1 postsRe: Topic 4 DQ 1
The health care system consists of clinicians, insurance companies or it’s plans, employer groups, health care facilities; such as a hospital, a network of organizations that are combined to facilitate the care to the individual or population with health care. The health care system, when it comes to insurances is challenging for me to understand. I was a case manager and would submit plan of cares for patient’s authorizations and there were always challenging and upsetting moments. The way the U.S has the health care system set up can be confusing.
The deliverance of the health care is either via private – owned groups, healthcare networks, HMO’s and PPO’s. The types of facilities that provide health care are private practices, hospitals, US Government health facilities, academic medical centers, psychiatric hospitals, nursing homes, long term facilities, rehab facilities, and any other approved medical facility.
The United States has the highest costs for health care than any other country. “Health care costs were about $3.3 trillion dollars in 2016. For decades, the amount of money spent on health care has increased more than the overall economy has grown (Roger I. Schreck, 2018)”. The health care debt increases due to nonfunded population. If people cannot afford healthcare insurance, most likely won’t be able to pay for their health care costs. The Affordable Care Act in 2014, helped minimize the amount of population uninsured. The financing aspect is either through private voluntary or public programs.
The U.S Department of Health and Human Services is the primary agency that manages the U.S health care system. The list of the organizations that fall within the HHS agency are: Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, National Institutes of Health, Health Resources and Services Administration, Agency for Healthcare Research and Quality, Food and Drug Administration, Center for Medicare and Medicaid Innovation, Patient Centered Outcomes Research Institute, National Academy of Medicine, and Joint Commission.
The sustainability methods include system integration and care coordination. “In 2011, the U.S. Department of Health and Human Services released the National Quality Strategy, a component of the ACA that lays out national aims and priorities to guide local, state, and national quality improvement efforts, supported by an array of partnerships with public and private stakeholders (The Commonwealth Fund, 2019)”.
Quality patient care and their health outcome is how many (if not all) facilities are reimbursed by CMS. I believe the outcome would be greater if health care focused on preventative and accessible care. Cost of health care services needs to be regulated. The type of response of being proactive rather than reactive is the best step. I do not fully understand the health care system, and I took courses for clinical case management. The courses consisted of heath care insurances and the many topics that were asked in this discussion. If I do not fully understand with that background, it might be challenging as well for someone who does not have the same background. I do hope reforming the health care system will mean a greater outcome.
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Question 19386165
/in Uncategorized /by developerIsleidy Alvarez 1 postsRe: Topic 4 DQ 1
The methods used to finance health care service is a major concern in America and it plays a major role in shaping a country’s health care system. Health care services include such as hospital care, physician care, dental services, and drugs that are provided directly to individuals.
The question of how to sustain, finance and manage healthcare involves a deeply ideological and political question, who is going to pay for it and how? Green (2018) discusses how the health profession continues to evolve, including various reforms in the United States public health policies, and the need for the development of plans to improve public health.
When evaluating healthcare and insurance companies’ clinical effectiveness, compared to their financial sustainability, one can see that as far as the stakeholder/patient is concerned, companies do not want you to know about the practice of “covert rationing”. This practice by insurance companies, often limits availability of treatments, as a cost savings measure, and to preserve profits or raise salaries to company staff (Torrey,2018).
These issues of cost-effectiveness and rationed care can directly affect the quality and availability of care needed to obtain positive patient outcomes. I believe a reform solution to improve effectiveness in this area of concern, would be the greater need for transparency of coverage on the healthcare providers side, and increasing competitiveness among provider companies.
I believe that plans for universal healthcare need careful reconsideration. Also, I feel that the influx of millions of immigrants to the united states does nothing to improve this healthcare crisis. Again, who is going to pay for it, and how? This raises the concerns that reliance on taxation may be associated with higher private payments, especially during economic downturns (Evans,2002). It is all about freedom of choice, personal responsibility and required political and social involvement.
