The document discusses the history and evolution of health care financing in the United States from the mid-1800s to present day. It covers the emergence of private health insurance, the creation of Medicare and Medicaid in 1965, the rise of managed care in the 1980s-1990s, and the passage of the Affordable Care Act in 2010. The document also examines factors that have driven rising health care costs such as fee-for-service payment and lack of cost control, and reforms attempted to address these issues through prospective payment systems and managed care.
Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
State of the US healthcare industry - a compilation of infographics 2014Dr. Susan Dorfman
2014 is the year of healthcare reform! The internet is full of amazing information showcasing the scope of the reform and its current successes and struggles - as well as the impact it will have on the varying healthcare stakeholders, from healthcare professionals to institutions, patients and pharmaceutical manufacturers
Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
State of the US healthcare industry - a compilation of infographics 2014Dr. Susan Dorfman
2014 is the year of healthcare reform! The internet is full of amazing information showcasing the scope of the reform and its current successes and struggles - as well as the impact it will have on the varying healthcare stakeholders, from healthcare professionals to institutions, patients and pharmaceutical manufacturers
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
A simple overview on heatlhcare costs and reasons why there is a global increase in the field. The presentation concentrates the Omani setting with a comparison to what is available in public reports.
Community based Health Insurance Scheme: An option to Health Care Financing i...Dr. Nkiru Nwamaka Ezeama
A synopsis of how community-based health insurance can ease the burden of health care financing in Nigeria.
Presented during the 2016 Physicians week of the Nigerian Medical Association
Physician Expectations and Primary Care Shortages: Evidence from the Affordab...Gerrit Lensink
This paper is the first installment in my undergraduate thesis on physician expectations and their effect on primary care shortages in the United States. Over following semesters I will be strengthening my research with econometric models and further analysis. Updates will follow as completed.
Health Financing Functions: Risk PoolingHFG Project
Presentation by Dr. Elaine Baruwa, Abt Associates, at Haiti's International Conference on Access to Health Care for All in Haiti: Challenges and Perspectives for Funding, April 28-29, 2015, Haïti
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
A simple overview on heatlhcare costs and reasons why there is a global increase in the field. The presentation concentrates the Omani setting with a comparison to what is available in public reports.
Community based Health Insurance Scheme: An option to Health Care Financing i...Dr. Nkiru Nwamaka Ezeama
A synopsis of how community-based health insurance can ease the burden of health care financing in Nigeria.
Presented during the 2016 Physicians week of the Nigerian Medical Association
Physician Expectations and Primary Care Shortages: Evidence from the Affordab...Gerrit Lensink
This paper is the first installment in my undergraduate thesis on physician expectations and their effect on primary care shortages in the United States. Over following semesters I will be strengthening my research with econometric models and further analysis. Updates will follow as completed.
Health Financing Functions: Risk PoolingHFG Project
Presentation by Dr. Elaine Baruwa, Abt Associates, at Haiti's International Conference on Access to Health Care for All in Haiti: Challenges and Perspectives for Funding, April 28-29, 2015, Haïti
Running head: PUBLIC HEALTH
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PUBLIC HEALTH
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Public Health
Student’s name
University affiliation
Public Health
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Briefly describe the public health problem and the policy that addresses the problem.
The public health problem of interest is limited accessibility of quality and affordable health care due to a rising cost of health care services. This is a major issue which has affected millions of Americans especially those who cannot afford to pay for their health care insurance or pay directly for health care services. The rising cost of health care services includes the rising prices of prescription charge, primary care, and specialized care which have limited the accessibility of quality health care. Some of the effects of rising health care cost include; i) rising insurance premiums, ii) limited access to specialized care such as breast cancer screening and maternal care for women, and iii) limited access to specialized care for different vulnerable groups such as persons who have chronic health conditions or those who are at a high risk of getting chronic illnesses.
To address this public health problem, the federal government introduced the Patient Protection and Affordable Care Act which famously known as Obama Care. This policy was signed by President Barack Obama in March 2010 with the goal of bringing key reforms in the health care sector to address the problem of health care cost, quality, and access. The primary objectives of the Affordable Care Act (ACA) were to; prevent the increase in the cost of prescription drugs and health care services, ensure that all citizens could have access to affordable health insurance coverage, promote patient protection, and deliver better services (Amadeo, 2019).
• Examine the nature and magnitude of the problem and the people who are affected.
Generally, the issue of increasing health care cost affected all Americans, especially those who could not afford health insurance coverage and the vulnerable population groups. Persons who could not afford health insurance could not access quality health care services since they were very expensive and they would not afford to cater for out-of-pocket payments. Vulnerable population groups included the aging population who are the most vulnerable group to be affected by chronic illnesses. The high cost of medication limited the ability of the affected group to access quality health care thus leading to a high mortality rate. The magnitude and nature of the high cost of health care can be analyzed as follows.
