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Healthcare and Politics Sample Paper

Healthcare and politics are inseparable, considering that the health sector relies on government policies and guidelines to define services’ quality, cost, and plans. The political domain influences various disciplines, including public policies, organizational systems, and legislative provisions. Depending on the existing political regime, healthcare changes are inevitable.

In the US, state and national politics determine comprehensive healthcare plans that include Medicare and Medicaid. Other healthcare developments dependent on the administrative tenures are patient protection Acts, Affordable Care Act (ACA), alongside others that continue to shape healthcare institutional expectations, operations, affordability, and accessibility. Therefore, politics and health are intertwined concepts that share historical dynamics.

History of Private Health Insurance and Managed Care

Private Health insurance and managed healthcare are among the fundamental health developments that became operational in the 20th century. In the late 19th century, few state and private insurance companies provide policies to cover care costs for employees and people with disabilities. Coverage for health issues unrelated to workplace accidents did not exist until the late 20th century. Between the 1910s to the mid-1940s, few hospitals and healthcare groups like the Western Clinic in Tacoma provided prepaid services.

For instance, the American Association of Labor Legislation conceptualized a health insurance bill framework for industrial workers in 15 states by 1915 (Oberlander, 2019). The program targeted lumber mill owners and employees. Between the mid-1940s to mid-1960s, states and federal governments embraced policies to foster the expansion of health benefits. Although at a slow pace, the era ushered the emergence of health insurance groups such as the Health Insurance Plan (HIP) of Greater New York and the Seattle-based Group Health Cooperative of Puget Sound.

Health insurance reforms unfolded in the subsequent years of the 1960s to 1970s. President John F. Kennedy proposed a health plan that became the Part A of Medicare. Kennedy’s plan targeted to finance healthcare services through taxes on earned income. In 1965, Congress passed two landmark Acts for healthcare insurance: Medicare for the elderly and Medicaid for low-income families (Hines et al., 2017).

However, it was until a decade later when managed care became a reality. In 1973, the Health Maintenance organizations (HMO) Act authorized startup grants and loans, more essentially, promoted the emergence of a holistic employer-based insurance market. From the 1970s to the 1980s, health insurance developments set avenues for the current policies such as the 2010 Affordable Care Act and Patient Protection (Gruber, 2017).

Although these landmark developments are fundamental in influencing access to healthcare services, the primary concern is reducing salary deductions and providing incentives to private insurance providers to share the cost of delivering medical covers. Therefore, the national government engages with various healthcare stakeholders to increase financial allocations and other prerequisite resources to complement private insurers’ efforts and reduce tax burdens.

Federal Laws that Protect Individuals Enrolled in Private Insurance

Undoubtedly, private insurers are fundamental in bolstering healthcare services by providing flexible and comprehensive insurance covers to employees and other individuals enrolled in their contracts. Therefore, the federal government includes these private insurance companies as subjects to various legal provisions to help protect individuals from price, safety, and quality compromises. The most profound laws that protect individuals enrolled in private insurance providers include the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Patient Safety and Quality Improvement Act (PSQIA) of 2005. The HIPAA provisions protect American employees, regardless of their employers, from transferring (carry) health insurance policies from job to job.

The program allows employees to apply for health insurance plans to replace lost coverage and adjust changes such as marriages, adoptions, and births (Cohen & Mello, 2018). More importantly, HIPAA protects insured individuals against discrimination based on health problems. Private health insurance providers who discriminate against individuals based on individual characteristics such as disability are punishable by federal law.

Simultaneously, PSQIA protects healthcare employees who report unsafe working conditions (Boulanger et al., 2019). The federal government created this Act to encourage effective reporting of medical errors while maintaining patient’s confidentiality rights. Therefore, the law is strict on protecting individual data during the process of healthcare quality reporting.

Customer-Driven Healthcare and Consumer Empowerment

Customer-driven healthcare and consumer empowerment are fundamental concepts that influence how people access, pay, and understand healthcare services. Consumer-driven healthcare originated in the late 1990s to engage consumers in healthcare purchases (Ferguson et al., 2020). The idea was to allow health insurance members to use various ways to pay for routine healthcare expenses. Before the plan, patients and people on regular healthcare services faced economic problems because healthcare expenses inflicted financial pressure. Therefore, the consumer-driven healthcare plan availed various payment opportunities to individuals, including health saving accounts (HSAs), Health Reimbursement Accounts (HRAs), and other payment accounts for medical purposes to protect individuals from costly out-of-pocket expenses. This aspect gave patients control over the health budget because they enjoyed opportunities to pay for routine services via personal-controlled accounts and fixed health insurance benefits.

Although consumer-driven healthcare services were essential in fostering quality and affordability, organizations faced the urge to embrace consumer empowerment practices to ensure greater transparency. According to Bridge et al. (2017), patient empowerment entails efforts to ensure that consumers have adequate support, resources, and tools to access, afford, and appreciate healthcare services. Under the consumer empowerment objective, the functional areas include promoting information transparency, engaging patients as partners, promoting patients’ experiences, and price transparency. These elements are crucial in improving relationships between patients and healthcare institutions.

