“Every American presidential administration following the end of World War II has, to some extent, proposed or supported changes to the healthcare system in this country… We have not yet arrived at the destination of a more accessible, cost efficient and high-quality health care system, but that destination is surely worth the difficult journey.”
—Jerry Taylor, JD, 2014
This Discussion aligns to the NCHL domain of Transformation. Specifically, it focuses on the first level of the Innovation competency: “Recognizes Patterns Based on Prior Experience.” For more information on how this icon aligns to the NCHL Health Leadership Competency Model 3.0, refer to the MHA Iconography page.
The U.S. healthcare delivery system is often described as a kaleidoscope, puzzle, or patchwork quilt to emphasize that healthcare delivery in this country involves multiple, loosely coordinated components, and does not function through one integrated system (Shi & Singh, 2022). The organization of this “system” has a significant impact on the delivery of services. As a healthcare administrator, it is important to understand how the healthcare industry has been shaped over time and the various factors that influence healthcare delivery today, including the Affordable Care Act and value-based care.
To prepare for this Discussion:
Research the one legislative act from the following list:
1937 Social Security Act
1946 Hill-Burton Act
1965 Social Security Amendments (Medicare/Medicaid)
1973 Health Maintenance Act (Managed Care)
1983 Introduction of Diagnostic Related Groups (DRGs) by Medicare
1986 Emergency Medical Treatment and Active Labor Act (EMTALA)
1986 Consolidated Omnibus Budget Reconciliation Act (COBRA)
1996 Balanced Budget Amendment
1996 Health Insurance Portability and Accountability Act (HIPAA)
2006 Medicare Part D Drug Benefit
2006 Massachusetts (Chapter 58) and Vermont (No.191) legislation to expand health coverage for state residents
Then, research both of the following legislative acts:
2010 Patient Protection and Affordable Care Act (PPACA) (ALL)
2015 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (ALL)
Review the information about your legislation in this week’s Learning Resources, including the chapters of the Shi and Singh text (2022). Conduct additional research using resources available in the Walden Library and on credible websites.
Post your evaluation of the historical influence of legislation and the outcome of legislation on healthcare delivery in the areas of cost, quality, access, and value-based care. Be sure to include the following:
Based on the three legislative acts you researched, identify historical events or circumstances that brought about the need for each piece of legislation and analyze what the circumstances were in the areas of cost, quality, and access for each act.
Then, analyze the impact of these developments in the evolution of value-based delivery of health care in the United States.
Evaluate the reported implications that followed the implementation of each act and then explain how each act has impacted healthcare delivery considering the shift to value-based care.