The Patient Protection and Affordable Care Act, signed into law by US President Barack Obama in 2010, can advance public health in the USA by supporting increased emphasis on prevention, and reversing the historic division between public health and private health care services, according to the authors of new research published in The Lancet as part of a new Series, The health of Americans.
The report was produced by health experts from the US Centers for Disease Control and Prevention, Atlanta, USA, and Centers for Medicare & Medicaid Services, Baltimore, USA. Their work shows how various provisions of the Affordable Care Act (ACA) can improve the health of the US population.
Besides increasing the proportion of people in the USA covered by medical insurance once the ACA is fully implemented, the authors show that structural and financing reforms introduced by the Act will help healthcare in the USA to transition from a "sick care system", largely focused on treatment of illness, to a system that includes disease prevention, health promotion, early detection, and public health as integral components.
According to Dr Frederic Shaw of CDC, Atlanta, USA, one of the study authors, "While the central achievement of the Patient Protection and Affordable Care Act is to bring the security of health insurance to millions of people, it also has the potential to improve population health over the long term."
Andrew Rein, formerly of CDC, and another of the study authors, adds, "The new law represents a historic opportunity for prevention and public health by establishing the first National Prevention Strategy, adding substantial new funding for prevention and public health programmes, and promoting the use of proven clinical preventive services by removing barriers."
"Due to the Affordable Care Act, Medicare is now providing coverage for evidence-based preventive services with no co-payments. We are testing new payment and service delivery models focused on prevention and population health, such as our Million Hearts initiative, through the CMS Innovation Center," says Dr Patrick Conway, another study author and Centers for Medicare & Medicaid Services Chief Medical Officer and Deputy Administrator for Innovation and Quality, in Baltimore, USA.
"The law provides impetus for greater collaboration between the US health-care and public health systems, which have traditionally operated separately with little interaction. Aligning, coordinating, and integrating the best of both systems has the potential to be a game-changer that improves the health of the US population," says Mr Rein.
The report shows that the ACA's provision to increase the health-care system's focus on population health can change financial, organizational, and clinical linkages between public health and health care. These measures – including public health entities beginning to bill insurers for covered individuals' services such as immunisation, and hospitals and public health practitioners collaborating to identify community needs – are likely to lead to greater integration and better quality services, say the authors.
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