Rising insurance premiums
As of 2004, the cost of health care services had increased by 4 percent. Quality health care services and prescription drugs were getting expensive forcing the healthcare insurance providers to increase their premiums. Premiums were rapidly increasing between 2000 and 2010 at a rate of 8 percent for family premiums covered by employers (Amadeo, 2018). Due to this, hundreds of tho.
SOCW 6351 Wk 9 Discussion 1. Need Responses.Respond in one of t.docxrosemariebrayshaw
SOCW 6351 Wk 9 Discussion 1. Need Responses.
Respond in one of the following ways:
· Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
· Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.
Support your response with specific references to the resources. Be sure to provide full APA citations for your references.
NA:
Top of Form
Medicaid is a medical assistance program developed specifically for low income individuals of any age, unlike Medicare, which is designed for those over 65 and have no income requirements (“Difference between Medicare and Medicaid”, n.d.). When health care policies are change, they affect programs such as Medicaid and Medicare. For example, when the ACA (Affordable Care Act) was implemented, it led to an increase of enrollment as it made the process easier and reached more individuals and it expanded Medicaid eligibility to low-income adults (Wachino, Artiga & Rudowitz, 2014).
In the state of Pennsylvania, a Medicaid policy that I would amend would be the Healthy PA policy, which was a Medicaid expansion that included drug and alcohol services (IRETA, 2015). The issue is the length of time it takes for someone to be admitted into a program. Whether it’s getting into an inpatient or outpatient program, the process needs to be expedited and more streamlined. Many who are suffering from substance abuse disorders struggle with finally getting themselves into a program and delaying the process could result in someone hesitating and deciding not to move forward with treatment that is crucial (IRETA, 2015).
In Pennsylvania, stakeholders include a steering committee, which is made up of hospitals, health care providers, consumers, foundations and academic institutions (“HIP”, 2019). This committee comes up with ways to improve population health and control health cost including Medicaid and Medicare. They developed a plan for heathcare delivery that will improve the quality of life for everyone, without limitations on income or background (“HIP”, 2019). This committee has 5 work groups that develop implementation plans for the goals that were developed by the committee and focus on specific aspects such as payment, price and quality transparency, population health, healthcare transformation and health information technology (“HIP”, 2019).
References:
HIP stakeholders. (2019). Retrieved from https://www.health.pa.gov/topics/Health-Innovation/Pages/Stakeholders.aspx
IRETA. (2015). Pennsylvania’s Medicaid expansion smooths the road to addiction treatment, but barriers remain. Retrieved from https://ireta.org/resources/pennsylvanias-medicaid-expansion-smooths-the-road-to-addiction-treatment-but-barriers-remain/
Wachino, V., A.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
Indian Healthcare - Transitional Shift Towards Sustainable & Mobile Care Bhavik Doshi
The Indian Healthcare sector constitutes mainly of hospitals, pharmaceuticals, Diagnostics, Insurance and Medical Equipment. The Indian Healthcare industry is growing by a rate of CAGR of 18% and is expected to grow to CAGR of 21% till 2020. This instills the signs of fulfillment of Vision 2020. The major factors influencing are increase in population, shift in demograpics, rise in disposable income, Increase in incedence of lifestyle related disease, rising literacy, tax benefits and rise in insurance coverage. Moeover the public health expenditure in India is very low which give the platform for the development. A holistic approach of "stakeholder relationship management" is required to bring about the trasntional shift in healthcare. New models are required to provide affordable and accessible solutions of healthcare. Public Private Partnership (PPP) model can be a boon to be provided as a solution. India has always been taking a leapfrog in welcoming new technological platforms. A classic example of such leapfrog of technology is transition of telecommunation from landlines to cell phones avoiding the transition to pagers. The introduction of mHealth have already created a revolution in changing the dimension of healthcare & cut-shorted the boundary between doctors and rural patients and have enhanced outreach and coverage.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
ANS: B
Rationale: B is correct because rapidly rising health care costs led Medicare to implement a prospective payment system in an effort to curb costs; the new system paid providers a set fee that was based on the patient’s diagnosis, as opposed to the retrospective payment system, which paid providers, after care had been provided, with built-in incentives for overuse of health care services. A is incorrect because managed care organizations were the result rather than the cause of the health care reimbursement revolution. C is incorrect because although technological advances have led to increased cost, they are not the only cause for the reimbursement revolution. D is incorrect because before 1983, the primary method of health care reimbursement was the retrospective system, which was a fee-for-service mechanism that encouraged overuse of health care services; reimbursement did not move to prospective payment until 1983.
Level of Difficulty: Comprehension
ANS: B
Rationale: B is correct because cost shifting is a major problem with the current system, leading to an increased cost for coverage for individuals, as well as for private and public payers. A is incorrect because in the United States, a higher percentage of GDP is spent for health care than in countries that provide government-sponsored health insurance for their citizens. C is incorrect because Medicaid coverage varies from state to state but can include coverage for people at some level above the poverty level. D is incorrect because private insurance companies have founded programs such as managed care, which limits unnecessary spending.
Level of difficulty: Application