...The Evolution of Medicaid Genesis65 HCS/310 April 19, 2010 Barbara Sinacori, RN, MSN, CNRN The Evolution of Medicaid Prior to 1965, the poor elderly in the United States were left with little options when it came to accessing and paying for preventative health related services. As a result, many of the poor in the U.S. went without routine health care or treatment for known illnesses. In response to this growing issue, the Federal government, under the direction of President Lyndon B. Johnson and in conjunction with state governments, established the Medicare program on July 30, 1965 through Title XIX of the Social Security Act (Centers for Medicare and Medicaid Services, 2010). Along with passage of the Medicare Bill in 1965, Congress also passed an insurance program known as Medicaid that would provide health care insurance for various groups of disenfranchised U.S. citizens. This paper will briefly discuss the evolution of the Medicaid program and examine how Medicaid has influenced the current health care system in the United States. The ever-rising cost of health insurance has prohibited many businesses from providing health insurance to their workers, effectively leaving millions of Americans uninsured or underinsured. According to the U.S. Census Bureau (2007), “The number of people without health insurance coverage [in the U.S.] rose from 44.8 million (15.3 percent) in 2005 to 47 million (15.8 percent) in 2006.” Medicaid...
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...Running head: HEALTH CARE SYSTEM EVOLUTION PAPER Health Care System Evolution Paper University of Phoenix Sandra Walther/ HCS 310 October 20, 2009 Understanding the roller-coaster experience with the use of market forces in health care over the past ten years provides important context for discussions of likely future developments in the nature of competition (Lesser, 2007). The period began with acceptance of managed care transforming the organization of medical care delivery and proceeded to a period in which many of the changes were reversed. This paper begins with observations on competition in 1995, which is slightly past what one might call the peak of managed care’s influence. It goes on to describe the market and policy responses to the backlash against managed care and then to competition in the post-managed care era; it concludes with some perspectives on the likely evolution of competition over the next few years. Competition in 1995 was highly influenced by the critical mass that managed care had achieved by that point. According to KPMG Peat Marwick’s 1996 survey of employers, 73 percent of those obtaining coverage through employment were in managed care plans, compared with 27 percent eight years earlier. Health maintenance organizations (HMOs) were the most popular plan type, accounting for 31 percent of the market (Lesser, 2007). The benefit structure in managed care plans included far less in the way of financial incentives for patients than had...
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...Significant Health Care Event Paper Sarah Miller HCS/531 February 22, 2015 Instructor: Georgetta Baptist Abstract Managed care has changed health care as a whole. Before managed care, providers were not knowledgeable about public health. Managed care made big changes for public health, and gave access to health care for those individuals who lived in rural areas, who otherwise could not have it, or the middle class that made too much for government insurance, but not enough to afford private insurance. How Managed Care Has Changed Health Care As previously mentioned, health care providers did not have much knowledge of public health before managed care came about for the health care industry. Before managed care, ideas such as immunizations, management of infectious diseases, diagnostics, and laboratory testing were both public and personal health entities. They were mainly funded by government programs, but could be funded by third party payers without the instances of prior authorization. Patients were also free to choose what providers they had, and the insurance companies had little control over how the benefits were utilized. Today, managed care is the most utilized type of insurance in this country. The plans can differ from a loosely structured networks that give the provider and client more choices, to a tight health maintenance program. The looser structured programs provide limited controls on how it is used based on providers who would offer...
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...society today is health care reform and government plays a large role in regulating managed health care systems. A 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...
