...The Health Care reform bill has the creation of an Institute for Comparative Effectiveness as a key component with the hope of improving quality and reducing health care costs. The institute would have the authority to make official determinations of the clinical effectiveness and cost-effectiveness of medical treatments, procedures, drugs, and medical devices. President Obama's initial nominee as Secretary of Health and Human Services (HHS), former Senator Tom Daschle (D-SD), has likewise proposed the creation of a supremely powerful Federal Health Board, which would have similar authority to make decisions that would be binding on health plans and providers financed by federal taxpayers, and potentially on private health insurance coverage.[2] While Senator Daschle has withdrawn his name from Senate consideration, the concept of such a board or institute is strongly indicative of the Obama Administration's policy orientation toward centralized health policy decision-making. Last year, congress has passed the American Recovery and Reinvestment Act (H.R. 1, which would establish a Federal Coordinating Council for Comparative Effectiveness Research. The bill provides $1.1 billion for the new council and delegate spending authority to the HHS Secretary to investigate the effectiveness of different drugs and medical devices.[3] Of course, there is no reason why anyone should not have access to information on what works and what doesn't. There is no reason...
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...service? * Relate these steps to the eligibility factor you identified and provide two examples of patient charges with corresponding billing transactions. Some factors that determine a patients benefits eligibility is their age, marital status, immigration status, healthcare needs, and work history. Also, if the patient works for a company that provides insurance, the insurance company may only cover the health care until a certain dollar amount, and then the patient is responsible for the rest. The appropriate steps to take when the insurance plan does not cover the service that is planned for the patient is to first tell them! The patient needs to be told and explained to that the insurance plan does not cover their service that was planned and if possible, why it is not covered. Many people think that their insurance will cover many different services but, this is not always true. I am still unaware of what my insurance plan covers and does not cover completely. Then, the patient needs to be told that if they choose to continue with the planned service, the insurance company nor the provider will be responsible for the remainder of the bill. They need to be told that they will be responsible for paying the bill completely. Some choose not to go through with the procedure and others will. EXAMPLES: 1. Service to be performed: Filling on decayed tooth Estimated Charge: $100.00 Date of Planned Service: October 5th, 2014 Reason for Exclusion: Insurance does not cover...
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...How To Feed A Billion. And Why It Pays Shoma Chaudhury | Aug. 30, 2013, 2:19 AMArticle views - 186 The Food Security Bill is not a spend; it is an investment, crucial for India’s future and growth On 26 August, after months of wasted sessions, the Lok Sabha finally passed a historic legislation: the Food Security Bill . Many Indians woke two days later to headlines that the rupee had nosedived and the Indian markets had been “food poisoned”. It was a smart phrase. It captured the horror industry and what investors feel about the Bill. But it also epitomised the damaging hysteria and misinformation around it. It captured one of India’s most harsh dividing lines. In the summer of 2012, I travelled with economists Jean Drèze and Reetika Khera through some of Uttar Pradesh ’s most impoverished districts. They were on a fact-finding mission, going door-to-door in the searing sun, asking people whether they had enough to eat and whether the government’s Public Distribution System (PDS ) reached them. It was a deeply humbling experience. In hut after hut, one was confronted by the sheer absurdity of the Indian situation. In some of the country’s most forsaken landscapes — dust and bare scrub for miles, not even the possibility of employment anywhere — destitute, bone-thin families produced their pink and white ration cards with utter bewilderment. The first, a BPL card — below poverty line — entitled them to rice, wheat, and some sugar. The second, an APL card — above poverty...
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...“Universal Healthcare” Synopsis: The essay, “A Universal Healthcare System: Is It Right for The United States?” by Marleise Rashford describes the positive effect of universal healthcare. In the essay she explains how a universal healthcare system will help this country. The United States is the only industrialize nation that does not provide healthcare for its citizens. She criticizes the American healthcare system. “The current American system cost too much, cover too little and excludes too many” according to Rashford. Marleise Rashford emphasizes that money is not the issue why America has not reform its health system. Corruption, lobbyist, and private insurances are the ones responsible for this. The essay mentions that 45 million Americans are uninsured. This essay will analyze and critique Rashford’s essay. I support the universal healthcare system. The United States is the only industrialized nation without universal healthcare. The United States ranks poorly compare to other industrialized nations on healthcare. Universal healthcare will cover all the American citizens. It will benefit the underprivileged citizens of this country. American citizens will have a longer life expectancy. Infant mortality rates will decrease. The United States is the only industrialized nation without universal...
