...of much debate. At one extreme are those who argue that Americans have the best healthcare system in the world, pointing to the freely available medical technology and state-of-the-art facilities that have become so symbolic of our system. At the other extreme are those who accuse our system of being fragmented and inefficient, pointing to the fact that the U.S. spends more on health care than any other country in the world, yet still suffers from a substantial rate of uninsured, uneven quality, and administrative waste (Sultz, 2013). A review of U.S. healthcare expenses by the Institute of Medicine revealed that thirty cents of every dollar spent on medical care is wasted, adding up to $750 billion annually (http://www.iom.edu, 2012). The Institute of Medicine report identifies six major areas of medical waste: unnecessary services; inefficient delivery of care; excess administrative costs; inflated prices; prevention failures; and fraud (http://www.iom.edu, 2012). Americans spend twice as much on health care per capita than any other country in the world. In fact, according to a series of studies by the consulting firm McKinsey & Co, the US spends more on health care than the next ten biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain, and Australia (http://www.mckinsey.com, 2008) Introduction Most industrialized nations have single payer systems. Many argue that such a system would eliminate the convoluted paperwork...
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...PubHealth129- Final Paper TA: Vinne 12/12/12 Single-Payer Systems The United States health care system and the health coverage it has for its citizens are both unmistakably flawed. While our country offers many means of achieving health insurance like private, employer, and government assisted, twenty percent of citizens still do not even have health insurance. This means that these people are not getting coverage on their medical bills, and are therefore a lot less likely to visit the doctor until there is no choice. Even people who do have health insurance in the United States still do not get the affordable, comprehensive coverage they should. Compared to similar industrialized nations, we are far behind their level of comprehensive and affordable services. These countries often have what is called a single-payer system. The single-payer system is a health care plan that funds every person’s medical expenses from the same pool of money. The challenges of implementing the single-payer system are going to be from political barriers and transitioning the United States from a mixed insurance system. There are both advantages and disadvantages to this type of insurance mechanism, but this method has proven to have worked. There is no reason not to implement this advantageous system in America. Right now the insurance industry in the United States is not only complex, but inadequate. There are tens of thousands of different health care organizations; HMOs, private billings...
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...third parties in healthcare situations? First party is the patient, second party is the provider and 3rd party is the Insurance companies. 2. Compare the UCR and CPR payment systems? UCR and CPR: Both or methods of payment within the type of tradition retrospective payment system. Both or based on data from past claims. Private Insurance companies use the UCR and Medicare uses the CPR. 3. Describe the two purposes of managed care? The two (2) purposes of Manage care are to control and reduce c\ost while ensuring continuing quality of care. 4. Why have many insurers replaced retrospective health insurance plans with group plans such as HMOs and PPOs? Provider get paid up front with controlled cost while providing quality care no risk, they get paid for level 1,2, or 3 preset price and no risk for Insurance companies. 5. What are advantages of capitated payments for providers and payers? The provider has a guaranteed customer base and the third party payer know the exact cost of the healthcare group payment. 6. Describe the major benefits of episode-of-care reimbursement according to its advocates and the major concern s about episode of care reimbursement expressed by its critics? The benefit is for the provider their paid upfront for all services provided over period of time or specific amount of days. They can’t add any individual fees or charges. The Insurance company/administrators are predicting or making healthcare decision rather than...
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... 1.1 a. What are some of the industries in the healthcare sector? Some of the industries in the healthcare sector are health insurance, pharmaceuticals and biotechnology, medical equipment and supplies and health services. Others include education institutions, government and private research agencies. b. What is meant by the term healthcare finance as used in this book? Healthcare finance is a term used in this book to describe accounting and financial management principles and practices used to ensure the financial well-being of health care organizations. c. What are the two broad areas of healthcare finance? The two broad areas of healthcare finance are accounting and financial management. Accounting is the recording of financial transactions concerning a business or organization, providing a summary of transactions. Financial management is the use of theory, principles, and concepts developed to help managers make better financial decisions. d. Why is it necessary to have a book on healthcare finance as opposed to a generic finance book? While each service industry has a certain definitive characteristic, the health service industry is different to most others. Non-profit corporations dominate the health service industry either by government or privately. Third parties such as insurance companies, employers and government programmes are the ones that make the majority of the payments to healthcare providers over individuals. The application of finance...