Roles of Nurses Within the Private Insurance Market

Notably, the private insurance market plays an essential role in promoting healthcare quality, accessibility, and affordability. Due to the existing federal government’s provisions under different health Acts, it is valid to argue that private insurers hold an ideal position in the overall health improvement objective. Regardless of the prevailing changes in the healthcare sector, nurses remain ethically bound to engage in different efforts of improving health and healthcare services (Salmond & Echevarria, 2017). The recent healthcare provisions such as the Affordable Care Act of 2010 require expanding institutional scopes and systems to accommodate many consumers enrolled in flexible medical covers.

Nurses are crucial stakeholders in facilitating such reforms by providing medical expertise, leadership skills, and innovative competencies that complement healthcare system expansion. More importantly, opportunities for integrating advanced healthcare systems and organizational infrastructures place nurses as ideal figures for healthcare promotion, alleviating disease morbidity and mortality rates, and utilizing evidence-based healthcare practices (Salmond & Echevarria, 2017, pp. 20). Therefore, it is valid to argue that nurses have opportunities for transforming healthcare practices by accommodating recent reforms and assimilating their subsequent provisions to enhance service quality.

Conclusion

Private insurance providers are crucial stakeholders in transforming the health care sector in the county. These insurers provide medical covers based on monthly premium payments and other terms agreed upon with customers. Due to their essentiality, the federal government values them and enacts provisions to protect individuals enrolled in such plans. The reason for integrating private insurers into the mainstream healthcare reforms is to promote consumer-driven practices and empower individuals to control their budgets.

Current reforms such as the Affordable Care Act (ACA) operates to consolidate all stakeholders to increase healthcare efficiency, affordability, quality, and accessibility. Regardless of the tremendous changes in the US healthcare sector, nurses are crucial stakeholders who provide the necessary expertise, models, and practices relevant to the changes. Therefore, their opportunities are increasing due to the expanding healthcare scopes.

References

• Boulanger, J., Keohane, C., & Yeats, A. (2019). Role of Patient Safety Organizations in Improving Patient Safety. Obstetrics and Gynecology Clinics of North America, 46(2), 257-267. https://doi.org/10.1016/j.ogc.2019.02.001
• Bridges, J., Loukanova, S., & Carrera, P. (2017). Patient Empowerment in Health Care. International Encyclopedia of Public Health, 416-425. https://doi.org/10.1016/b978-0-12-803678-5.00324-6
• Cohen, I., & Mello, M. (2018). HIPAA and Protecting Health Information in the 21st century. JAMA, 320(3), 231. https://doi.org/10.1001/jama.2018.5630
• Ferguson, W., White, B., McNair, J., Miller, C., Wang, B., & Coustasse, A. (2020). Potential savings from consumer-driven health plans. International Journal of Healthcare Management, 1-6. https://doi.org/10.1080/20479700.2020.1770425
• Gruber, J. (2017). Delivering Public Health Insurance Through Private Plan Choice in the United States. Journal of Economic Perspectives, 31(4), 3-22. https://doi.org/10.1257/jep.31.4.3
• Hines, A., Raetzman, S., Barrett, M., Moy, E., & Andrews, R. (2017). Managed care and inpatient mortality in adults: effect of the primary payer. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2062-1
• Oberlander, J. (2019). Lessons from the Long and Winding Road to Medicare for All. American Journal of Public Health, 109(11), 1497-1500. https://doi.org/10.2105/ajph.2019.305295
• Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopedic Nursing, 36(1), 12–25. https://doi.org/10.1097/NOR.0000000000000308

Health Systems Comparison Discussion

The health systems concept varies between countries worldwide. The variation is influenced by factors such as geography, culture, disease epidemiology, and resource availability. Inherently, each country tunes its implementation to these factors to realize the preventive, curative, and rehabilitative benefits of healthcare. The article explores specific differences among the USA, Canada, and Germany, based on the five parameters of the structure, expenditure, resource allocation, quality indicators, and outcomes.

