The history of medical reforms in the United States goes back to 1965
when the then president introduced the Medicare insurance system. The
purpose was to have a medical insurance cover for a senior citizen that
was paid by the employers during the period which employees worked.
Since then, many reforms have been enacted mainly through legislation
and the purpose is to improve the medical insurance schemes and reduce
the cost of medical care. Research has shown that debts related to
medical care account for a very large proportion of personal debts and
the purpose is to reduce this burden. Healthcare is a basic human need
and thus, the legislators seek to have every person receive this need so
as to protect human dignity. This paper looks at the most significant
medical reforms that have had the greatest impact on the sector.
Medical Reform and Impact on Hospital System
Market values and dynamics impose certain conditions on hospital
systems, forcing them to refine their strategies along with alternations
in their policies to a meet changing environment of competition. These
reforms are affected by various factors such as advancement of medical
technologies, new market competitors, weakness in the organization and
opportunities. It is observed that all of the above factors, cannot
impact the hospital reforms more than changes in legislation. Periodic
changes in laws and regulations can impact the rate of modifications in
strategies within the hospital system.
Medical reforms are intended to improve healthcare systems so as to
make them more efficient and improve access to medical care. This is
mainly done through the medical system itself or government legislation.
Thus, the main aim is to increase medical facilities by making it
affordable. This is projected to reduce avoidable deaths and improve the
overall health of the population. The other aim is to weed out
unscrupulous medical practitioners. It has been noted that over the
years, many people who are not qualified medical personnel open clinics
which purport to offer affordable medical services while, in fact, they
offer substandard medical services. This causes health complications,
which cost higher amounts of money to treat. Thus, governments have
introduced medical reforms with strict guidelines on how to access
On the other hand, hospitals have to keep revising their policies and
strategies due to increased competition, changing legislation, and
changing technologies. These bring conflicts to the medical systems
because changing dynamics usually affect how hospitals operate so as to
offer quality, and affordable services (Nauhausen et al, 2013). The
management of healthcare systems must keep changing according to the
market demands and changes. Physicians and consumers are also affected
by the changes because they affect the operations of hospitals.
The first major reform to affect the healthcare system is the
implementation of a standard insurance system for all citizens (American
Medical Association, 2013). This was so as to ease access to medical
services affordably. A research conducted in 2009 by Harvard school
revealed that more than half of personal bankruptcies were linked to
medical care. Thus, the purpose of the health insurance was to reduce
the burden of medical costs on individuals.
The insurance was also aimed at enabling citizens to access medical
care even when they do not have money. This is after the research
revealed that many people die due to lack of access to medical care due
to lack of money (Krugman, 2005). This is especially for avoidable
deaths. Thus, the medical insurance is purposed to enable access to
medical care at all times so as to reduce avoidable deaths. Medical
insurances also come with regular checkups, to ascertain health
standards (Pear, 2011). These are essential in early detection of
diseases which reduces medical costs in the end because the illnesses
are treated at their infancy stage which costs less. Thus, the medical
insurance schemes are aimed at reducing overall medical costs for the
citizens and increasing access to medical care (Krugman, 2005).
However, the medical insurance has its fair share of controversies.
Medical practitioners claim that it leads to waste treatment. This is
because patients seek medical care for ailments that can easily be
treated through home based remedies (Nauhausen et al, 2013). The
physicians on the other hand prescribe treatment for such health
problems because the purpose it to make more money. Thus, the health
insurance medical reform is aimed at making healthcare more affordable
but it ends up making it wasteful (Pear, 2011).
The healthcare insurance system has also been faced with fraud. Some
hospitals have been found to use patient information to access funds
through fraudulent means. This places a burden on the insurers who are
faced with huge medical claims (Pear, 2011). Some health insurers have
also colluded with hospitals to defraud the insurance system through
fraudulent claims. Thus, the medical reforms are aimed at also curbing
fraud through more transparency. The FBI, for example, was able to
recover 4.2 billion dollars that had been paid out through fraudulent
payments (Pear, 2011). The government has also put harsher penalties on
those found defrauding the system so as to deter future criminals.