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...The United States is known as one of the greatest, if not the greatest nation in the world. It is known for having the most productive economy, and the most powerful military in the world. So, my question is, why wouldn’t a superpower like the U.S. provide its citizens with a universal healthcare system? Of the 25 healthiest nations in the world it is the only one without it. With an estimated 45 million people in the U.S uninsured, it baffles my mind that the so called “greatest nation” still does not have this system. I personally all persons should have the right to be provided with health coverage, and that our nation should be obligated to provide it to us. During th (Thibodeaux, 2010)ese next few pages I will be discussing what a universal health care system entails, how it is provided, and its advantages and disadvantages....
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...policy Analysis University of Mississippi Medical Center School of Nursing Define the problem and assemble the evidence Too many Veterans in the United States lack health insurance and are ineligible to receive care provided by the Veteran’s Health Administration. According to American Community Survey (ACS) conducted in 2010, one in 10 of the nation’s 12.5 million veterans under the age of 65 is uninsured. A veteran is defined by federal law as any person who served for any length of time in any military service branch. Contrary to the presumption of most, not all veterans qualify for free healthcare through the Department of Veteran Affairs. The Veterans Health Administration (VHA) operates as a branch of the Department of Veterans Affairs and is the largest health system in the nation. It is recognized for its commitment to providing high-quality population specific healthcare. The VHA also works closely with academic medical centers across the nation. Haley and Kenney (2012) identify eligibility for health care provided by the VHA as being on veteran status, service-connected disabilities and income level. Other factors include demographic location and cost sharing requirements. Health insurance coverage for veterans as with other groups of nonelderly adults has heavy dependence on access to employer sponsored insurance (ESI) and the costs of obtaining it. It must also be considered that the majority of states in our nation deny Medicaid coverage to nondisabled adults...
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...million uninsured Americans. In the 1960s the two major events that impacted health policy were 1) expanding health insurance to the poor and elderly through Medicaid and Medicare and 2) the start of rapidly increasing health care costs. The average per capita cost of healthcare in 1970 was $297 and during President Clinton’s pursuit of national health care reform it rose to $2937 per capita. By 1980, 31 million Americans were still uninsured. Many sought coverage through their employers however small businesses with a majority of low-wage workers were reluctant to offer insurance. When many employers finally offered coverage, lower-wage workers continued to refuse enrollment as they faced a greater impact from their pay reduction compared to higher-wage workers (Barr, 2011). Reasons attributed to this unresolved issue in spite of the ACA include: a large population of undocumented immigrants, select states still refusing to expand Medicaid eligibility, lack of awareness about Marketplaces in high-risk groups, affordability and eligibility, and lack of clarity regarding health insurance plans (Collins et al., 2016). Past initiatives to address the uninsured population include Hawaii’s Prepaid HealthCare Act and Massachusetts’ Individual Mandate; although these plans, like many in the past, lacked a solution for the undocumented portion of the uninsured. The discussion about uninsured is important but so is the concern about underinsurance; in fact, they are inter-related...