Comparison Matrix

USACANADAGERMANYHealthcare structure is run at the national and at the state level, where specific policies can be made. Most organization is loose and left for the individual states (Makeeba et al., 2017). Healthcare is largely privately owned, hence most people (42M) are either uninsured or underinsured (Ridic et al., 2012).Its medical system is called Medicare, which trickles down to the population through its provincial and territorial organization (Marchildon, 2019). Hospitals are regionally distributed as local, district, and base depending on case complexities they handle (Marchildon, 2019). Provisions for health administration are stipulated under the 1984 Canada Health Act.Its structure is based on principles of social insurance and solidarity, whose formal origins are in the Sickness Insurance Act of 1183 (Ridic et al., 2012). Healthcare is managed in a stepwise fashion, where the state legislates, provincial governments plan and manage hospitals and worker associations, and local governments run local facilities (Busse et al., 2017). Healthcare management is much decentralized.Health insurance is both private (70%) and public (26%). Public insurance is in the form of Medicare and Medicaid from the federal government (Ridic et al., 2012). Payment is through multiple have third-party involvement and even use of prepaid health plans (Makeeba et al., 2017). However, physicians are paid using a government-fixed fee-for-service basis.Healthcare costs are settled using a government-run national insurance program (NHI), which is universal (Ridic et al., 2012). Out-of-pocket payments by consumers are minimal, and patients do not get involved in the reimbursement processes (Yu & Zhang, 2017). Importantly, physicians are significantly autonomous and their payments are on a fee-for-service basis, which is reviewed periodically (Marchildon, 2019).Almost everyone has access to medical care, since having health insurance is anchored in law (Ridic et al., 2012). Low-income earners join sickness funds for their insurance needs, while the higher ones opt for private insurance Busse et al., 2017). There is, however, no restriction in joining either, voluntarily. Also, other cadres are recovered by public assistance, student insurance, and police officers insurance. The sickness funds, which are largely self-regulating, account for about 70% of healthcare spending.It allocates the highest amount to health, at 18% of GDP or $3.5T, with the amount being both privately and publicly pooled (Ridic et al., 2012). Its per capita spending is also highest at $11072.The allocations are financed by general taxes, which was $265.5B, or about 11.5% of Canada’s GDP (Ridic et al., 2012). Capita spending stands at $5418.Allocations are both government and individual-driven and amounted to $499.8B or 11.7% of Germany’s GDP (Ridic et al., 2012). Its capita spending is at $6646.

 

The USA has 2.7 physicians per 1000, 3.7 hospital beds per 1000, and an average hospital stay of 7.1 days. It also has more MRI units and CT scanners than Canada, but not Germany.Canada has 2.1 physicians per 1000, 4.7 hospital beds per 1000, and an average hospital stay of 8.4 days.Germany has 3.5 physicians per 1000, 9.3 hospital beds per 1000, and an average hospital stay of 12.0 days. It also has more MRI units and CT scanners than the USA.The USA has the highest infant mortality and lowest life expectancy of the three (Makeeba et al., 2017).

 

 

 

Importantly, patient satisfaction with the systems is the least in the USA.

Parameters in Canada are in the intermediate area for life expectancy and mortality rates between the three (Marchildon, 2019).

 

Importantly, patient satisfaction with the systems is greatest in Canada.

Germany has the lowest infant mortality and highest life expectancy of the three.

 

 

 

Importantly, patient satisfaction with the systems is intermediate in Germany.

References

• Busse, R., Blümel, M., Knieps, F., & Bärnighausen, T. (2017). Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition. The Lancet, 390(10097), 882-897. https://doi.org/10.1016/S0140-6736(17)31280-1
• Marchildon, G. (2019). Health System in Canada 32. https://www.researchgate.net/profile/Gregory-Marchildon/publication/332258919_Health_system_of_Canada/links/5caa2c0592851c64bd57a7ef/Health-system-of-Canada.pdf
• Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany, and Canada. Materia socio-medica, 24(2), 112. https://dx.doi.org/10.5455%2Fmsm.2012.24.112-120
• Yu, J., & Zhang, Y. (2017). Comparison of Single-Payer and Non-Single-Payer Health Care Systems: A Study of Health Administration Efficiency. Modern Economy, 8(06), 816. http://www.scirp.org/journal/PaperInformation.aspx?PaperID=77092&#abstract
• ???????, ?. ?., ????????, ?. ?., & ???????, ?. ?. (2017). Structure And Main Features Of Health Service System In Usa. Comparative Characteristic Of Health Service Indices In Russia And Usa. In ????????????? ?????-???????? ? ?????????? (pp. 16-17).

Healthcare Budgeting and Financing of a Primary Care Facility

Introduction

The proposed private primary care is the Shadge Hospital. Its main specialization will entail monitoring patient’s health data by use of wearable monitoring devices. The business model of this private primary care is built around the need to over value to customers by monitoring their health remotely (Grayston, Fairhurst & McKinstry, 2019). The potential customers for the business include the aged population which is at a high risk of blood pressure and heart disease (Vu, Bales & Bredenkamp, 2020). The data obtained from their customers will be relayed to a data center for action.

Volume of Patient Visits

The Shadge hospital is located in a community of 650,000 people. Within this community, there isn’t any primary care health facility that offers the same services. However, the population of the target customers is 4 percent since the larger majority are the youth. Thus, it is likely to experience a maximum volume of patient visits of about 26,000 patients. This volume might however change depending on the demographic changes in the coming years.

Revenues

While calculating revenue for Shadge Hospital, all calculations were based on a single estimated sale price, which is $400 and a single estimated purchase price, which is $300. The materials cost for Shadge Hospital’s products is calculated by using this equation:

???????????????????????????????? ???????????????? = ???????????????????? ????????????????????????????????????/???????????????????????????????????? × ???????????????????????????????????? ????????????????????????????? ????????????????????. The following statements and reporting give a projection of Shadge Hospital’s monthly and annual revenue as per the provisions of López, Rich & Smith, (2015).

Financial Projection #1: Shadge’s Hospital Revenue.