References
Evans RG. Financing health care: taxation and the alternatives. In: Mossialos EDA, Figueras J, Kutzin J,
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Question 19386171
/in Uncategorized /by developer1 postsRe: Topic 4 DQ 1
The U.S. health care system has many weaknesses with the primary issue being the extremely high cost of care. Individuals have access to care in many different settings however issues with transportation, restrictions regarding eligibility for certain services and ability to pay providers for services rendered are barriers to care for many Americans (Green, 2018). As health care evolves, there is an increased need for reform in the U.S. public health policies and for advancement of proposals to improve the health of the population. In the last century, the cost of high-quality medical care has risen to extraordinary rates, resulting in out of pocket payment and self-payment for services. Even minor illness or injury can incur high costs for health care consumers and the majority of Americans do not have the ability to pay for services (Green, 2018). The ability to pay medical bills often comes from health insurance coverage, either government based or through private companies to guarantee payment for health care services. Establishing costs within the health care system for procedures can help patients, employers, insurers and government officials identify the elusive value of health care services provided (Daniels & Ritter, 2018). Cost management tools can improve cost effectiveness of care such as cost information for services being available to consumers to make informed decisions about where to seek care.
References
Daniels, D. J., & R
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Question 19386339
/in Uncategorized /by developerThe Affordable Care Act (ACA) otherwise known as Obamacare, is a legislative health care provider that aims to improve the financial burdens that communities face. It creates an incentive for employers to provide health insurance and requires that nearly all people not covered by their employer or a government insurance program, enroll in Medicare or Medicaid, or purchase private health insurance (Schrek 2016).
The most important element regarding this Act is the pre-existing condition coverage. It means that Health insurers can no longer deny coverage or charge more for services, once the insurance is bought and there’s a pre-existing condition like cancer or diabetes (U.S Department of Health & Human Services, 2017). This Act also aims to provide health insurance for those who would not have otherwise had the money. The role of the community and public health is to offer pre-screening for diseases, preventative care, and low-cost services that will benefit all the people.
The role of the nurse in implementing this law is to advocate for patients to seek accessible health care and to seek preventative care even if they are healthy. For example, holding Fairs and Health information sessions to help with educating the community about vaccinations for the flu virus during the flu season, pre-screening for high blood pressure and annual health checks. Nurses play a role in the mission of the ACA, nationally and globally, provide equitable health care and the reduction of health disparities (Green 2018). The nursing profession is crucial in educating and taking care of the public. The American Nurses Association (ANA), is very supportive of the Affordable Care Act and upholds any court decisions. The ANA is “actively engaging with federal policymakers and regulators to advocate for system transformation” (ANA 2014).
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Question 19386809
/in Uncategorized /by developerThe Affordable Care Act (ACA) otherwise known as Obamacare, is a legislative health care provider that aims to improve the financial burdens that communities face. It creates an incentive for employers to provide health insurance and requires that nearly all people not covered by their employer or a government insurance program, enroll in Medicare or Medicaid, or purchase private health insurance (Schrek 2016).
The most important element regarding this Act is the pre-existing condition coverage. It means that Health insurers can no longer deny coverage or charge more for services, once the insurance is bought and there’s a pre-existing condition like cancer or diabetes (U.S Department of Health & Human Services, 2017). This Act also aims to provide health insurance for those who would not have otherwise had the money. The role of the community and public health is to offer pre-screening for diseases, preventative care, and low-cost services that will benefit all the people.
The role of the nurse in implementing this law is to advocate for patients to seek accessible health care and to seek preventative care even if they are healthy. For example, holding Fairs and Health information sessions to help with educating the community about vaccinations for the flu virus during the flu season, pre-screening for high blood pressure and annual health checks. Nurses play a role in the mission of the ACA, nationally and globally, provide equitable health care and the reduction of health disparities (Green 2018). The nursing profession is crucial in educating and taking care of the public. The American Nurses Association (ANA), is very supportive of the Affordable Care Act and upholds any court decisions. The ANA is “actively engaging with federal policymakers and regulators to advocate for system transformation” (ANA 2014).
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Question 19387859
/in Uncategorized /by developer1 postsRe: Topic 4 DQ 1
The health care system consists of clinicians, insurance companies or it’s plans, employer groups, health care facilities; such as a hospital, a network of organizations that are combined to facilitate the care to the individual or population with health care. The health care system, when it comes to insurances is challenging for me to understand. I was a case manager and would submit plan of cares for patient’s authorizations and there were always challenging and upsetting moments. The way the U.S has the health care system set up can be confusing.
The deliverance of the health care is either via private – owned groups, healthcare networks, HMO’s and PPO’s. The types of facilities that provide health care are private practices, hospitals, US Government health facilities, academic medical centers, psychiatric hospitals, nursing homes, long term facilities, rehab facilities, and any other approved medical facility.