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...Introduction…………………………………………………………………………………………………………………3 The History of Healthcare Reform……………………………………………………………………………..…4 The Problem with the ACA……………………………………………………………………………………………6 The Current Policy………………………………………………………………………………………………………..8 Policy Alternatives………………………………………………………………………………………………………10 Evaluation Criteria………………………………………………………………………………………………………10 Policy Recommendation……………………………………………………………………………………………..12 Conclusion…………………………………………………………………………………………………………………..13 References………………………………………………………………………………………………………………….14 Introduction Recent health care reform legislation, The Patient Protection and Affordable Care Act and Education Reconciliation Act, which is now being referred to simply as the Affordable Care Act (ACA), was signed into law by President Obama on March 23, 2010. Since the 20th century, several United States presidents have faced challenges in passing national health reform into law. Before the ACA was enacted, national health reform proposals under different governments in the United States faced strong opposition from various stakeholders and multiple interest groups. Therefore, the enactment of the ACA is revolutionary healthcare reform in the history of the United States. Healthcare insurance is a program that assists in paying medical expenses through privately purchased insurance or social welfare programs. In other words, health insurance is a system that provides protection against health costs. This newly legislated healthcare reform offers health insurance for...
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...Principles of Healthcare Reimbursement Anne B. Casto, RHIA, CCS Elizabeth Layman, PhD, RHIA, CCS, FAHIMA Copyright ©2006 by the American Health Information Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, photocopying, recording, or otherwise, without the prior written permission of the publisher. ISBN 1-58426-070-X AHIMA Product No. AB202006 Ken Zielske, Director of Publications Susan Hull, MPH, RHIA, CCS, CCS-P, Technical Reviewer Marcia Loellbach, MS, Project Editor Elizabeth Lund, Assistant Editor Melissa Ulbricht, Editorial/Production Coordinator All information contained within this book, including Web sites and regulatory information, was current and valid as of the date of publication. However, Web page addresses and the information on them may change or disappear at any time and for any number of reasons. The user is encouraged to perform his or her own general Web searches to locate any site addresses listed here that are no longer valid. AHIMA strives to recognize the value of people from every racial and ethnic background as well as all genders, age groups, and sexual orientations by building its membership and leadership resources to reflect the rich diversity of the American population. AHIMA encourages the celebration and promotion of human diversity through education, mentoring, recognition, leadership, and other programs. American...
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...continues to spend significantly more on health care than any country in the world; however, even though with this statistic the United States has a lot of uninsured and does not have the healthiest citizens. The lack of universal healthcare coverage in the United States has been a forefront issue. With the overwhelming amount of uninsured Americans and the past unsuccessful efforts of health care reform, the possibility of universal health care seemed to be very unlikely. The new healthcare reform bill that was recently passed under Obama’s administration anticipates covering 30 more million of the uninsured (Riegelman, 2010). However, this bill does not offer universal healthcare. While excellent medical care is available in the United States, the rising cost and the U.S. health care delivery system present many challenges for the consumer and lawmakers. This paper addresses four dimensions that are pivotal to the successes and failures of the system: cost, efficiency, quality. The cost of the U.S. health care system is higher than any country in the world. Its efficiency is also under heavy scrutiny. If it were not an emergency most physicians would require insurance verification. Therefore, patients would be delayed of treatment. Moreover, The healthcare system in the U.S. should be redesigned in terms of prevention rather than treatment when people are already sick. Insurance should not go higher for people that have pre-existing conditions or with more health risks. Prevention...
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...have been debating healthcare for the last hundred years. Before the 1900s, doctors didn’t have much technology to diagnose and treat the sick, so it was more affordable to patients. Once new medicines were found, doctors started taking advantage of these new treatments, which increased cost. Therefore, as the cost went up, the public needed a way to pay for the treatments; this was the start of health insurance. Health insurance and healthcare came about during the time of the Great Depression. There are currently two main methods of providing healthcare: public and private. Public healthcare provides universal access and is funded through the government. Two forms of public healthcare are Medicare and Medicaid which President Johnson signed into law in 1965. Medicare, or public healthcare, was first enacted by the U.S. government to provide healthcare to the elderly. Medicaid provides insurance to anyone who has a disability or is in poverty. Private insurers are funded by premiums and cover clients while also making a profit. The first private insurer was the Baylor Hospital in the 1930s, which later became Blue Cross Blue Shield Health Insurance. The purpose of this report is to determine whether private healthcare coverage, as it currently exists in the United States, is more or less effective than a single payer system according to three criteria: cost, availability, and quality. Method: The Commonwealth Fund supports research on healthcare issues and helps to...