The Shadge HospitalMonthlyAnnuallyTarget profit (includes. owner€3,500€42,000salary)loan servicing€500€6,000Income after taxes€4,000€48,000Taxes 24%€960€11,520funding requirements€4,960€59,520loan interest€80€960Required)€5,040€60,480(A)Fixed costtarget salaries€2,000€24,000rent€800€9,600electricity, heat, water€200€2,400advertising€150€1,800insurance€150€1,800transport€150€1,800telephone/internet€250€3,000stationery/postage€50€600repairs/renewals€50€600depreciation€600€7,200local taxesTotal fixed cost€4,400€52,800(B)Revenues€9,440€113,280Purchases +materials and supplies€4,500€54,000(net of VAT)Net sales required€13,940€167,280VAT 24%€3,804€45,648Total Projected Revenue€17,744€212,928

The Shadge Hospital Projected Expenses

Fixed costtarget salaries€2,000€24,000rent€800€9,600electricity, heat, water€200€2,400advertising€150€1,800insurance€150€1,800transport€150€1,800telephone/internet€250€3,000stationery/postage€50€600repairs/renewals€50€600depreciation€600€7,200local taxesTotal Expenses€4,400€52,800(

 

Assumptions to justify all Volumes, Revenues and Expenses

There’s an obvious logic as to why the 26,000 volume of patients is logical. As mentioned in prior sections, the Shadge hospital is located in a community of 650,000 people. Within this community, there isn’t any primary care health facility that offers the same services. However, the population of the target customers is 4 percent since the larger majority are the youth. Thus, it is likely to experience a maximum volume of patient visits of about 26,000 patients. The revenue projection forecasts the amount of sales the healthcare facility can generate in a year’s time. Similarly, the expenses calculator gives a projection of the hospital’s total fixed costs in a year’s time.

3-year Operating Budget

                                                               The Shadge Hospital

Th

 

MonthlyAnnually3 yearsSales€17,744€212,928638,784Variable costsmaterials€13,248158,976476,928direct wagesotherTotal variable costs€13,248€158,976476,928Gross profit/contribution€4,496€53,952161,856Fixed coststarget salary (incl. taxes)€2,00024,00072,000rent€8009,6002,880electricity, heat, water€2002,4007,200advertising€1501,8005,400insurance€1501,8005,400transport€1501,8005400telephone/internet€2503,0003000stationery/postage€506001800repairs/renewals€506001,800depreciation€6007,20021,600local taxesotherTotal fixed costs€4,400€52,800158,400Net profit€96€1,1523,456Break-even point = A/B x C€17,365€208,381625,143

Break-even Analysis

Total fixed costs€4,400€52,800(Net profit€96€1,152Break-even point €17,365€208,381

 

Hint: Break-even Point is given by A*B*C.

Internal Rate of Return

To determine the Internal Rate of Return, it is critical to calculate the initial investment first as below:

The Shadge Hospital – Investment calculation

Rental deposits (3 months)85m2 (900Sqft) furnished accommodation in EXPENSIVE€2,700areasRenovation€4,000Telephone, fax, copying, internet€250Computers and software€3,000Furnishings & fixtures€1,500Supplies€1,000Marketing investment€1,000Registration fee€225Initial inventory (100 devices x 300 dollars)€30,000Working capital€10,000Total capital requirement€53,675

If Year 1’s Cash flow is 17,361, year 2’s cash flow is 208,381, and year 3’s capital investment is 625,143, then the IRR is 132.56%.

Net Present Value

Present Value of Cash Inflows (PVIFA) = 657,678

Net Present Value (NPV) = 604,003

Assessment of the Financial Risk

Starting the Shadge Hospital is a calculated financial risk. From the cash flow analysis above, it is evident that business will definitely work out. The business has a strong business model of offering primary care to aged population and at the same time, selling them wearable technologies to monitor their conditions.

The fundamental aspects that have to be taken into consideration when implementing these projections include keeping all factors constant, more so when it comes to marketing. Another fundamental that can be reflected in the finance projections above is the lack of competition. Within this community, there isn’t any primary care health facility that offers the same services. However, the population of the target customers is 4 percent since the larger majority are the youth. Thus, it is likely to experience a maximum volume of patient visits of about 26,000 patients. The revenue projection forecasts the amount of sales the healthcare facility can generate in a year’s time.

References

• Grayston, J., Fairhurst, K., & McKinstry, B. (2019). Using new technologies to deliver test results in primary care: structured interview study of patients’ views. Primary Health Care Research & Development, 11(02), 142. doi: 10.1017/s146342360999034x
• López, D., Rich, K., & Smith, P. (2015). Auditor size and internal control reporting differences in nonprofit healthcare organizations. Journal Of Public Budgeting, Accounting & Financial Management, 25(1), 41-68. doi: 10.1108/jpbafm-25-01-2013-b003
• Vu, L., Bales, S., & Bredenkamp, C. (2020). What drives utilization of primary care facilities?: Evidence from a national facility survey. International Journal Of Healthcare Management, 1-7. doi: 10.1080/20479700.2020.1752984

Healthcare Delivery Systems Sample Paper

Health is an integral part of human life and the law also allows one to access quality health. The health of the population determines the life expectancy of a population and health outcomes. A better healthcare system leads to a better outcome and increased expectancy as most people will access timely care. Health delivery systems are practices or processes of availing healthcare services to the population (Brach & Borsky, 2020). The effectiveness, accessibility, quality, and affordability will determine if a population will adopt the health care delivery system or not. A better healthcare delivery system is measured in terms of morbidity, mortality, life expectancy, and the presence of preventive measures. Several models of healthcare delivery systems exist in the United States, aimed at both enhancing access to care and improving population health. The modes described in this paper include managed- care, self-directed services, and telemedicine. The discussion will include the similarities, differences, description of the model, and their effectiveness.

