...Access to Insurance Versus Access to Care October 23, 2011 Access to Insurance Versus Access to Care Access to insurance means that a person has a contract where a company will reimburse either the person or health care professional for treatment of a certain disease process or medical problem. However, one may have insurance for a condition but not be able to access care for that condition. This can arise for several reasons including physical proximity to the care being rendered, available care opportunities already being occupied by people requesting the care earlier than the next-comer, and businesses closing their doors due to costs not being reimbursed adequately for care being provided. Access to Insurance The Patient Protection and Affordable Care Act of 2010 (PPACA) as explained by Davis (2010) gives more access to insurance for United States citizens. Improved access to insurance comes from multiple rules that range from prohibiting restriction of insurance coverage to covering children of already those already covered by insurance up through age 26. Since the PPACA is based on the Massachusetts’ 2006 health care reform plan (Gruber, 2011), it is reasonable to evaluate the effects that have been experienced in Massachusetts. One thing to note is that 124,000 fewer people in Massachusetts have employer-sponsored insurance, creating an even bigger public burden, since this is a way to reduce non-salary personnel expenses (Byron, 2011). The same scenario is being...
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...it comes to the Health System. One similar being is both of their cultures and their health status. They have unlimited access to health care and are able to provide good quality care to their citizens no matter the cost. There are far more differences than similarities though. The most significant differences between the two countries are the role of private health care insurance and spending levels. Canada’s health system seems to do more for less, they provide access of health care to many of its citizens. Canada’s health system allows unlimited access to the public for many medical health services. These different services include the different physician and hospital services for their patients. Their health care system is through a government-sponsored system. They have many advantages and their unlimited coverage is universal and portable. In Canada health system, any and all citizens are covered through medical insurance no matter what their age or job may be. Many health systems won’t give you medical coverage because of your age and that shouldn’t be the case. Just because you may be too young or too old, everyone should have unlimited access or health care coverage. Also just because you may not have a job or have a career job that gives you everything you need for the rest of your life. You should still get coverage and Canada allows this access. One positive being about Canadas health system is that your preexisting medical conditions cannot deny you from any health...
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...The Rising Cost of Health Care: Effects on Access to Care The rising cost of health care is a trend that is negatively influencing access to health care. According to our course textbook, Policy and Politics in Nursing and Health Care, over 46 million Americans did not have health coverage in 2008, and 25 million American adults were underinsured (p. 124-125). For most people, this can be attributed to the high cost of premiums, co-pays, and deductibles. The purpose of this paper is to discuss the history of the trend of rising health care costs, the influence rising costs have on the delivery of health care, how rising costs create disparities in health care, and two ways that nurses can address inadequate access to health care. Access Trend In the U.S., there are more people today than ever before, unable to access quality health care. “Access is the ability to obtain needed, affordable, convenient, acceptable, and effective health care in a timely fashion” (Mason, Leavitt, & Chaffee, 2012, p. 124). This lack of access is attributable to the high cost of health care, which makes it unaffordable for the working poor, and those working for small businesses, to pay for adequate health care. There is an inverse relationship between the cost of health care and good patient outcomes. It is estimated that $7,000 per person, including children, is spent on health care in the U.S., yet the country does not rank in the top 15 of industrialized countries in terms of good health...
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...Barriers to Access In an ideal world, after the enactment of the ACA, millions of Americans would gain coverage under the Medicaid expansion or young adults expansion, and all of these newly covered people would then have the opportunity to set up a primary care provider and receive care and treatment through their own primary care physician. Unfortunately, that is not the case and millions of Americans are left with coverage, but no access to primary care. Thus resulting in higher numbers of ED visits by newly insured individuals due to lack of access to primary care. Identifying the barriers to accessing primary care will help to formulate solutions for this health care crisis. One of the most popular barriers to access to primary care is an inadequate supply and availability of primary care options (Cheung et al., 2012). Most primary care offices run a normal 8am to 5pm Monday through Friday schedule, which proves to be difficult for many Americans who are working. Specifically looking at Medicaid versus private insurance, there is a large gap between access to primary care, 16.3% of Medicaid beneficiaries had greater than or equal to one barrier to timely primary care compared to the 8.9% of private insurance beneficiaries (Cheung et al., 2012). In a recent survey, researchers took five common...
