...Public Health Insurance ------------------------------------------------- The Impact on Low Income Individual Medicaid is the U.S.’s primary public health insurance program designed to provide health coverage for low-income children and families who lack access to private health insurance because of their limited finances, health status, or severe physical, mental health, intellectual, or developmental disabilities1. Currently, 1 in every 5 Americans uses Medicaid as their primary form of insurance. This means that as of 2015 over 65 million Americans, by guidelines of the department of health and human service, live on or below the federal poverty line 2. Although those numbers may seem large, former guidelines for Medicaid have left a large portion of the low-income population excluded from coverage and uninsured. Currently, adults under age 65, in nearly 25 states, no matter how low their income, are ineligible for Medicaid unless they are disabled or pregnant. As a solution to this problem the Supreme Court passed The Affordable Care Act (ACA), which would provide an expansion of Medicaid to millions of low-income, uninsured adults who were previously excluded. However the choice to expand remains a state option. While many states have chosen to move forward with the expansion, many have either opted out or lie in debate. One of the major arguments against the expansion of Medicaid lies in the debate of whether “Medicaid is worse than no coverage at all 3.” My paper...
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...Healthcare Utilization Access to health care refers to the ease with which an individual can obtain needed medical services. Access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. Individuals who have difficulty gaining access to health care may delay seeking and obtaining treatment, underutilize preventive health care services, and may have a high prevalence of chronic disease risks. Access and Usage of Healthcare Services Disparities in access to health services affect individuals and society. Limited access to health care impacts people's ability to reach their full potential, negatively affecting their quality of life. Barriers to services include lack of availability, high cost and lack of insurance coverage. Health insurance coverage helps patients get into the health care system. Uninsured people are less likely to receive medical care, more likely to die early and to have poor health status. According to Kaiser Family Foundation analysis of the 2000-2012 National Health Interview Surveys, in 2014, 48% of uninsured adults said the main reason they were uninsured was because the cost was too high. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for public coverage. In addition, undocumented immigrants are ineligible for Medicaid or...
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...HOBBY LOBBY VS. THE AFFORDABLE CARE ACT Leonila Gonzalez oUR LADY OF THE LAKE UNIVERSITY HOBBY LOBBY VS. THE AFFORDABLE CARE ACT Leonila Gonzalez oUR LADY OF THE LAKE UNIVERSITY Businesses can be affected by many laws and mandates that are set by the state or federal government. It can be difficult for a small firm to stay in business when such mandates are passed. The Affordable Care Act was signed into law by President Obama on Mach 23, 2010. Key components to the law are improving quality and health care costs, new consumer protections and access to healthcare, and mandating that all firms provided insurance for their employees. Small Business Tax credits were also included as an incentive and a way to reduce cost for the smaller firms. (Human Health Services, 2014) In order for a firm to be exempt from providing insurance to its employees they had to be classified as a non-profit organization or a Church. A businesses classification will give them exemptions for example a non-profit organization. A non-profit organization can be defined as “an incorporated organization which exists for educational or charitable reasons, and from which its shareholders or trustees do not benefit financially” (Investor Words, 2014). Because of the mandates of the Affordable Care Act, it is now in the center of litigation in which a for-profit organization is asking for exemptions from providing women health care, contraceptives, due to the owner’s religious belief. (Reese...
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...Capitation vs. Fee-for-Service Article Review HS546 HS546 Article Review Capitation vs. Fee-for-Service It seems that even the aspect of how health care cost should be paid is an every evolving problem in the United States. The Article Capitation Is for Specialist, Not for Primary care Physicians, describes transition to a group Capitated pooled system for Specialist. In addition to an every changing health care system and the introduction of Managed Care, there is also a shift towards capitation to fund health care. Most physicians have been paid through a Fee-for-service type setup for much of the 20th century. In an article from Health Care Financing & Organization News & Progress, researchers discuss capitation as one of the three worst forms of payment for physicians. James Robinson from the University of California states that Capitation rewards the denial of appropriate services, and leads to the dumping of chronically ill patients, and also narrows’s the scope of practice (http://hcfo.net/pdf/news1200.pdf). The Idea of Capitation is to control cost and limit physician’s ability to over prescribe or treat a patient. Capitation is negotiated with the insurance company to provide a fixed amount of dollars per month for patient care. This amount is fixed per month regardless of services rendered if the clinic goes over the amount of capitation; they are responsible for eating the cost, not the insurance company. This introduces financial risk to the organization...
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...then, that the combined interaction of these environmental forces influences the course of health care delivery in the United states. The main characteristics of the U.S health care systems : No central governing agency and little integration and co-ordination Technology driven delivery system focusing an acute care High on cost, unequal in access, average in outcome. Delivery of health care under imperfect market condition Legal risks...