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...Dealing with Fraud By: Kevin McCarthy To: Dr. Michelle Rose HSA 515 Health Care Policy, Law, and Ethics December 13, 2012 Abstract As the Chief Nursing Officer, I am responsible for one of the state’s largest Obstetric Health Care Centers. I have received word of some fraudulent behaviors in the center. I will evaluate how the Healthcare Qui Tam affects health care organizations. I will provide four (4) examples of Qui Tam cases that exist in a variety of health care organizations. I will devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals. I will recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth. I will devise a plan to protect patient information that complies with all necessary laws. Evaluate how the Healthcare Qui Tam affects health care organizations Qui tam is shorthand for a Latin phrase that means “he who sues for the king as well as for himself.” In a qui tam case, the whistle – blower (aka relator) files the suit as a kind of “private attorney general” on behalf of the government. The government can choose to take over the prosecution, but if it declines to do so the relator can proceed alone (Showalter). Any person with information about health care fraud can be a qui tam plaintiff. Person is defined as “any natural person, partnership, corporation, association...
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...provider or member maliciously submits or makes someone else to file information that is misleading. There are many forms of such deceptive health care schemes where a health care practitioners and members are involved. The opportunity to commit frauds specifically in the healthcare in industry is considered to be looking any employee in the eye due to the ease of getting away with it. With the ethical and moral issues that have plagued the healthcare industry the commission of fraud by my healthcare workers is one of the most common. Too many cases of healthcare fraud had been done unnoticed and so many healthcare workers have become rich. While there are some fraudulent activities that have been caught, there are still many opportunities that present themselves for every healthcare worker and professional to challenge their ethics, morals, and values. One example of a health care fraud by a provider involves billing patients for services that were never rendered to them. Some doctors would send Medicare or Medicaid a bill for a clinical procedure that never happened. Dentists bill for extractions that were not performed, or nursing homes may bill for supplies that were not bought or used. With the bills submitted, false receipts or records are made to back up these claims. Billing for procedures or services that are unnecessary can also be another type of fraud. According to Cady (2007, p. 57) these facilities (hospitals,...
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...Healthcare reform and policy establishment has been driven by politics since modern medicine began to make a rise in our western culture. In 1935, President Franklin Roosevelt was the first to attempt to integrate a national health care program within social security. President Harry Truman proposed a multi payer insurance fund while in office but also was unsuccessful. Multiple presidents have attempted to succeed at providing healthcare reform and finally succeeded in 2010 with the Affordable Care Act. Each political party has their own agenda that they use to guide the policies they support. Unfortunately, many health care providers are not aware of the policy challenges that our profession faces daily and the impact our government has on healthcare policies. Policy making is driven by committees within our federal and state government where bills that have been presented are reviewed. Each party typically will push for new policies that benefit their political party often voting for bills in the legislature that gain the most popular vote. The passing of policies through our legislature impacts healthcare in various ways. For example take the Bill presented by Illinois congresswomen on safe patient-staff ratio. If this bill is passed and becomes policy, hospital systems will be forced to revamp patient census requirements, when there is only one study available showing improved quality of care. . It is crucial that evidence based practice be incorporated with policy making...