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...Read Me First HCA/210 Weeks One and Two Introduction THE HEALTH CARE INDUSTRY IN THE UNITED STATES IS QUITE UNIQUE FROM OTHER COUNTRIES. UNLIKE MOST DEVELOPED COUNTRIES, IT IS NOT RUN BY THE GOVERNMENT WHERE EVERYONE HAS ACCESS TO HEALTH CARE (TORRENS, 2002). ALSO, OVER THE YEARS, ECONOMICS, POLITICS, SOCIAL ISSUES AND TECHNOLOGY HAVE INFLUENCED TODAY’S HEALTH CARE DELIVERY SYSTEM. HEALTH CARE IN THE UNITED STATES IS PART OF A FREE ENTERPRISE SYSTEM. THERE ARE A HOST OF DRIVERS TO CONSIDER WHEN HISTORICALLY REVIEWING ITS DIVERGENT SYSTEMS, FUNDING, TRENDS, BUSINESS PRACTICES, DEMOGRAPHICS, AND ETHICAL CONSIDERATIONS. Changing population and demographic composition over time has changed the way health care is delivered today as opposed to 50 years ago. People are living longer today than in previous years. Life expectancy continues to increase. The National Vital Statistics Report (2010) indicated the average life expectancy has risen to 77.9 years. In totality, experts consider population change using three components: births, deaths, and migration (Denver as cited in Shi & Singh, 2001). Basically, “lower death rates, lower birth rates, and greater longevity together indicate an aging population” (Shi & Singh, 2001). Each of these components have manifested over the past 50 years contributing to longer life spans. Increased access to health care services ultimately has led to increased use and costs. Increased costs have forced the public and private...
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...Dale Mueller Managed care is the process of reducing health care costs while improving the quality of care. This is relevant to the changes in health care because it allows consumers and employers to have an alternative to traditional health care insurance that is less costly, while still maintaining a higher level of care than that which is found in traditional health care insurance. This relates to the changes in health care because it reduces the costs and allows more individuals to be able to afford health care without suffering a reduction in the quality of care that they receive. Furthermore, it allows businesses that may not previously been able to afford health care for their employees more options to facilitate coverage. For example, a small sized business may have a difficult time affording traditional health coverage for their employees, now has the ability to provide health care to their employees at a fractional based cost system. Furthermore, an individual who is paying their own health care costs independently can benefit from the efficiencies of managed care by controlling cost without sacrificing quality of care. The health care system underwent a drastic change in the 1990’s that saw traditional health care systems transition in to more managed care settings. This has impacted health care significantly because traditionally the four basic health delivery systems were fragmented, whereas, now, they are more integrated in the managed care environment....
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...Control of Health Care in Puerto Rico Josie Valentín Walden University Overview of the health care system The Puerto Rico Department of Health (PRDH), the State Health Agency (SHA), is a free-standing, independent agency. Under its jurisdiction are all the health-related affairs of Puerto Rico. The PRDH performs the following functions: Planning, evaluating, and regulating as well as auditing the programmatic, administrative, and fiscal aspects of health facilities and services. The PRDH performs these duties in the public and private health sectors of the commonwealth. The system is driven by health needs or problems to produce health results or outcomes. The government’s role in health, once limited primarily to protecting the public from epidemics of infectious diseases. This information are Retrieved from http://www.cdc.gov /phppo/inpho/profile/pr Who controls health care in Puerto Rico today? Why? Several affiliated organizations function under the SHA. Included in this group are the General Health Council, Administration of Health Facilities and Services, Administration of Medical Services of Puerto Rico, and Central Areawide Comprehensive Health Services Corporation (CACHSC). The CACHSC is a private non-profit organization which serves as fiscal agent to the SHA for Federal grants earmarked to provide high-quality primary and migrant health care to medically underserved and low income residents of the mountainous municipalities. The General Council of...
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... 1. Compare the three (3) main types of health insurance in the U.S. and assess the solvency of each. Make a prediction regarding the longevity of each type over the next 30 years. Health insurance is essential because it provides people with an affordable way to stay healthy and get medical care when ill. It also protects people and their families from the high cost of health care. In some cases, medical bills can be financially devastating. The likelihood of no insurance is a real risk to many workers who may experience either phases of unemployment or jobs that do not provide health insurance benefits at all.The three most common forms of health insurance plans are fee-for-service, managed care, and consumer directed. Fee-for-service plans mean the doctor or other health care professional will be paid a fee for each health care service provided to the patient. Patients can see the doctor of their choice and either the health care professional or the patient files the claim ("Health insurance 101," 2012). There are two kinds of fee-for-service coverage: basic and major medical. Basic protection pays toward the costs of a hospital room and care while you are in the hospital. It covers some hospital services and supplies, such as x-rays and prescribed medicine. Basic coverage also pays toward the cost of surgery, whether it is performed in or out of the hospital, and for some doctor visits. Most fee-for-service plans have a "cap" or limit on the amount you...