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...|The Case For Single Payer, Universal Health Care For The United States | | | | | | | | | |Nicole Jones | |April 2011 | |HS 544 Health Policy and Economics | |Fowler | | | Table Of Contents Page Section 1: Executive Summary …………………………………………….. 3 Section 2: Introduction …………………………………………….. 4 Section 3: Literature Review ……………………………………………… 5 Section 4: Problem Analysis ……………………………………………… 10 Section 5: Solutions and Implementations ………………………………………… 17 Section 6: Justification ……………………………………………… 18 Section 7: References ……………………………………………… 20 Executive Summary Almost four decades ago, Canada and the United States had very similar health care systems. Today, they are very different. The...
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...Comparison of the United States and Canada Healthcare Systems The United States is the only industrially advanced nation with over 15 percent of its population uninsured for health care services.(1) This aspect of American health policy has earned us a reputation of "backwardness"; for both Western Europe and Canada have systems of universal entitlement to health care (Torrance, 1984). A comparison of the American healthcare system to the Canadian health care system reveals the difference is cost, government involvement, philosophical attitude, and overall health of the citizens. In regards to economics, the American system practically doubles the cost of Canada per-capita bus yet does not yield the healthiest citizens, which clearly indicate there is room for change to improve or reform the U.S. healthcare system. This reform starts with the exchange of dialogue between the two countries policy makers and healthcare experts by identifying and implementing changes that are improvements of specific healthcare needs. Neither model is perfect but there are lessons that can be shared that could possibility lead to a more efficient healthcare system for both the United States and Canada. The United States and Canada are culturally similar therefore it is a realistic possibility that Americans could adopt a huge portion of the Canadian model and be successful with it. One of the main differences between the two separate healthcare systems is the huge gap in cost when comparing...
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...Williams ObamaCare (Final) Grantham University ObamaCare (Final) This essay is being written to debate the advantages and disadvantages of ObamaCare, aka Affordable Care Act (ACA), for the American people. While many are elated and view the government as taking responsibility for those who in the past have not seen a doctor on a regular basis due to having no insurance, there are still others who believe that the passage of the law will be detrimental to the country’s economy. Many are concerned that individuals will no longer have the choice of what type of medical attention they receive because the government will make those decisions for them. The truth is the Affordable Care Act requires certain types of coverage and ends discrimination that has led to higher costs and cancellations for women and people with pre-existing medical conditions. “The new ACA is a law aimed at reforming the American healthcare system. Its main focus is on providing more Americans with access to affordable health insurance, improving the quality of healthcare, regulating the health insurance industry, and reducing health care spending in the US.” In spite of the many attempts by the GOP to overthrow the ACA, the fact is that it is not Government provided healthcare, but an approach by the government to subsidize and regulate private health insurance and expand Government healthcare programs like Medicare and Medicaid. There are ongoing arguments between Democrats, Republicans, and the American...
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...maximize the efficiency and value of the enterprise. e. Financial management is of no value in decision making. 2. Which of the following statements about the role of finance in healthcare organizations is incorrect? a. Over time, the finance function has become increasingly focused on strategic issues, such as joint venture decisions. b. Today, the most critical finance function is cost identification. c. The finance function often supports cost containment efforts and third-party payer contract negotiations. d. The primary activities of the finance function can be summarized by the four Cs: costs, cash, capital, and control. e. In times of high profitability and abundant financial resources, the finance function tends to decline in importance. 3. Which of the following is not a hypothesized benefit of integrated delivery systems? a. Information systems that track all aspects of patient care can be developed more easily. b. Integrated delivery systems can provide population-based care, such as chronic disease management, that is often not offered by stand-alone providers. c. Integrated delivery systems have better access to capital. d. Integrated delivery systems are easier to manage than stand-alone providers. e. Integrated delivery systems are able to offer payers "one-stop shopping." Questions: (NOTE:...
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