Managed-Care System

A managed care plan is based on the principle of transferring all or some vital service delivery protocols to the healthcare providers. Health maintenance organizations (HMOs), managed fee-for-service plans, and preferred provider organizations (PPO) form part of the managed-care plans. Among the fundamental components of managed care plans include promotion of health, capitation payment, reasonable pricing of services, peer review, and criteria for quality check. According to Heaton and Tadi (2021), physicians, pharmacies, hospitals, and companies offering home care do share the emerging financial risks. Peer review is important in tracking the amount spent compared with the quality of services offered.

Capitation payments help in reducing cost through payment of the prior agreed fee for services offered to the patients between the insurance company and the health care providers such as physicians. Prospective pricing and bundling of services are essential in reducing inpatient costs, thus affordability of care. This model ensures that only relevant items including correct prescription are given to the patient to help in cutting down the unnecessary cost. The principles of managed care have led to reduced inpatient services to Medicare beneficiaries, helped in redirecting services to alternate providers, lowering prices of services by HMOs and PPOs (Heaton & Tadi, 2021).

The mission of Managed care focuses on reducing the cost of care while encouraging competition and encouraging accountability of the administration (Heaton & Tadi, 2021). It focuses majorly on improving the healthcare quality thus improved services offered with a better outcome. The agreement between an insurance company and specific hospitals or doctors must be honored regardless of the number of patients that access care. This leads to reducing the cost of care and enhancing easy access to medical services. The vulnerable population including the elderly, disabled, the poor and children can be included in this model to enhance easy access to services.

Telemedicine

Telemedicine includes using technology to offer care to patients in remote settings in their homes. Electronic communication and software are used to offer remote services without patients visiting the facility (Kichloo et al., 2020). Audio and video connections can be used in the follow-up of patients, management of medications, chronic disease management, consultation, preventive care, and offering care following discharge. For example, people with chronic conditions are taught how to self-monitor their sugars and communicate to their health care providers in case of any danger signs. The healthcare providers respond to patient concerns including offering timely interventions.

Services offered through telemedicine include surveillance, health promotion, diagnostic, prompt care, and public health functions (Kichloo et al., 2020). The patient is in direct communication with the healthcare providers and the patient addresses his/her concern to the care providers. Danger signs are diagnosed and care provided early enough. Health promotion services include educating on cessation of smoking and weight loss to prevent the occurrence of heart diseases. School-going children have also benefited from telemedicine services. In case a child becomes ill in school, technology can be used to link up with healthcare providers who will provide instructions or reassure the parents.

Compared to in-person visits, telemedicine offers major advantages to both the provider and the patient. The patient, for example, will reduce travel expenses, reduced exposure to contagious disease, less time spent out of work, increased privacy, and reduced interference of responsibilities (Kichloo et al., 2020). The providers o the other hand will; offer improved patient follow-up, reduced missed appointments, improved efficiency of the office, and encourage reimbursement of the private payer. The final achievement is the provision of quality care at a reduced cost. Effective management of chronic conditions such as diabetes and hypertension reduces the incidences of heart diseases and stroke.

Telemedicine aims at offering quality care at a lower cost through timely care, increased knowledge exchange, enhanced research, and the application of science and technology in the provision of quality care. The application of telemedicine is relevant in the current situation of the COVID 19 pandemic (Kichloo et al., 2020). Guidelines offered to reduce the spread of COVID 19 include social distance, wearing the mask, washing hands regularly, and staying at home. Telemedicine offers an opportunity for the offering of services without contact thus prevent overcrowding in hospitals.

Self-Directed Care

Self-directed care services are defined by the philosophy that allows the participants to be actively involved in their care including in decision-making. According to Cook et al. (2019), such patients can assess the quality of services, evaluate the services, determine how services are offered, and decide on whoever will provide the services. Participants focus on person-centered services and offer all specialized management. Decisions are made by the participant regarding the service providers and mode of service delivery. Self-directed care falls under Medicaid services allowing patients to hire providers that will address their personal needs.

Planning for a person-centered process requires prioritization of individual needs and designing the best possible plan that suits an individual. According to Hamovitch, Choy-Brown and Stanhope (2018), factors including strength, desired outcomes, needs, and preferences guide the type of plan to be adopted. Contingency planning is necessary when assessing risks. This model ensures that more services can be offered to the patient, which in turn results in improved outcomes. Self-directed care is a common in-home care and nursing homes.

Whoever is chosen to provide care must always be present. Services offered are dictated by the needs of the patients and the directives offered. Resources required to meet the needs of the patient must be offered to enable the achievement of goals. The attention and services offered to patient leads to better health outcome.