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...self-service actions and retrieving critical medical information. Providers of medical services face extreme challenges in making health records available to patients while guaranteeing the highest levels of security and privacy. EPIC EHR and EMR software can automate the safe sharing of medical and health records, but unless all patient records and data sources are integrated into the operating system, the software will fall short of its full potential to improve patient care, provide easy access to health records and...
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...National Health Insurance Model There are four basic insurance models adopted by different countries in the world: the Beveridge Model, Bismarck Model, National Health Insurance Model, and Out-of-Pocket Model. This paper will focus on the National Health Insurance model and will discuss the meaning of the model, the countries that use the model, who funds the model and discuss the strength and challenges of the model. The model. The National health insurance model is a form of insurance that is run by the government with the taxpayers’ money (Wallace, 2013). In this system, every citizen is free to seek medical services anywhere throughout the country without concern of being denied. The providers of care in this type of insurance model are...
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...There are several rationales for or against government intervention in or regulation of the health care industry in the United States. This section will focus on the grounds on which government intervention in or regulation of the health care industry in the United States might be justified. The overriding objective in regulation was, and continues to be, rate setting (Folland, Goodman, & Stano, 2010) in the health care industry. Generally, markets are problematic in health care because markets do not provide goods efficiently or equitably. Though markets usually work well, however, there are many circumstances in which market forces, left to them, will fail to maximize economic and social welfare, and, as a consequence, there will be a case for government interventions (Hayes, et al., 2011). Its primary goal is to limit the high price-cost margins that would otherwise be expected (Folland, Goodman, & Stano, 2010), along with promoting the best minimal quality levels while reducing waste and abuse of expenditures. Recent review from Cochrane Database of Systematic Reviews identified four main categories of market failure that might justify government intervention: intervention externalities; imperfect information; demerit goods; time-inconsistent preferences (a situation in which an individual’s preferences change over time without any change in information (Hayes, et al., 2011). An example of demerit good is something that is seen as intrinsically unhealthy, degrading or...
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...can impact a litigation process, which in the case of Stevens vs, Hickman Community Hospital was prominent when the Tennessee Court of Appeals dismissed the case based on failure to comply with Tennessee’s Medical Malpractice Act and the Health Insurance Portability and Accountability Act of 1996. This paper will include an IRAC Brief that will explain the case in detail followed by a brief explanation of governmental principles of regulatory compliance requirements, a brief explanation of methods for managing the legal risks that arise from regulatory compliance issues, and how this case can be applied within a business managerial setting. IRAC Brief Christine Stevens a Tennessee woman filed a malpractice lawsuit against Hickman Community Hospital, the emergency room services and physicians who cared for her husband Mark Stevens, which subsequently resulted in his demise. The case however is being challenged as a result of failing to comply with regulatory requirements set forth in the Tennessee Medical Malpractice Act and the Health Insurance Portability and Accountability Act of 1996. Case In accordance with the Tennessee Medical Malpractice Act, on April 11, 2011, counsel for Mrs. Christine Stevens the spouse of Steven Stevens, formally notified Hickman Community Hospital and Dr. Whitaker of the impending malpractice allegations in their care and treatment of Mark Stevens (FindLaw, 2013). The formal...
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...United States health care system is quite unique when compared to Canada’s health care system and those of other countries. Canada provides universal coverage, is privately run and is publicly funded through taxes. The U.S. is the only industrialized country that does not offer universal health coverage. The U.S. is said to be part of the developed world in terms of technology, well trained health professionals and job opportunities although when it comes to health outcomes it doesn’t do so well. Available studies suggest that the health outcomes in Canada were superior to those compared the U.S. The U.S. faces multiple barriers that have made their health care system inconsistent and so costly. In the past the system focused on revenue maximization instead of quality care at an affordable cost. The U.S. spends twice as much more per capita on health expenditures when compared to Canada (O'Neill & O'Neill, 2007). Canada spends much less on health care and yet performs better than the U.S. in health outcomes, infant mortality and life expectancy. A comparison of the U.S. health care system and Canada’s system performance will be evaluated along with the health outcomes that have resulted from each system. The U.S. has a multi-payer private health care system where Canada has a single payer and is mostly a publicly funded system. “In Canada in order to receive full funding for health insurance the provincial government must meet the following criteria: care available to all eligible...