The United States has the highest costs for health care than any other country. “Health care costs were about $3.3 trillion dollars in 2016. For decades, the amount of money spent on health care has increased more than the overall economy has grown (Roger I. Schreck, 2018)”. The health care debt increases due to nonfunded population. If people cannot afford healthcare insurance, most likely won’t be able to pay for their health care costs. The Affordable Care Act in 2014, helped minimize the amount of population uninsured. The financing aspect is either through private voluntary or public programs.
The U.S Department of Health and Human Services is the primary agency that manages the U.S health care system. The list of the organizations that fall within the HHS agency are: Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, National Institutes of Health, Health Resources and Services Administration, Agency for Healthcare Research and Quality, Food and Drug Administration, Center for Medicare and Medicaid Innovation, Patient Centered Outcomes Research Institute, National Academy of Medicine, and Joint Commission.
The sustainability methods include system integration and care coordination. “In 2011, the U.S. Department of Health and Human Services released the National Quality Strategy, a component of the ACA that lays out national aims and priorities to guide local, state, and national quality improvement efforts, supported by an array of partnerships with public and private stakeholders (The Commonwealth Fund, 2019)”.
Quality patient care and their health outcome is how many (if not all) facilities are reimbursed by CMS. I believe the outcome would be greater if health care focused on preventative and accessible care. Cost of health care services needs to be regulated. The type of response of being proactive rather than reactive is the best step. I do not fully understand the health care system, and I took courses for clinical case management. The courses consisted of heath care insurances and the many topics that were asked in this discussion. If I do not fully understand with that background, it might be challenging as well for someone who does not have the same background. I do hope reforming the health care system will mean a greater outcome.
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Question 19387865
/in Uncategorized /by developer3 postsRe: Topic 4 DQ 1
The United States spends more on health care than any other country (Gross and Laugesen, 2018). These numbers were once thought to be the result of high utilization of services by the consumers; however, more recently the finance expenditures on health care in the United States have been identified as a direct result of the pricing (Gross and Laugesen, 2018). In fact health care costs in the US are 40% greater than the average annual cost of 30 industrialized nations yet the life expectancy is 1.1 years less than the average of these countries (Masters, 2009). This means that higher costs are not leading to better outcomes for the people of the United States.
Insurance and pharmaceutical companies are partially to blame for driving up these costs and reap the benefit of those price increases. I propose that there are stricter guidelines and regulations on insurance pricing/coverage and medication costs to help keep health care more affordable in the United States. With pharmaceutical costs accounting for 20% of health care costs and a large portion of that due to brand-name drugs it is easy for prices to escalate quickly (Seeley et al., 2018). Slowing the growth of these expenses and limiting insurance companies ability to capitalize on consumers should drive costs down or at least slow the rising costs.
Health care reform will take everyone deciding on a direction and moving towards it together. This includes all of the stakeholders including the government, insurance companies, health care providers, and patients. Given our current processes are so complicated, it will take time to fully reform the way the United States delivers health care. The Affordable Care Act of 2010 has started this reform and although not perfect has shown to decrease the medical cost trend from about 9% in 2010 to a projected 6% in 2019 (Cleveland et al., 2019).
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Question 19387869
/in Uncategorized /by developer1 postsCAT: Brainstorm & discussion. ( points considered for participation)
Class, as you research your answer for this topic, pick an element of public health that you are passionate about, and elaborate on how it has been impacted by the ACA (positively or negatively, and the rationale). If you could imagine any changes/additions to this particular element, explain them, and provide the rationale for this suggestion. I look forward to your responses!
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Question 19389977
/in Uncategorized /by developer3 postsRe: Topic 4 DQ 1
The method of delivery of health care along with regulatory control over the system differ from country to country. Cost-sharing required at point-of-service and range of benefits also vary globally. What is common is the incorporation of private insurance, but the importance varies considerably across nations (The Commonwealth Fund, 2019). According to the Commonwealth Fund’s new 11-country report, the “level of income defines the health care you receive far more in the United States than in other wealthy nations” (The Commonwealth Fund, 2019, para. 1). The study found that U.S. ranked last in providing equally accessible and high-quality health care, regardless of a person’s income. There have been great advances with access and coverage of health care in the U.S. due to the Affordable Care Act, but there are far too many Americans that continue to struggle with access to health care (The Commonwealth Fund, 2019).
