Abstract of Dissertation

Keyword : US Healthcare System; Medicaid; Universal Health care Coverage

Objective : I. To obtain a comprehensive understanding of Medicaid in terms of structure and functioning. II. To understand the trends and changes in Medicaid for the year 2017.

Background : The U.S. health care system is unique among advanced industrialized countries. The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating healthcare coverage for almost everyone. The US healthcare system before the introduction of the ACA was inefficient and was focused on treating chronic diseases while not being proactive or helping people take care of their overall health and most of the uninsured were low-income and either couldn't afford coverage or didn't have access to it. In 2016, 34 percent of U.S. health care spending came from private funds, with 28.1 percent coming from households and 19.9 percent coming from private businesses. The federal government accounted for 28.3 percent of spending while state and local governments accounted for 16.9 percent. Most health care, even if publicly financed, is delivered privately. National health spending is projected to increase at an average rate of 5.6% per year between 2016 and 2025 and 4.7% per year on a per-capita basis.

Methodology : The study undertaken has the following design characteristics: 1) Type of study – A Descriptive, Desk-based Secondary research was undertaken. 2) Geographical Setting – United States of America 3) Time-frame of the study – Cross-sectional study was undertaken with an emphasis on recent credible data. 4) Type of data – Publicly available secondary research data sources were deployed to obtain the following information -> Economic indicators -> National Insurance Statistics -> Information about Medicaid -> Various process, flowcharts, press releases, interviews and analyst report, etc.

Findings : The U.S. Health Care System has moved close to the Universal Health Care Coverage with the enactment of ACA. Medicaid expansion under the ACA suggests that expansion has had largely positive impacts on coverage; access to care, utilization, and affordability. Medicaid accounts for more than one-fifth of the U.S. population (Covers 77 million / 23% Americans). Private MCOs administer care to more than 70 percent of Medicaid enrollees. The Department of Health and Human Services estimates that at least 14 million people have enrolled in Medicaid through the ACA expansion.

Recommendations : The study observations suggest a potential for gains in coverage and access to consumers. Medicaid enrollment has increased following implementation of the ACA, while the rate of individuals without insurance has declined but still 28 million people in the U.S. are uninsured. Currently, providers in the remaining non-expansion states are considering adopting the expansion in the future which will further increase the enrollment of people falling under coverage gap.