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...Evolving Practice of Nursing and Patient Care Delivery Models The Speech Hello, my fello nurses. Thank you for being here at the Summit of Nursing Evolution. My name is Chhay Yann-Ly and I am a nurse. We are living in an era where the United States (US) health care system is going through tremendous changes and challenges, with sky-rocketing health care costs, fragmented and poor quality of care, high volume of aging population, and passage of the Patient Protection and Affordable Care Act (PPACA) in 2010. A summary of the PPACA is basically to improve the health care delivery system, expand coverage, and control cost (Democratics Senate Gov/Reform, n. d.). With these changes, comes the evolutionary nursing professional transformation process. This speech is a crash course on the evolving practice of nursing and patient care delivery models. The goal of this speech is to discuss the continuity or continuum of care in relation to accountable care organizations, medical homes, and nurse-managed clinics health care models. Since nursing is the backbone of health care, all of these care delivery models require a robust nursing contribution for success (American Nurses Association (ANA), 2010). The first model is the accountable care organizations (ACO). ACOs is a “shared savings” with Medicare (part A & B). The ACO, according to the ANA (2010), is “a collaboration among primary care clinicians, a hospital, specialists and other health professionals who accept joint responsibility...
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...3 The Evolution of Health Services in the United States Learning Objectives To discover historical developments that have shaped the nature of the US health care delivery system To evaluate why the system has been resistant to national health insurance reforms To explore developments associated with the corporatization of health care To speculate on whether the era of socialized medicine has dawned in the United States “Where’s the market?” 81 26501_CH03_FINAL.indd 81 7/27/11 10:31:29 AM 82 CHAPTER 3 The Evolution of Health Services in the United States Introduction The health care delivery system of the United States evolved quite differently from the systems in Europe. American values and the social, political, and economic antecedents on which the US system is based have led to the formation of a unique system of health care delivery, as described in Chapter 1. This chapter discusses how these forces have been instrumental in shaping the current structure of medical services and how they are likely to shape its future. The evolutionary changes discussed here illustrate the American beliefs and values (discussed in Chapter 2) in action, within the context of broad social, political, and economic changes. Because social, political, and economic contexts are not static, their shifting influences lend a certain dynamism to the health care delivery system. Conversely, beliefs and values remain relatively stable over time. Consequently, in the American health care delivery...
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...Evolution of Health Care Information Systems There has been a very fast growth in the U.S. health care system since the early 1980s with regard to the information technology related to health care. This can be viewed as an attempt towards the standardization of the fragmented health care system. Information technology like in every other field of life has become a necessity even in the health care system and is covered by the federal regulations. The implementation of the Electronic Health Records (EHR) by 2014 has become mandated as ordered by President George.W.Bush in 2004 which was seconded by the Joint Commission for the Accreditation of Health Care Organizations (JCAHO) and Health Insurance Portability and Accountability Act (HIPAA). These organizations asked the health care providers to comply with the new legislation and those community-based physician practices who were earlier reluctant to accept and implement it have now realized that the health care in sequence systems in the form of CPOE (computerized physician order entry), EMR (electronic medical records), the tele-medicine, complex disease management, and automated billing systems are very beneficial to them The paper intends to showcase the comparison and contrast between a contemporary health care facility and a traditional health care facility which prevailed before twenty years. At least two major events and technological advantages influencing the practice of the current health care information system...