The delivery of health care in the U.S. is comprised of a variety of public and private entities (Green, 2018). Government entities and in collaboration with community nonprofit organizations and faith-based organizations comprised the public health system. The private health settings include inpatient, outpatient, ambulatory, long-term care, mental health, home care, wellness center, and alternative care, which are regulated by the overarching governmental agencies (Green, 2018). Payment for medical services can by paid individually but the costs for services may not be feasible for most. Therefore, people rely on health care insurance, an arrangement with the government or private company, that will provide guarantee payment for health care services (Green, 2018). Whether private or public, the person must be eligible for these services. Either or, a person may accrue out-of-pocket costs. Although the percentage of uninsured people have decreased since the passage of the Affordable Care Act, there continues the existence of 28 million people who are uninsured in the U.S. as of 2017 (Berchick, 2018).
Studies have shown that physician-patient relationship that focused on quality and personalized preventive care resulted in positive health care expenditure outcomes and improved health management over a three-year time period (Musich, Wang, Hawkings, & Klemes, 2016). According to the Centers for Medicare & Medicaid Services, the U.S. health care spending increased by 3.9 percent in 2017. This equates to $3.5 trillion or $10,739 per person. Much of the expenditures can be reduced when the focus of health is on prevention and not disease management.
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Question 19390405
/in Uncategorized /by developer4 postsRe: Topic 4 DQ 2
The Affordable Care Act (ACA) was signed into law by President Barack Obama in March 2010, or the Patient Protection and Affordable Care Act (PPACA), is the healthcare reform legislation, the regulatory rebuild of the U.S. healthcare system, mostly known for the expansion of coverage.
States gane the authority to expand eligibility for Medicaid to persons under the age of 65 if the family income is below 133% of the federal poverty level (Falkner, 2018). Also, health insurance companies cannot deny the health care coverage because of pre-existing conditions and keeping them at the same rate as for others. The plans must include coverage for 10 essential health benefits, such as outpatient/inpatient, ER, prescription drugs, labs, mental health and more (https://www.healthcare.org).
The objectives set in the SEC. 2402, of Affordable Care Act, Removal of Barriers to Providing Home and Community-Based Services, are aimed to the improvement of the community care. The Federal Human Services to promulgate regulations to ensure that all States develop service systems that are designed to – allocate resources, provide strategies, provide the support and coordination (https://www.hhs.gov).
As the whole health care system attention shifting towards outpatient and community care, following the ACA, the number of new community health centers expanding, more nursing jobs are opening up in this area of services. The demand for nurses, is growing nationwide in the rate that faster than average for all occupations, especially for nurses in home care, case management and community health care. Affordable Care Act authorizes funding for nursing development programs and loan repayment programs for nurses to help with preparation of the nursing workforce to meet the demand.
ACA’s grants are given to develop Nurse-Managed Health Clinic, which are nurse-managed, by advanced practice nurses, health clinic that provides comprehensive primary care or wellness services to underserved or vulnerable populations (https://www.hhs.gov).
The nurses’ role in the implementing this law is in achieving higher education, expanding the scope of practice, and extension the primary and community care to nurses while improving the quality of services at the lower cost.
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Question 19390411
/in Uncategorized /by developerElizabeth Homrighausen 1 postsRe: Topic 4 DQ 2
Health care systems in the United States are quite complex. There are insurance companies that dictate what cares they cover, which providers and which medications. When thinking about the multiple players that contribute to the delivery of health care services, we must analyze if the it is adequate for the patients needs. “The USA is currently the only high-income country without nearly universal health-care coverage. Attempts to achieve universal health coverage have been made since the 1940s but – apart from the development of Medicare and Medicaid (which provides coverage for the poor, near-poor residents, including children, pregnant women, parents, seniors and individuals with disabilities) in 1965 – little progress had been made before the implementation of the ACA (Affordable Care Act)”(Rice , et al., 2014). According to Rice, Medicare and Medicaid cover approximately 30% of the population, and in 2012 about 18% were uninsured.
“The ACA is much more than just a health insurance law. It touches on almost every aspect of the delivery of the health service and was designed to encourage more primary care, to promote a greater focus on quality and prevention, and to encourage doctors, hospitals and other providers to coordinate care through new entities called accountable care organizations” (Rice , et al., 2014). I believe that the ACA will not completely fix our health care problems, but it is certainly a start. One of down falls to the ACA is higher premium costs for patients with private insurance causing financial burden for the middle-class families. The great thing about the ACA is that it promotes health by having insurance companies cover the costs of preventive care. The role of nurses is to advocate for our patients well being and educate on the importance of health promotion and the continuation of health care needs. We must also help inform them what their health insurance covers as far as care, many patients don’t entirely know what all their insurance will and will not cover.
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"