5 Changes in Affordable Care Act Over the Past 200 Years


A study on the history of health care revealed that health expenditures were increasing, accompanying a telling reduction in death rates during the twentieth century. However, over the past ten years, expenses have been escalating continually while death rates haven’t seen any significant changes.

The corresponding author and MD of the research, Gregg Meyer said that the difficult question raised is whether the shy improvements made in mortality rates over the past decade are worth the present-day course of costs. Focus must be maintained on a sustainable health care system. The system is not present as of now, but work needs to be done towards it.

The authors of the paper created a chart to reflect inpatient death rates for every year since people were initially admitted to Massachusetts General Hospital in 1821. The results indicate the distinct eras in the value of health care.

  • The first period of health care: The 1st period ran from 1821 through 1910, and the average costs per patient that was discharged alive amounted to around $1,000. Death rates fluctuated greatly, mainly due to events like epidemics and were estimated at 8.7 at an average.
  • The second period of health care: The 2nd period, running from 1911 through 1960, saw an increase in costs and a relatively slow drop in mortality.
  • The third and fourth periods of health care:  From 1961 to 2000, a set of factors like private health insurances becoming available, Medicaid and Medicare, and the advancements of expensive medical technologies saw costs rise while the death rates lowered significantly.

Throughout the twentieth century, an increase in costs tracked the reductions in deaths closely. During the initial part of the twentieth century, every increase of $1,000 saw a decrease of two deaths per thousand patients. After 1960, the same increase in costs saw the death rates reduce to 2.4 per thousand patients.

However, since the turn of the millennium, costs have been increased rapidly while not much change has be seen in death rates, making the authors call it the period that is characterised by declining returns, with increase in costs not doing enough to reduce inpatient mortality. While noting that the costs at MGH are higher than most other hospitals in the US, Meyer said that it reflects on the results found in health care generally.

Coming to the changes made recently, the Affordable Care Act included almost twenty new provisions.

  • There is a greater transparency in the health care plan and there is progress seen towards closing the Medicare Part D coverage gap.
  • There is no longer a requirement for paying co-payment for Medicare covered services such as annual screenings and flu shots.
  • For better access to all Americans, many more institutes and centres will be established to provide quality and timely services.
  • Provisions in this Act include medical loss ratio requirements. This provision will help in ensuring that the consumers’ health plans spend all the money directly on the expenses and bills related to health-care.
  • Also, the vending machines in all the health care centres will have to disclose the nutritional content of the standardized food items.

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