According to Howard (2009) the best medical reform could be the
implementation of preventive medical care and not curative medicine. He
says that this could save the government up to 200 billion dollars
annually because preventive care is simple and cheaper. This also
reduces avoidable deaths as patients are treated early enough (Pear,
2011). Thus, this is advantageous in the long run because it saves lives
and saves the government and insurers lots of money. However, this has
been opposed by hospitals mainly because it reduces revenue because
preventive care is cheaper.
Advancement in medical technologies also affects the hospital system.
This is because the changes in technology come at higher costs and are
frequent. Hospitals argue that reliance on the government to funds alone
cannot adequately cover the costs of these upgrades (American Medical
Association, 2013). Thus, the individual hospitals must keep up with
technological changes through individual spending. This also leads to
better business as patients prefer to use the best medical facilities
available. Additionally, changes in medical technologies also lead to
demand for constant staff training on new technologies. These are costs
that hospitals try to meet so as to have well trained personnel (Hogg,
Baskerville & Lemelin, 2005).
Thus, changes in technologies lead to higher costs for hospitals which
must meet because better technologies lead to efficiency in medical
care. This also comes with training costs for healthcare providers
(American Medical Association, 2013). In order for hospitals to meet
these costs and still remain profitable, the costs must be passed to the
final consumer, and this pushes medical costs up. Medical practitioners
have, therefore, asked the government to consider the changes in
technologies while implementing medical reforms (Morrisey, 2008). Thus,
medical reforms should also take into consideration the changes in
technology which affect how hospital managements put in place their
The healthcare system just like any other system is faced with market
competition. This is because it is a business entity like any other
(Morrisey, 2008). This means that hospitals are faced with competition
and they must, therefore, put up strategies that help them to fight off
competition. One of the proposed healthcare reforms is in marketing of
hospitals and healthcare products. It is argued that advertisements of
these services give people the impression that they need medical care
even if they do not (Morrisey, 2008).
Several surveys have revealed that citizens began using certain
medicine after seeing advertisements about them on television and
billboards. This leads to unnecessary self- medication which can affect
a person’s health in the long run. Most people diagnose themselves and
start using over- the – counter medications which can harm their health
in the end (American Medical Association, 2013). Thus, one of the
medical reform strategies is to control the advertisement of medicines
so as to encourage people to seek medical knowledge if they are unwell.
In the case of advertisement of hospitals, the managements have
proposed the legislation of advertisements. This is so as to fight off
competition which threatens business (American Medical Association,
2013). However, this legislation has been blocked because such
advertisements can be misleading and can cause an increase in seeking
medical help unnecessarily. Thus, it is assumed that the sole purpose of
hospitals should be to offer medical care and not to make profits.
However, this is unrealistic because hospitals also need to make money
so that they can offer quality services.
Most hospitals are faced with the problem of weak management systems.
This is because the management of most hospitals is derived from the
health workers (American Medical Association, 2013). These are usually
people with no knowledge of business operations, and this weakens
management due to lack of proper skills and training. This has caused a
weakness in how hospitals are managed which leads to inefficiencies that
can be costly (Amadeo, 2013). Medical practitioners usually do not like
to have people from the corporate sector running hospitals because they
see it an intrusion. This has led to poor management of hospitals which
has a direct impact on quality of services.
There have also been reforms in medical training systems. The aim was
to improve the quality of skills taught to students so as to meet market
needs (Morrisey, 2008). The reforms were also aimed at making the skills
taught to be more responsive to emerging medical problems and not to
focus on traditional medical practices only (Amadeo, 2013). This was
mainly in relation to use of technology to help in solving medical
The first reform was aimed at changing the education system from
knowledge- based to team- based, patient- based, and outcomes oriented.
The aim was to make the skills taught to be gauged in terms of skills
earned based on outcomes (Amadeo, 2013). This enables students focus on
particular treatment aimed at curbing the central problem. This focus on
outcomes also ensures that students remember what is taught in class
long after leaving school.
