- With fairly large sects of the political spectrum opposing various provisions of the Patient Protection and Affordable Care Act as many as six years after its passage, it grows vital to examine whether or not this landmark healthcare legislation has actually been successful in improving medical care and saving costs. One editorial from The Journal of the American Medical Association (JAMA) outlines some of the successes and ongoing misgivings of the Affordable Care Act.
First, it is vital to point out that the Affordable Care Act has brought health insurance coverage to 20 million more people around the country. One individual study called the 2008 Oregon Health Insurance Experiment used many similar provisions to the Affordable Care Act and found both benefits and disadvantages within the program.
This program used Medicaid expansion and it was found that patients received more medical services, were prescribed more medications, and obtained more preventive care than before having health insurance. The results showed that rates of depression diagnosis were lower and people experienced less medical debt.
However, the 2008 Oregon Health Insurance Experiment did not change hypertension or diabetes management among patient populations while medical spending increased. This shows that the ACA does show promise but it also has some misgivings that need to be considered for the future of healthcare reform.
While greater insurance coverage is an important part of keeping populations healthy, the fragmentation of the healthcare industry still needs to be addressed. A major part of the Affordable Care Act has been the establishment of the accountable care organization (ACO) and the Medicare Shared Savings Program.
Accountable care organizations were meant to reduce this fragmentation seen in the healthcare industry by redesigning primary care and bringing more innovation as well as population health management. The results have shown that accountable care organizations have brought more timely appointments with primary care physicians and greater patient satisfaction.
Additionally, it is important to note that ACOs have become a general mainstay of the healthcare industry that has surpassed the Medicare Shared Savings Program. Private payers have adopted accountable care contracts and the system has moved across commercial markets.
Despite some of the benefits that ACOs exhibit, the American Journal of Managed Care outlined a study that found hospital participation in an accountable care organization does not necessarily correlate with success in Medicare value-based purchasing programs.
The type of programs this study focused in on include the Hospital Value-Based Purchasing Program (HVBP), the Hospital Readmissions Reduction Program (HRRP), and the Hospital-Acquired Conditions (HAC) Reduction Program.
Along with ACOs, other important structures of the Affordable Care Act were meant to reduce healthcare spending. The results show that the healthcare cost growth rate has slowed down in the initial five years since passage of the ACA. However, due to new technologies, there has been a rise in certain healthcare costs that the ACA hasn’t reduced.
“Because of these newer technologies, health care costs have increased substantially in recent years. According to data from the Altarum Institute, between March 2014 and March 2016, inflation-adjusted health care spending increased by 8.1 percent, nearly double the 4.1 percent growth in gross domestic product,” the report from The Journal of the American Medical Association stated.
“Because of this rapid growth rate in health care spending, Altarum estimates that the share of gross domestic product devoted to health care has also increased, from 17.3 percent in March 2014 to a record 18.1 percent in March 2016. Little of this increase during the past several years has been because of health care prices, which have increased at about the same rate as prices overall, but rather, the increase in health care spending reflects greater use of health care services.”
There are clearly both benefits and potential obstacles on the horizon for the healthcare industry after the passage of the Affordable Care Act. Even if there are certain issues at hand, the innovations created through accountable care organizations and greater coverage has shown the successes of the Affordable Care Act.