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...Better The Economics of Health and Health Care June 10, 2013 Strayer University Assignment #4 Select a country that has universal health care system provided by that country and provide some background information on this country. The Obama administration passed a health care bill that takes the U.S. part of the way towards a government-controlled system. However, it’s no secret that health care costs are increasing out of control in this country. Research says, as individuals we spend more per person on health care than both food and housing. Insurance premiums are multiplying much faster than inflation, which prevents economic growth and leaves businesses with less money to provide raises or hire more workers. While the quality and availability of medical care in the United States remains among the best in the world, many wonder whether we'd be better off adopting a universal government-controlled health care system like the one used in Canada. America doesn’t have universal health coverage; over 37 million people are without health insurance and approximately 53 million are underinsured, which means that they are inadequately insured in the event of a serious illness. Universal health care is a term that refers to a government system meant to ensure that every citizen or resident of a region that has assess to the required medical services. Thirty years ago there wasn’t a significant difference in the provision of health care between the U.S and Canada. However, Canada...
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...The first step that ABC Insurance Company should do is the conduction of some research in regards what Verde Greene Hospital wants them to do in order to get with their contract. ABC has always taken in consideration what employers wants and how to provide services for their costumers. They should analyze how much they will win or loose if they get the contract with the stipulations that Verde Greene Hospital has requested. If they agree they should consider an antitrust behavior and consider the two laws that controls those type of action: 1. The Sherman Act (1890) “Section 1: Every contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several states, or with foreign nations, is hereby declared to be illegal. (Stone, 2011)” 2. The Clayton Act (1914) “Section 2: It shall be unlawful for any person engaged in commerce . . . to discriminate in price between different purchasers of commodities of like grade and quality . . . where the effect of such discrimination may be substantially to lessen competition or tend to create a monopoly in any line of commerce, or to injure, destroy, or prevent competition (Stone, 2011).” Is evident that Verde Greene Hospital as a condition to sign the contract imposed ABC to get exclusivity and be the only provider in cardiac and maternity services for the 14 counties that they served. Verde Greene Hospital is getting into the antitrust practice and monopolistic behavior and...
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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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...Standards of Evaluation: A Comparison of Health Care Standards Between the US and Canada The Canadian health care system is often compared to the US system. In 2007 a systematic review concluded that outcomes may be superior in Canada versus the United States. The US system spends the most in the world per capita, and was ranked 37th in the world by the World Health Organization in 2000, while Canada's health system was ranked 30th (Guyatt, 2007). In terms of access, more Canadians seem to be covered with a decent health care insurance than Americans. Canada employs the single-payer system, which is a type of healthcare that is financed by a single public body (the Canadian government) from a single fund. In some ways, it appears to be a monopoly of care, because Canadians do not enjoy a wide range of choices in terms of services. This can lead to long wait-times and delays in delivering quality healthcare (Nieves, 2009). According to Dr. Albert Schumaker, former president of the Canadian Medical Association, and estimated 75% of health care services in Canada are delivered privately, but funded publicly. The US, on the other hand, has a mixed private and publicly funded healthcare, with about 16% of the population being uninsured (Guyatt, 2007). This is why there is a lot of pressure on the government to implement universal healthcare, because of the stupendous amount of money being wasted and spent on paying expensive healthcare for the uninsured. There is a push...
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...the Affordable Care Act Submitted By: Vodney Wynn vewynn@aol.com October 12, 2014 PA582_CourseProject Table of Contents 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...
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...widespread and affordable health care to its citizens. Will health care reform be able to deliver quality services at affordable cost with its existing workforce crisis in the healthcare system? Number of uninsured Americans has significantly increased, mainly due to aging population and income change. The prevalent issue of America’s healthcare system is insurance coverage, access to healthcare. Americans believe this issue should be prioritized, and it is the direct responsibility of federal government to ensure medical care for those citizens that lack insurance. This essay include history of United States healthcare system, its evolution and how healthcare providers can contain costs of healthcare and provide quality and access to healthcare for everyone. From the beginning of 2014 Affordable Care Act by Obama government is trying to solve the enduring issue of American healthcare system. It is a step in the right direction but this reform is facing lots of resistance from Republican Party, that this reform will put country in debt stress. Many Americans are concerned with quality and access to healthcare with the influx in number of insured entering the healthcare system which is already facing the workforce crisis. United States Health care History Healthcare in United States is enduring issue and it is very sensitive subjects for Americans. United states from the beginning choose a market approach to medical care. Medical care is as a market commodity, that...