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...Government services, including Medicaid, the State Children’s Health Insurance Program (SCHIP) and Accessing Community Care through Eastside Social Services (ACCESS). These programs enable eligible low-income individuals and their families to seek medical assistance reducing uncompensated care and hospital costs. The primary source of funding for uncompensated care is government dollars. The government collects taxes to fund various public services. American taxpayers have every right and should be concern about how the money is being spent. Controlling tax expenditures poses a major concern especially when considering reducing deficit as well as reducing taxes for Americans. The federal government is by far the largest funder of uncompensated care. In 2013, the federal government provided $32.8 billion (61.5 percent) to help providers cover costs associated with caring for the uninsured. State and localities are the second largest, providing another $19.8 billion; the private sector is estimated to contribute $0.7 billion (Caswell, Coughlin, Holahan, & McGrath, 2014). Medicare, Medicaid, SCHIP, and Affordable Care Act marketplace subsidies together accounted for 24 percent of the federal budget in 2014, or $836 billion. Nearly two-thirds of this amount, or $511 billion, went to Medicare. The remainder of this category funds Medicaid and CHIP, which typically on a monthly basis provide health care or long-term care to about 70 million low-income...
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...Health Care Spending Analysis Y Grand Canyon University: HCA-530 November 19, 2014 Health Care Spending Analysis Health care spending in the United States has been on a steady rise with no signs of slowing down. It is also the highest among developed countries in the world. Although Americans spend the most on health care, this does not translate into the best care available. Many developed countries outrank the U.S. in quality and access of care. Before the Affordable Care Act came along, many individuals and families would forgo purchasing insurance premiums due to the high costs and only utilize emergency rooms when in need of care. Health care reform ideally will address the millions who are without health insurance and provide a higher standard quality of care. The reform of the health insurance system aims to reduce national spending by making changes to the law to incentivize health care providers and organizations to reduce unnecessary spending and focus on increasing access to meet the new demand of the newly insured. Profit vs. Non-Profit Consider for a moment that the majority of health services spending is done by non-profits. These same non-profit organizations are now held to a higher standard, specifically, what exactly they are doing to serve the underserved in their local markets. Recent healthcare reform is a mixed blessing for non-profit and for profit hospitals. Over 30 million Americans previously uninsured Americans will now have the ability...
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...2012 Improving the access and affordability of health insurance coverage for all Americans should be a primary concern for those who help create the laws of the land. At this date, there are roughly 44 million Americans without any type of healthcare coverage. Another 38 million people have inadequate health insurance (PBS, 2012). What this all means is that the people who need it the most are putting off seeing a doctor until last moment and then usually end up visiting an emergency room. If they cannot pay for the visit, the cost of that ER visit falls back on the taxpayers, people who have health insurance coverage, and the Federal Government. The young, under the age of nineteen, are usually covered by Medicaid and the elderly, 65 and up, are usually covered by Medicare. The people lost in the middle are mainly those aged 19-64, who are uninsured and do what they can to keep themselves healthy. When that does not work, the local health departments and emergency rooms are expected to take up the slack. Of those who may have health insurance coverage, that coverage comes through their employer. The people who have insurance through their employer make up about 56% of the population American workers, while about 11% have privately purchased insurance (Jovanovic, et. al., 2003). The people who do not have traditional jobs such as those who work part-time, work through a temporary agency, or work for a small company who does not provide health insurance, make up 29% of the...
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...Investing in healthcare disparities and solutions. INTRO- Healthcare disparities continue to be a major problem in our present-day society, creating uncertainty about access to necessary services and health outcomes. This essay aims to analyze the complicated structure of healthcare disparities while shining a light on the approach to universally fair healthcare outcomes and access. This essay will explore the complicated link between healthcare disparities and how factors such as socioeconomic status, race, location, and differences in cultures affect health outcomes and unequal access to medical treatment. This essay does this by drawing on the information offered by numerous studies. It will address the root causes of healthcare inequality...
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...health are more costly, some studies show if people exercise we can reduce need for restorative health • Migrating from medical model to public health is difficult, clinical intervention associated with restorative health • Preventive: whole is greater than sum of the parts • PA’s and NP’s to extend primary care, about improving access and slowing cost curve increase • States are the primary vehicles for licensure for healthcare personnel, states need to expand the scope of practice • Managed care: managed cost, in 1980s there was financial disincentives for referring to specialists • Public health very small effort of maintaining health • Institution: doctors, payors, hospitals, insurance, technology, pharmaceuticals, taxpayers, professionals, communications, • free market vs. gov. control: history founded on individual rights and liberties, we are a society and there are needs greater than any of us as individuals, works for other countries that don’t have a culture of individualism • Most hospitals are not for profit, for-profit chains are low percentage, VA, military, state hospitals aimed at behavioral health • Cost, Quality, Access: Interwoven quality and access closely related, buyer is not • Hospitalcompare.gov • Remind him about my question on people who opt-out • Medicare: A) Hospitalization: get it when turn 65, financed by payroll tax, federal, passed in 1965 B) Ambulatory services: Voluntary, 99% sign up for part B, financed by premiums and general fund...
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