Health Care Reform Case Study

The focus on health reform is constantly changing due to societal needs – in terms of general health, political context and financial hardships. Over the past decades, there have been various health reform efforts, each one improving access to health care. As reported by Hoffman (2009), most efforts have failed either because of “the plan’s complexity, ideological differences, weakened Presidency or decentralization of Congressional Power.” The reasons for failure demonstrate the political weight carried on by reform itself.

According to Hoffman (2009), we’ve witnessed the reform process from Truman’s Fair Deal agenda up until the market-oriented health care in the 90’s. During World War II, many exchanged services for the fringe benefit

In consonance with the class presentation, Puerto Rico’s Health System, there have been 3 different stages of reform in Puerto Rico (Soto, 2015). In 1954, Dr. Guillermo Arbona and John B. Grant worked on the first reform, regionalization. Regionalization avoids costly duplication of services and ensures availability of the same. The second reform was under the Comprehensive Health Services Reform Act in which the government was held responsible for access to health services and emphasis was on primary health. Lastly, the Health Care Reform (1993) accepted the Health Card and focused on a managed care model. Today the health plan of PR relies on primary and specialty benefits and has cut out behavioral health. In 2010, Puerto Rico implemented an Integrated Health Model (Mi Salud) that incorporated PPACA and additional benefits; regrettably, this plan did not pull

Tas (2015) emphasizes the need for coordination around care in order to deal with the complications that come with chronic conditions in advance. Fragmented care focuses on disease-specific care rather than the individual’s well being as an entity. As a result, this segregated type of care, is all in all ineffective, leading to “unsustainable high costs, poor quality and inequality” (Stange, 2009). An integrated care team would work towards a holistic system, achieving optimal wellness; this system is not only beneficial for the quality of care of patients, but also helps physicians interrelate certain circumstances or complications with specific-diseases