This was after it emerged that most students could not remember what
they learnt in their first and second years of medical school (American
Medical Association, 2013). This bearing in mind that the medical field
requires that doctors are able to remember everything they learn to
better practice what is learnt (Amadeo, 2013). Team work was also
encouraged so as to enable students to learn how to link their different
skills in areas of specialization when treating one patient.
The training reforms were also aimed at making students to focus more
on health maintenance as compared to focus on diseases. The healthcare
system should move towards maintaining good health standards as compared
to treating diseases (Nauhausen et al, 2013). The modern world has
complex health needs, and one of the best ways to tackle the ever
emerging health problems is by encouraging health maintenance and not
treatment. This also leads to improved health standards which reduce
pressure on health facilities. It also helps to focus more resources on
research as compared to the current system where most funds are spent on
treatment (Hogg et al, 2005).
The use of technology in training was also identified as a way of
reducing pressure on students and physicians. This is because technology
improves performance of medical skills such as surgery. This reduces
pressure on doctors as a procedure can take less time, leaving the
doctor with enough time to attend to as many medical cases as possible
(Hogg et al, 2005). This also reduces the workload of doctors, and they
are able to relax and his improves the quality of services rendered
(American Medical Association, 2013). The adoption of IT has also
impacted well on medical practices. This is because feedback is
immediate and this enables he practitioners to improve their service
The reformers also sought to improve the communication skills of the
students. This is because poor communication leads to misdiagnoses which
can greatly affect the outcome of treatment (American Medical
Association, 2013). Poor communication also affects how patients
understand the nature of their health problems. Therefore, there arose
the need for training on better communication skills in medical
practitioners so as to improve the patient- doctor relationship (Hogg et
Medical reforms have also increased the call by the public for better
quality services. The reforms established a medical board which is
tasked with hearing complaints of individual patients about the conduct
and professionalism of individual doctors (Burroughs, 2013). This was
after it was established that disgruntled patients usually had to rely
on the management of individual hospitals to hear their cases. It
emerged that the management usually protected their staff at the
disadvantage of patients and this reduced accountability.
The medical board was, therefore, established to bring impartiality and
give justice to patients. The legal system was also viewed as being
incapable of adequately handling the complaints of patients due to the
lengthy procedures and the high costs of the system (American Medical
Association, 2013). Thus, the medical board was a phenomenal reform
because it brought about more accountability and professionalism to the
The board is also tasked with assessment of the performance of
individual hospitals in terms of quality of services offered. This has
been able to keep hospitals on their toes with regard to the quality of
services because they risk closure if they are found to offer poor
quality services (Hogg et al, 2005). On the other hand, the board also
monitors the ethics of the healthcare field, and this has a direct
impact on the quality of services offered. Ethics are very significant
in the healthcare system because they protect both patients and doctors
(American Medical Association, 2013). Thus, a proper system of ethics is
valid for the system.
The reforms also introduced a system of constant evaluation of the
skills of medical practitioners. This was aimed at ensuring that doctors
did not start to be content with outdated skills, which were no longer
relevant to the needs of patients (Hogg et al, 2005). This also protects
patients from getting poor quality services which can have a negative
impact on their health. Thus, the regular evaluation of skills ensures
that the doctors continually offer quality services.
Recent medical reforms have been aimed at protecting the patients.
These include allowing dependants to remain under the medical cover of
their parents or guardians until the age of twenty- six (Hogg et al,
2005). This is aimed at expanding the population of people under medical
aid because it is viewed that most people become fully independent after
the age of twenty- six. This is usually the age limit at which people
attain a particular level of financial stability and can now pay for
their own health insurance (Kachalia & Mello, 2011).