The mission of self-directed services is to support physically disabled individuals and elderly people with independent person-centered care (Cook et al., 2019). Commitment and taking up responsibility are vital in offering quality care. Choices, inclusion, and development of community health promotion are necessary for self-directed care. This model ensures that high-quality, individualized care is provided to meet the needs of a patient.

Conclusion

Health care delivery systems are essential in determining the choices made by providers and patients. Both health care delivery systems aim at providing quality care while reducing costs. Telemedicine is an integral field that ensures remote care thereby reducing overcrowding in healthcare facilities, makes it easier for individuals to access immediate care and allows for easier remote patient monitoring. An individualized care plan, as described in this paper, is essential in ensuring better healthcare outcome.

References

• Brach, C., & Borsky, A. (2020). How the U.S. agency for Healthcare Research and quality promotes health literate health care. Studies in Health Technology and Informatics, 269, 313–323. https://doi.org/10.3233/SHTI200046
• Cook, J. A., Shore, S., Burke-Miller, J. K., Jonikas, J. A., Hamilton, M., Ruckdeschel, B., Norris, W., Markowitz, A. F., Ferrara, M., & Bhaumik, D. (2019). Mental health self-directed care financing: Efficacy in improving outcomes and controlling costs for adults with serious mental illness. Psychiatric Services (Washington, D.C.), 70(3), 191–201. https://doi.org/10.1176/appi.ps.201800337
• Hamovitch, E. K., Choy-Brown, M. & Stanhope, V. (2018). Person-Centered Care and the Therapeutic Alliance. Community Mental Health Journal, 54, 951–958 (2018). https://doi.org/10.1007/s10597-018-0295-z
• Heaton, J., & Tadi, P. (2021). Managed care organization. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557797/
• Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala, R. C., Kanugula, A. K., Solanki, S., & Chugh, S. (2020). Telemedicine, the current COVID-19 pandemic, and the future: a narrative review and perspectives moving forward in the USA. Family Medicine and Community Health, 8(3), e000530. https://doi.org/10.1136/fmch-2020-000530

Healthcare Data: Describe the two online databases you worked with in VLab

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The purpose of this assignment is to reflect on how technology assists with the management of healthcare data to improve services and outcomes. This is a reflective paper that is intended to be completed after you have successfully completed Tableau VLAB Activity 3.

In a 750–1,000 word reflective essay, discuss how health information technology assists with the management of health data. Include the following in your essay:

1. Describe the two online databases you worked with in VLab.
2. Describe how you utilized health information technologies, applications, tools, processes, and structures to manage health data.
3. Which specific analytics technologies are utilized most often by healthcare organizations?
4. Analyze and interpret the data from the Tableau VLab and explain how the data can be used to improve healthcare services and health-related outcomes and promote wellness among populations.

Prepare this assignment according to the guidelines of APA Style.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part, and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.

Healthcare Data: Describe the two online databases you worked with in VLab Instructions

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.

LopesWrite Policy 

• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

• Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
• Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

 

Healthcare Environment Week 5 Discussion

Healthcare Environment Week 5 Discussion

Find an article related to nursing’s role in leading change in our current healthcare environment & complete an Annotated Bib based on the attached instructions. The article must be < 5 years old.

An Annotated Bibliography includes a summary, assessment & reflection of an article. The annotation aims to inform the reader of the article’s relevance, accuracy, and quality. Your annotated bib assignment should include a paragraph for each component (use these headings).

See Annotated Bib Assignment grading rubric. See the OWL website for examples and samples of annotated bibliographies*. 1.

Summarize: brief paragraph of the main points/topics

2. Assessment/Evaluation

a. Was this a useful resource – why or why not?

b. Is the information reliable?

c. Is this source biased or objective?

d. What is the goal of this article?

e. See OWL handout on “evaluating resources”*

3. Reflection: examining and interpreting experience to gain new understanding.

a. Was this article helpful to you?

b. How can you apply this information to your practice?

c. Has the information changed how you think about this topic? *

Owl Purdue Online Writing Lab https://owl.english.purdue.edu/owl/resource/614/1/

Annotated Bib Assignment: • Find a peer-reviewed article (<5 years old)

? Submit a 1-page Word document

? Title page not necessary; maybe single-spaced; APA format for reference

ORDER THROUGH BOUTESSAY

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort, and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.

Read over your paper – in silence and then aloud – before handing it in, and make corrections as necessary. Often, having a friend proofread your paper for obvious errors is advantageous. Handwritten corrections are preferable to uncorrected mistakes. Early Childhood Safety and Health Discussion

Use a standard 10 to 12 point (10 to 12 characters per inch) type ace. Smaller or compressed type and papers with small margins or single-spacing are hard to read. Letting your essay run over the recommended number of pages is better than compressing it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted and double-spaced with a one-inch margin on each page’s top, bottom, and sides. When submitting a hard copy, use white paper and print it out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

Healthcare Finance Problems: Understanding Healthcare Financial Management

Healthcare Finance and Private Health Insurance

Healthcare finance is the system of managing funds and other financial resources in the healthcare industry. It entails employing financial strategies and principles to plan and manage the financial aspect in hospitals and other healthcare organizations. Private health insurers are non-governmental for-profit insurance providers, whereby groups and individuals can get different health insurance covers.

