Healthcare Reforming and the Federal Government Role

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Table of Contents

The Federal Government Is a Leader in Insurance Programs
Insurance Reimbursement
Billing Practices
Underlying Factors that Create More Impact on Medicare
Effective Legislative Bodies to Create Reform
Most Effective Legislative Body Pertaining to Pharmacy
Potential Areas for Improvement with Pharmacy Legislation
Conclusion
Works Cited

The Federal Government Is a Leader in Insurance Programs

Federal programs help to create a significant basis for public health services and services that could be available to all people on the territory of the United States.¹ Nowadays, the federal government turns out to be a leader in insurance reform because of its power to make changes, the abilities to control different spheres of living and even the necessity of having a strong body that could improve safety and quality of healthcare services.

Driving healthcare reforms and the improvement of healthcare services quality are the initial tasks of the federal government, and it is important to understand the effects of such practices as reimbursement or billing on Medicare and other programs to identify the bodies that could succeed in pharmacy reforming.

Insurance Reimbursement

The evaluation of the governmental impact on healthcare reforms shows that Medicare is one of the most sensitive programs in regards to insurance reimbursement. This kind of payment is made to a provider or a patient in exchange for certain healthcare services.² The peculiar feature of reimbursement concerning Medicare is the necessity to consider all limitations and barriers that include appropriate therapy choices, consider the product development, and understand the effects of payment rates regarding covered therapies and other cost-sharing requirements.³ Other insurance plans do not have such specific characteristics and requirements. Therefore, the impact of insurance reimbursement on other healthcare plan and programs remains to be insignificant.

Billing Practices

Billing services introduce another important type of insurance practice that has to be properly organized and run by professionals, who understand how to design and implement the accounts in healthcare practice.² Federal government insurance billing practices usually impact Medicare because of the necessity to consider insurance claims, additional payments, patient demographics, charges, and other insurance information. In other words, billing practices of Medicare are predetermined by the government and cannot be changed in accordance with a patient or hospital demand. Other insurance plans do not have such strict restrictions and obligations, and patients are free to choose the types of fees in their insurance programs.

Underlying Factors that Create More Impact on Medicare

Medicare is one of the well-known federally funded programs that aim at providing Americans with health insurance and support for a long period of time.⁴ In comparison to other insurance plans, Medicare has a number of advantages plans that could help to cover general medical and hospital benefits and additional medical, prescription, vision, and dental services.⁴ Regarding such opportunities, the federal government has to follow the conditions under which Medicare cooperates with patients and offers its services. Another important factor that could explain the phenomenon and its impact is the absence of a certain out-of-pocket maximum and the possibility to spend as much money as possible on any healthcare services.

Effective Legislative Bodies to Create Reform

The American President could face a number of challenges while presenting various policies and laws to be implemented in the healthcare system. Congress is the legislative branch that controls the decisions. There are two legislative bodies in Congress, including the House of Representatives and the Senate.³ Each body type could represent different parties, and the division of powers has to be properly organized and explained. The House of Representatives usually supports the interests of ordinary people, and the Senate considers the general financial and political position of the country to make weighted decisions.

Most Effective Legislative Body Pertaining to Pharmacy

The quality of pharmaceutical service is a frequently discussed topic in the United States because it deals with drugs, food, and cosmetics control. Legislation and regulation should not be defined as the same thing. Regulations are the rules that help to interpret laws, and legislation is the process of laws creation.³ The laws could pass or be rejected. Therefore, one of the main impacts of the body is the necessity to identify the steps that could prove the importance of a bill or reduce such importance. Another effective means includes the possibility to control the drugs that should be imported and offered to people whose lives depend on the quality of the products.

Potential Areas for Improvement with Pharmacy Legislation

Regarding the impact of pharmaceutical legislation, it is possible to say that there are a number of areas that could be improved with the help of special laws and rules. For example, it could be suggested to evaluate the trade sphere of the country and define appropriate trade relations with the countries, which succeed in producing effective drugs and cosmetics (Switzerland, Germany, or China). Another suggestion touches upon the healthcare system of the country and citizens possibility to get access to the drugs they are in need of. Medicare helps people to cover their expenses. However, not all people get a chance to understand the true effect and importance of the offered drugs. Therefore, it is necessary to improve the sphere that could help people to exchange information about drugs in their lives.

Conclusion

In general, the role of Medicare is crucial in the majority of American lives. Still, the federal government is the body that controls this program. Therefore, the role of the government should not be neglected as well because it helps to create appropriate reimbursement and billing standards, define legislative bodies, and develop the laws and rules that could facilitate a life.

Works Cited

Burke, J, Friedman, LH. Essentials of Management and Leadership in Public Health. Sudbury, MA: Jones & Bartlett Learning; 2011.
Beik, JI. Health Insurance Today: A Practical Approach. St. Louis, MO: Elsevier Health Sciences; 2014.
Kronenfeld, JJ, Kronenfeld, M. Healthcare Reform in America: A Reference Handbook. Santa Barbara, CA: ABC-CLIO; 2015.
Kronenfeld, JJ. Medicare. Santa Barbara, CA: ABC-CLIO; 2011.

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