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...grave impacts on an individual’s access to health care. These disparities have been around for several centuries and continue to be problematic despite the little progression being made with the revisions of preexisting health care laws. Laws and regulations are continually being revised to allow further health insurance expansions in hopes to reduce the ethnic and racial disparities for access to adequate care. Even with the increase in awareness, policymakers and clinicians have...
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... 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 features and basic...
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...discuss the reimbursement mechanisms presented in the Sullivan article, the economics of providing ESRD treatment from the organization's point of view, patients options and potential trade-offs related to cost, quality, and access to treatment, and the ethical implications of treatment options based on cost evaluation. Reimbursement Mechanisms The major reimbursement mechanism presented in article End Stage Renal Disease Economics and the Balance of Treatment Modalities is Medicare. The system in place at this time is the fee for service with additional charges for medication and medical testing (Sullivan, 2010). The current reimbursement structure is based on a three times a week structure, because hemodialysis (HD) is the primary treatment for ESRD (Sullivan, 2010). According to Sullivan (2010) "The most ideal treatment for patients with ESRD is transplantation" (p.45). The reimbursement for peritoneal dialysis (PD) is the same as that of HD. With the passing of The Medicare Improvements for Patients and Providers Act of 2008, the payment structure will eventually become a bundled rate (Sullivan, 2010). This should help to control cost associated with additional medications, and also create a quality environment through quality measures to make sure care is not being reduced (Sullivan, 2010). "The current Medicare payment is $20.3 billion for 437,334...
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...difficult for him to make ends meet. With only six employees, the company’s owner cannot afford to offer health insurance. Leo’s annual salary of $30,000 allows him to purchase only the most basic of health plans, one that does not include coverage for prescription medications. Leo frequently must decide between medications and food, often opting for cheap junk food that is neither nutritious for his young family nor appropriate for a diabetic diet. Leo has recently applied for and been offered several other jobs, but at a lower salary and with no health insurance coverage. Recently, Leo’s diabetes has worsened. He has developed a serious infection that has led to lost wages and, far worse, the loss of his right leg below the knee. Leo is weighing his options. He has heard about a new clinical research trial open to insulin-dependent diabetics that pays $100 a week to research subjects. He has also been quite depressed and begun to wonder if his children might not be better off without him. He has several life insurance policies that would pay off generously if something were to happen to him, and he has broached the subject of assisted suicide with his long-time physician. Is there a way, he asks his physician, to have his death look like it was from natural causes so his children could collect on the policy? CHAPTER QUESTIONS 1. What ethical responsibilities do health care professionals have to their patients? 2. What ethical rights do patients have?...
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...What is patient satisfaction? Is it access to care, communication, treatment received leading to unnecessary testing, staffing, training, or privacy issues? All of them have an impact. Every patient have experiences that are quite different, however, many can agree that their main concern is the quality of care. Many facilities like hospitals, clinics, and major health care insurance companies have been struggling to control the numbers of disgruntled patients complaining about the quality service they received at their provider offices. Even though this is dealt with an institutional level, the United States Department of Health and Human Services also struggles at a federal level as they try to find ways to improve quality of health care for their people. Every year, Congress is given a report submitted by the United States Department of Health and Human Services from various agencies, such as Agency for Health Care Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), Health Resources & Services Administration (HRSA), Food & Drug Administration (FDA), Indian Health Services (HIS), National Institutes of Health (NIH), Substance Abuse & Mental Health Services (SAMHSA) of their agency specific quality-strategic plans (AHRQ, 2002). To develop quality-strategic, each agency follows the National Quality Strategy (NQS) guidelines that outlines specific areas that impacts quality. All agencies are trying to...
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