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...Singapore government helps its citizens to pay for their healthcare needs. The primary policy that will be discussed will be the Ministry of Health’s 3M framework and a policy analysis will be conducted based on it. A brief introduction of the development of this policy will be provided followed by an evaluation of the policy and recommendations on how to improve the policy. The report will be concluded with a discussion on the impacts that the policy brings about. 1.2 Background Public health care is an emotive issue that remains a major concern of the public in our country. With the rising costs of financing public healthcare systems and the pressing aging problem issue, how our government finances our public health care systems becomes a major issue and debate within our public sector. Hence, I have decided to study on the Singapore’s Ministry of Health and how it plans to help Singaporeans to finance for their health care in a framework known as the “3M Framework”. This was also specially mentioned in the Budget 2008 announced recently and I will also discuss about changes to this framework in the report. 1.3 Objectives This project aims to study the effectiveness of the 3M framework as a financial means to help Singaporeans finance for their healthcare. 1.4 Scope This project will cover a brief history of the Ministry of Health and the 3M framework as well as the framework’s role in Singapore’s public healthcare policy. 1.5 Methodology The basis of the report...
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...The medical liability system needs reform to promote better patient safety and lower health care costs. In this paper I plan to show different types of reform that are needed in the medical liability system and how those changes will impact patient safety and cost. Also discussed will be the governments backing (or not) of medical liability reform. The current medical liability system was designed to provide monetary compensation to patients who suffer injury due to medical negligence. The system also works to reduce the chances of future patients being harmed by preventable medical errors. However, most individuals in the healthcare industry do not believe it accomplishes any of these goals. The biggest issues, as reported by critics of the system, are the cost and access of liability coverage, impact on patients’ safety, and the administrative costs of lawsuits. To address the shortcomings of the system, some reform has been introduced to modify the current tort system. Included in these reforms are Full disclosure/early offer programs, Certificates of merit programs, Caps on damage awards, periodic interim payment rules, joint and several liability reform, collateral source rule reform, screening panels and health courts. All of these programs are designed to lower the costs of Medical Liability insurance for the health care provider as well as addressing the safety of patients in various ways. They also give both the patient and the health care provider peace of mind because...
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...From the Heart: Healthcare Transformation from India to the Cayman Islands From the Heart: Healthcare Transformation from India to the Cayman Islands My immediate thoughts as I began to watch the movie, From the Heart: Healthcare Transformation from India to the Cayman Islands (Horstmeier, 2014), took me back to the time I spent in the hospital for my first born. My daughter was born with a birth defect and lived at University of North Carolina hospital until she passed away at five months old. I was not given a bill and forced to make an unethical decision like many parents around the world before she received any treatment or any of the five surgeries. After she passed away we received a bill for a half a million dollars. This bill was sent to me by mistake and was soon covered entirely by my insurance company. While losing my daughter was heartbreaking, I know that I am blessed. I was blessed to have insurance that covered the bill. The thought of paying for such a large expense and not even having my daughter is unfathomable, but yet this is the case for many parents who are faced with enormous healthcare expenses. The Impact of High Cost Many parents are faced with the inability to pay for critical heart surgeries. The video From the Heart: Healthcare Transformation from India to the Cayman Islands (Horstmeier, 2014), shows the extreme problem with healthcare systems around the world, and the changes Health City is making to the systems in India and the...
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...vast difference between movement along and shift in the demand curve for the different health care systems. For instance, the government funds Medicaid and Medicare to provide services to the indigent and disabled population. However, many factors exist that influence the control of health care spending from an economic standpoint. The objective of this paper is to discuss the role of government and the supply and demand curves concept to show the difference between movement along and shift of the curves in the managed care system. The concept of medical price elasticity to evaluate the manage health care industry is also discussed. Resource Allocation Law makers presented several proposals for health care reform and the final bill passed with the intention of providing health care to all Americans. One important issue concerning many consumers about health care reform is the selection of an appropriate managed health care program because one must choose a managed care provider by December 31, 2010. The application of principles to understand the health care systems is challenging because of the complexity of health care as a product or service; however, the fundamental problem addressed by economics is allocation of limited resources among unlimited demand (Scott, Solomon, & McGowan, 2001). Such is the case in the health care industry. According to Scott, Solomon, & McGowan (2001), “The market for health care services is considered an imperfect market...
