act Bit by Bit: Will Transparency and Sunshine Shrink Costs? ACPE.ORG

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