Private health insurers play a significant role in financing healthcare. This discussion explores managed care, the initiatives implemented by private insurers to transform healthcare, roles played by nurses to improve quality patient outcomes tied to reimbursements. The strategies nurses can use to advocate for healthcare consumers and reduce the increasing cost of healthcare will also be discussed.

Managed care refers to a group of strategies taken to reduce healthcare costs. Members of managed care systems come together to coordinate medical services to control the cost of care provision while improving care quality. According to Heaton and Tadi (2023), managed care organizations integrate different healthcare entities, reducing healthcare expenditure. Managed care organizations continue to shape healthcare delivery in the United States by enhancing preventive medicine strategies, providing treatment guidelines, coordinating care, forming provider networks, and financial provision through incentives.

Private health insurers play a significant role in transforming healthcare. Private health insurance is one of the major sources of funding since a huge proportion of patients is covered using private health insurance covers. According to Denny and Collins (2021), private health insurers provide health insurance coverage to individuals and groups, transforming healthcare by enhancing better health for individuals, groups, and communities. Additionally, private health insurers have a great stake in facilitating universal health coverage since more people can access and afford healthcare services through insurance coverage. Private health insurers also promote value-based care and compete with government health insurers, thus reducing the cost of care. Denny and Collins (2021) note that value-based care is associated with better care quality, thus transforming the system.

When patient outcomes are tied to reimbursements, it means that the healthcare providers’ payment is directly linked to the quality or effectiveness/outcomes of the care delivered to patients. Quality patient outcomes directly linked to reimbursements include hospital readmission rates, complication cases, hospital-acquired infection, patient-reported outcomes, and timeliness of care (Kutz et al., 2019). Nurses can improve the quality of patient outcomes tied to reimbursements in several ways. These ways include infection control, patient education, medication management to avoid adverse reactions and errors, and compliance with evidence-based practice. Infection control would help prevent hospital-acquired infections and related readmissions, thus improving reimbursement-related outcomes. Patient education would help improve adherence, hence improving patient outcomes. In addition, complying with evidence-based practice would improve patient outcomes such as hospital readmission and complications.

Furthermore, nurses can advocate for healthcare consumers and reduce the cost of healthcare. The strategies that nurses can use to advocate for healthcare consumers include empowering them through education, providing access to information that would help patients make decisions related to healthcare costs, and participating in policy advocacy to regulate healthcare costs. In addition, Byrne et al. (2020) note that nurses are among the stakeholders that can influence healthcare costs through approaches such as patient-centered care.

Private health insurers are a major source of healthcare funding. Managed care through managed care organizations regulates healthcare costs. Nurses play a major role in patient outcomes related to reimbursements. In addition, nursing advocacy for health consumers is pivotal in reducing healthcare costs.  

Healthcare Finance References

Byrne, A. L., Baldwin, A., & Harvey, C. (2020). Whose center is it anyway? Defining person-centered care in nursing: An integrative review. PloS One, 15(3), e0229923. https://doi.org/10.1371/journal.pone.0229923

Denny, J. C., & Collins, F. S. (2021). Precision medicine in 2030-seven ways to transform healthcare. Cell, 184(6), 1415–1419. https://doi.org/10.1016/j.cell.2021.01.015

Heaton J, Tadi P. (2023). Managed Care Organization. In: StatPearls [Internet]. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK557797/

Kutz, A., Gut, L., Ebrahimi, F., Wagner, U., Schuetz, P., & Mueller, B. (2019). Association of the Swiss Diagnosis-Related Group Reimbursement System With Length of Stay, Mortality, and Readmission Rates in Hospitalized Adult Patients. JAMA Network Open, 2(2), e188332. https://doi.org/10.1001/jamanetworkopen.2018.8332

HCA 320 Module 7 Assignment Financing Healthcare

Financing Healthcare

Consider how compensation for healthcare services shape delivery of care, and reflects policy and policy changes and write a paper that addresses the bullets below. Be sure to completely address each bullet point. There should be four (4) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Include a “Conclusion” section that summarizes all topics. This assignment will be at least 1250 words.

This week you will reflect upon accountability in healthcare finance to address the following:

• Discuss the history of private health insurance and manage care and how it involved into a healthcare industry?  
• Identify the key federal laws that protect individuals who are enrolled in private insurance.
• Briefly discuss consumer-driven healthcare and the empowerment of the healthcare consumer.
• Explore the opportunities which have emerged for nurses within the private insurance market.

Start by reading and following these instructions:

1.   Study the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
2.   Consider the discussion and the any insights you gained from it.
3.   Review the assignment rubric and the specifications below to ensure that your response aligns with all assignment expectations.
4.   Create your assignment submission and be sure to cite your sources, use APA style as required, and check your spelling.

The following specifications are required for this assignment:

Length: 1250-1500 words; answers must thoroughly address the question in a clear, concise manner

Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment.  Your essay must include an introduction and a conclusion.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.