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...Just last month, the US senate unanimously passed a bill (97-0) that many proponents agree may significantly improve the delivery of healthcare to people who live in rural America. The Expanding Capacity For Health Outcomes (ECHO) act was initially developed and introduced by Senators Orin Hatch (R-Utah) and Brian Schatz (D-Hawaii). The bill has garnered complete bipartisan support among senators and lawmakers with the hope that this model will markedly improve healthcare services and delivery where there are a few or no healthcare workers. The aim of the ECHO act is to integrate the use of technology to help deliver and educate with the help of a collaborative model. The model offers dynamic interactions with specialists through teleportals 24/7 in any part of the country. Over the past few decades, there has been a major decline in available health services with many healthcare workers moving away to urban cities. Patients with acute and chronic problems often had to travel miles to see a healthcare provider to reach specialists working in cities. Senators Hatch and Schatz first became aware of this problem in the rural areas of their respective states a few years ago. They quickly became aware that many Americans living in rural areas where to seek to travel; and a better option would be was to deliver healthcare to them. They proposed a bill in...
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...So what is the Health Care Bill all about? This bill is a way for the leaders of our society to make money in the long run, and help the needy, while hurting the middle class. An Anthropologist may have found that in other cultures this bill would not of even thought of. In such places like the Trobriand Islands where they get health care by the use of magic rituals, and not by paying lots of money. Other places around the world may have a different type of culture, and medicine is thought of as asinine. This newly passed bill costs an estimated $940 billion over ten years. This health care plan is said to expand coverage to 32 million Americans who are currently uninsured. “The uninsured and self-employed would be able to purchase insurance through state-based exchanges with subsidies available to individuals and families with income between the 133 percent and 400 percent of poverty level.” (By CBS News Capitol Hill Producers Jill Jackson and John Nolen ) With America being in debt trillions of dollars how are we paying for this $940 billion plan? If a college student comes out of college in debt thousands of dollars and lands a six figure job, he will be penalized? More taxes for the young that don't even need healthcare! I do believe the rich should have a little more higher taxes but not for health care that is not optional. I myself personally don't currently need health-care seeing as I am in great health and have no medical problems or history. The young...
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...Running head: An Overview of the Canadian Health Care System with a Comparison to the United States Heath Care System Canadian And American Health Care Parween Nooruddin Stratford University Abstract The reason for this exploration paper is to look at healthcare systems in two very progressed industrialized nations: The United States of America and Canada. The principal piece of the exploration paper will concentrate on the portrayal of healthcare system in the aforementioned nations while the second part will dissect, assess and measure up the two systems in regards to value and proficiency. Canadian And American Health Care In this research paper I will be comparing Canadian and American HealthCare systems. In this paper I will provide a description of health care system for each country. I will also analyze, evaluate and compare the two systems regarding equity and efficiency. We begin by giving a general portrayal and examination of the structure of Healthcare systems in Canada and the United States. CANADA’S HEALTH CARE – OVERVIEW Canada's health care system is a group of socialized health insurance plans that provides coverage to all Canadian citizens. It is openly subsidized and controlled on a common or regional premise, inside rules set by the national government. Under the health care system , singular natives are given preventive care and medical treatment from essential consideration doctors and in addition access to clinics, dental surgery and extra...
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...The Debate over Socialized Healthcare The topic of socialized healthcare has been a hot topic for awhile, with both sides having great arguments it’s hard to make a decision. Both sides should strive to meet in the middle, so less people will suffer the consequences of not having healthcare. No matter what side people take it is obvious that a change needs to happen. Our current health care system is a mess, and no one is benefiting from the system, expect for the greedy drug and insurances companies. The current health care system needs a change, and to change we need to identify the problems and come up with sustainable solutions. One side of the debate believes that socialized healthcare is the solution to fix America’s health care crisis, and wants everyone to receive care. The other side believes that socialized healthcare is not the solution. If people wanted health care they should pay for it. The start of this debate stems from current issues on health care in the United States. With health insurance becoming increasingly unaffordable the overall health of USA has gone down. “The cost of health care keeps rising 7% each year” (Collins, R,2011, paragraph 2), with costs rising health insurance coverage is going down, making it more difficult for people to pay to get treatment. Without the right medical help and check ups its hard to sustain a healthy lifestyle to prolong life. “People shouldn’t have to pay to live a healthy life” (Davenport, K, 2012 para.3), as a society...
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