...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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...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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...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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...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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...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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...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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...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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...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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...Affordable Care Act PPA 601 Foundations of Public Administration Timothy Smith December 20, 2015 If an individual needs emergency medical care, the first place that most would seek treatment is through the emergency room at the closest hospital. Even if that individual does not have any medical insurance, they know that they can and will receive treatment if they go to the emergency room instead of going to the doctor’s office. The reason that individuals can count on this serves is because of the many women and men in Congress that have spent many hours making public policies around health care that showcase how providers will attend to their patients. Public policy is the way that the government maintains order and also how the government addresses the needs of its supporters through actions that are outlined by its constitution. That definition seems vague because public policy is not a concrete thing but rather it is a term that is used to describe a plethora of laws, mandates, or guidelines that are founded through a political process. There are many types of public policies because policies are put in place to address the needs of individuals and those policies are divided into different categories as they relate to society. For example, health policy includes not only insurance but also includes all policies that are related to the heath of a certain group. When the AIDS epidemic came about in the early 1980’s, governments from all over the world had to initiate...
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...Canadian Healthy Policy vs. United States Health Policy AHS 330 Health Care Systems: 7Q April 2, 2014 Healthcare in the United States is extremely different from the rest of the world. Over the years government and political analysts have compared and contrasted the health care systems of the United States to that of Canada’s. Despite being located on the same continent both countries have different ways of delivering health care to its citizens. Canada has a single-payer system that is publicly funded, while the United States has a multi-payer system that relies heavily on privately owned healthcare. This could be due to the differences in how many patients are cared for compared to those in America or it could be just a matter of who developed the better healthcare. However, due to the close proximity of the countries it is possible that the United States can adopt the Canadian healthcare system. According to Health Canada, Canada's publicly funded health care system is best described as an interlocking set of ten provincial and three territorial health insurance plans. Known to Canadians as "Medicare", the system provides access to universal, coverage for hospital and physician services. With this being said it is safe to assume that health care services are provided on the basis of need, rather than the ability to pay. “The Canadian Health Act contains a single national plan that is composed of thirteen provincial and territorial health insurance plans that all share common...
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...Comparison and Contrasts of the United States and Canadian Health Care Systems Devry University HSM 310 Comparison and Contrasts of the United States and Canadian Health Care Systems Canada In the 1960’s, Canada reformed its system providing a universal single payer health care system which covers all services provided by physicians and hospitals it is mostly free at point of use and has most services provided by private entities. Single payer health care is the financing of costs of delivering universal health care for an entire population through a single insurance pool. The government took over full funding of both physician and hospital services, setting minor physician fees and hospital budgets. Everyone is covered at all times. United States of America For the past 8 decades, the U.S. has run its country on a private health care system where the individual pays for their choice of health care. Depending on the coverage of the health care amounts to the cost. In the U.S, government funding for health care is limited to Medicare, Medicaid, Veterans Administration and the State Children’s Health Insurance Program, which covers senior citizens, the very poor, disabled people, veterans and their families and children. The United States is the only country in the developing world that does not have a fundamentally public tax-supported health care system. The National healthcare debate is one that has been a continuing arguing point for the last decade. The goal is...
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...Lewis Mustard | Kristie Parker, December 19, 2012 | 1. Select three to four main aspects that you discovered in your research to highlight. The first thing that I would like to highlight in my research of Canadian universal healthcare vs. US healthcare is that Canadian health care is federally funded and covers mostly all of the medical services used by the residents. The US has healthcare for the people but is covered at the citizens’ expense via an insurance company. The citizens are responsible for maintaining the premiums set by the insurance companies via the employer of the citizens or privately attained. However, this could explain why nearly 50 million people are uninsured because a lot of Americans cannot afford the premiums set by the insurance companies or quoted to them privately. The issue without healthcare is that the premiums are many times to expensive. The insurer will not pay because the conditions the patient may have could be pre-existing and will cause the company to pay for many expenses that are acquired before they are insured. Unlike the US, Canadian is federally funded so those issues are not of a concern, only finding when the care can be provided is the concern. Next, even though universal care for the Canadians appear to be ideal and a dream come true, the Canadians still have longer waiting lines and longer times for the services to be carried out than the US. The Canadian are much slower to adopt expensive technology to perform certain...
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