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...A Marketing Plan for an Imaginary Managed Care Organization Executive Summary and Situation Analysis Working for the Managed Care Organization of America, the ultimate goal would be to ensure cooperation in the understanding, agreement, and commitment between all divisions and units. One of the problems at the Managed Care Organization of America is that the healthcare professionals are put in a position where they are inhibited in their involvement over the communication and networking systems between the Nursing Administration, the head of each nursing unit or the RN or LVN in charge, and the certified nursing aids. This executive summary takes a brief look at designing and developing a contract process program that integrates cooperation and communication systems between the Nursing Administration, the head of each nursing unit or the RN or LVN in charge, and the certified nursing aids. Another challenge for the Managed Care Organization of America is the unclear policies in the Hospital Equipment Management Program. This executive summary offers a proposal whereby the healthcare professionals would develop and monitor a two-way communication channel and incorporate it into the Hospital Equipment Management Program, hold related workshops that can be attended by the Director of Hospital Operations and the division managers, build a cooperation team that unites operational goals and develop systems that evaluate whether these operational goals are being met and implemented...
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...varied levels of care. The levels of health promotion in nursing will be discussed and any differences therein. Also discussed will be the evolution of nursing roles and responsibilities. Health Promotion Defined In order to begin, the three levels of health promotion will be defined. The first level- Primary Prevention, are ‘methods to avoid the occurrence of disease’ (Wikipedia 2013). Primary care is what one would seek when an acute issue has occurred; for example, the development of flu symptoms, an infection or a broken bone. Primary care is also concerned with preventive medicine such as pediatric well baby visits. Secondary Prevention is ‘a method to diagnose and treat existent disease in early stages before it causes significant morbidity’ (Wikipedia 2013). Typically a primary care provider will refer the patient to a secondary care specialist; for example, an oncologist who is a doctor that specializes in cancer. The third level- Tertiary Prevention, are ‘methods to reduce negative impact of existent disease by restoring function and reducing disease-related complications’ (Wikipedia 2013). For a patient that has ended up in the hospital setting and requires a higher level of specialty care and use of specialty equipment; for example, coronary artery bypass surgery, dialysis or severe burn treatment. Discussion Health care providers may be doctors, nurse practitioners and physician assistants, but nurses are crucial members of the health care team as they are...
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...health care system is most often complex, inconsistent and costly. To maintain and improve the business, healthcare organizations are continuously innovative and evolving to meet the demands of consumers. The purpose of this paper is to discuss a case study of UnitedHealthcare Group, what they are about, their network and resource management, their view on nursing and how they satisfy their patients. About United Healthcare The largest for profit healthcare carrier in the United States (US) is UnitedHealth Group, the parent of UnitedHealthcare. Headquartered in Minnetonka, Minnesota, UnitedHealth Group is a diversified managed health care company founded in 1977 and ranking #17 in the top 500 companies in the US, according to Fortune magazine. UnitedHealth Group has a total workforce of approximately 150,000 in the 50 US states and 20 other countries and serves more than 85 million individuals worldwide (UnitedHealth Group, 2013). They offer a wide spectrum of health care services and products through two operating businesses: UnitedHealthcare, which provides benefits services to individual consumers and employers of all sizes and health care coverage: and Optum, which provides technology health services and information in care delivery and improving the operating and clinical elements of the system and population health management (UnitedHealth Group, 2013). “UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience...
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...in 1776 in Scotland. ("What is economics,”) With healthcare increasing in the country and insurance agencies providing consumers with the proper coverage for care these conditions are becoming a stress. But within this tension agencies are finding ways to merge and accommodate all aspects of consumers need financially and providing the care needed. According to the “Competitive Effects Analyses of Hospital Mergers” over the past decade, there have been more than 500 hospital transactions and realignment is expected to continue in 2014 and beyond. (Guerin- Calvert, 2014) Economically to control the flow, smaller independent hospitals are being advised to affiliate themselves with larger facilities to better contain their businesses as well as their patients. Innermost concern that patients have is the cost of coverage for the care that will be provided to them. And the trends in network to diminish a patient and their finances benefits are designed with lower premiums and out of pocket costs such as deductibles and copays. But, within this plan a patient has fewer providers to choose from. Another trend is risk based contracting which is a contract based on how well a provider performs and if seen to perform poorly the provider is penalized. A patient would be taking a risk as well just to save money on care that may or may not be...
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