The reforms also seek to remove the requirement of medical tests so as
to determine the premium payment. The requirement that insurance seekers
undergo compulsory medical tests to determine premiums usually brings
inequality in healthcare insurance (Hogg et al, 2005). This is because
the health of a person is the determinant of the premiums paid. The risk
of poor health increases with age and thus, older citizens have to pay
more premiums. This makes people shy away from medical insurance schemes
as most people find the insurance premiums too high (American Medical
Currently, insurers do not cover high risk insured. This is because
they are deemed expensive due to the constant need for medical
attention, which raises medical claims. These have a negative impact on
the profit margins of insurance companies. They include the terminally
ill who have high medical insurance claims. This leaves out a whole
population who actually need the insurance care because of the high
medical costs incurred. These are usually costs that are hard to meet
and leave a huge financial burden on family members.
The medical reforms proposed also seek to remove the lifetime coverage
insurance limits. Currently, there is an age limit to medical insurance
(Hogg et al, 2005). The limit is with regard to age because insurers
claim that medical needs for the elderly are usually too high, and this
does not correspond with the premiums paid. They, therefore, seek to
give an age limit for insurance cover, at the disadvantage of the
elderly who need the cover the most. The medial reforms seek to address
this issue so as to reduce over reliance on family members for
healthcare needs of the elderly (Hogg et al, 2005). The aim of the bill
is to introduce insurance covers for a lifetime so as to cover the
medical needs that come with old age.
Currently, insurance covers also do not cover medical costs with
regard to preventive care. This includes use of supplements and regular
medical checkups which have been found by economists to save the economy
billions of dollars (Hogg et al, 2005). Frequent medical checkups also
save lives because early detection of diseases enables patients to seek
medical care. It also reduces costs in the long run which escalate as a
result of terminal sicknesses. However, current insurance schemes do not
cover preventive medical care (Nauhausen et al, 2013). Thus, citizens
who seek preventive medical care do it at their own cost. This reduces
the popularity of preventive medical care which leads to higher medical
costs in the long run. Thus, the proposed medical reforms seek to compel
insurers to offer preventive cover so as to maximize its popularity.
Currently, most businesses do not offer medical covers to their
employees. The individual employees are instead required to get their
own medical covers at their own costs. The business people do not make
any contribution to this medical insurance (Nauhausen et al, 2013).
However, the proposed medical reforms bill seeks to reverse this order
through offering tax cuts to businesses which offer medical insurance
covers to their workers. This will encourage employers to insure workers
so as to reduce their tax burdens.
In conclusion, medical reforms have considerably changed over the
years. The patients now benefit more from medical reforms than
initially. Medical reforms have brought more accountability to the
healthcare sector which has led to better quality services. The reforms
have also gone a long way in reducing the cost of medical services, and
this has improved the general health of the citizens. However, a lot
more still needs to be done to improve the quality of services offered
in public hospitals. There is also need to further reduce the cost of
American Medical Associtation. (2013). “Help Your patients get the
Health Coverage they need” American Medical Association. New York:
American Medical Association.
Howard, P, K (2009). “Why Medical malpractice is off Limits” The
Wall Street Journal. New York: Dow Jones & Company.
Hogg, W., Baskerville, N., Lemelin, J. (2005). “Cost savings
Associated with Improving Appropriate and Reducing Inappropriate
Preventive Care: Cost-Consequences Analysis” BMC Health Services
Morrisey, M, A. (2008). “ Healthcare” Concise Encyclopedia of
Economics (2nd ed). Indianapolis. ISBN.
Krugman, P. (June 13, 2005). “One nation, Uninsured” The New York
Times. New York: The New York Times.
Kachalia, A., Mello, M, M. (April 21, 2011). “New Directions in
Medical Liability Reform” NEJM. Massachusetts: Massachusetts Medical
Pear, R. (Dec 3, 2011). “Health Official Takes Parting Shot at
Waste.” The New York Times. New York: The New York Times.
Burroughs, J, H. (May 20,2013). “Just What is healthcare Reform
Anyway?” Hospital Impact. United States: n.p
Amadeo, K. (July 11, 2013). “Why Reform Health Care: How Health Care
Reforms Affects the Economy” About.com. United States: About.com.
Neuhausen, K., Spivey, M., Arthur, L. (Oct 31, 2013). “State Politics
and the Fate of the Safety Net” NEJM.org.Massachusetts: Massachusetts
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