Format: Save your assignment as a Microsoft Word document (.doc or .docx).

Filename: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.docx”)

Undergrad Simple Essay Rubric v1 Healthcare Finance

CriteriaDoes Not Meet 0%Approaches 60%Meets 70%Exceeds 100%Criterion ScoreContent Weight: 30%0 pointsTopic is inappropriate to assignment, inaccurate understanding of concepts, unclear and difficult to understand; does not address many assignment requirements. Information has weak or no connection to the assignment topic.18 pointsTopic is mostly covered and appropriate to assignment, but does not adequately demonstrate accurate understanding of concepts; mostly clear and understandable; lacks some of the requirements of the assignment description and/or provides little detail; Information relates to the main topic, but few details and/or examples are given.21 pointsTopic is covered completely and appropriate to assignment; overview of key concept dimensions is evident; clear and understandable; addresses all of the requirements of the assignment description, with adequate attention to detail.30 pointsIn-depth coverage of topic; outstanding clarity and explanation of concepts demonstrated in information presented; approaches assignment with depth and breadth, without redundancy, using clear and focused details.Score of Content Weight: 30%,/ 30Organization Weight: 25%0 pointsOrganization is confusing and interferes with reader’s ability to follow ideas. Weak or no introduction of topic or purpose is unclear, weak, or missing. Conclusion lacks a summary of topic, or is missing or irrelevant.15 pointsIdeas are sometimes disorganized or irrelevant; Flow is sometimes choppy; somewhat clear organization. Basic introduction that states topic but is presented in an uninteresting way. Conclusion contains basic summary of topic without final concluding ideas, may inappropriately introduces new information.17.5 pointsStructures ideas in a coherent, organized order that has good flow and an obvious framework. Proficient introduction that is interesting and states topic. Conclusion contains good summary of topic with credible concluding ideas and introduces no new information.25 pointsExceptionally clear, logical, mature, and thorough organization permitting smooth flow of ideas; Introduction that grabs interest of reader and states topic in clear, unambiguous terms. Excellent concluding summary with succinct and precise ideas that impact reader.Score of Organization Weight: 25%,/ 25Logic/Argument Weight: 15%0 pointsDemonstrates little logical reasoning for the claims and thoughts within assignment; Many claims are weak or illogical.9 pointsLacks some logical reasoning for the claims and thoughts within the assignment; Some claims are weak.10.5 pointsUses solid logical reasoning for the claims and thoughts within the assignment.15 pointsProvides exemplary logical reasoning for the claims and thoughts within the assignment.Score of Logic/ Argument Weight: 15%,/ 15Support Weight: 20%0 pointsLacks support; Uses poor sources for references; Citations lack credibility, relevance, or academic quality or are not current; Does not meet the minimum number of required citations in assignment description. APA format and style are not evident.12 pointsProvides weak support or not enough support; Citations are not consistently credible, current, relevant or academic; Meets the minimum number of required citations in assignment description Missing APA elements; in-text citations, where necessary, are used but formatted inaccurately and not referenced.14 pointsProvides sufficient support with credible, current, relevant academic citations; Meets the minimum number of required citations in assignment description. ; In-text citations and a reference page are present with few format errors. Mechanics of writing are reflective of APA style.20 pointsProvides very strong support from credible, current, relevant, academic citations; Meets or exceeds the minimum number of required citations in assignment description. Accurate citations and references are presented. No APA errors are evident.Score of Support Weight: 20%,/ 20Quality of Written Communication Weight: 10%0 pointsStyle and voice inappropriate or do not address given audience, purpose, etc. Word choice is excessively redundant, clichéd, and unspecific. Inconsistent grammar, spelling, punctuation, and paragraphing. Surface errors are pervasive enough that they impede communication of meaning.6 pointsStyle and voice are somewhat appropriate to given audience and purpose. Word choice is often unspecific, generic, redundant, and clichéd. Repetitive mechanical errors distract the reader. Inconsistencies in language, sentence structure, and/or word choice are present.7 pointsStyle and voice are appropriate to the given audience and purpose. Word choice is specific and purposeful, and somewhat varied throughout. Minimal mechanical or typographical errors are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.10 pointsStyle and voice are not only appropriate to the given audience and purpose, but also show originality and creativity. Word choice is specific, purposeful, dynamic and varied. Free of mechanical and typographical errors. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.Score of Quality of Written Communication Weight: 10%,/ 10

Healthcare Financing Questions and Answers

A1. Compare the U.S. healthcare system with the healthcare system of Great Britain, Japan, Germany, or Switzerland

1. I shall compare the healthcare system in the U.S with that in Germany.

A2. Compare access between the two healthcare systems for children, unemployed people, and people who are retired.

In both Germany and the United States, access to healthcare is compulsory. Nonprofit insurance companies in Germany cover a large chunk of the population in what is dubbed “sickness funds” (Berghöfer et al., 2020). In these programs, the insurance premiums are catered for by the government making the costs quite low and affordable to the insured persons. This insurance option is available to any citizen regardless of their age or employment status. This does not however restrict anyone from pursuing other health insurance options. For instance, individuals earning over 30,000 Euros may decide to seek private health insurance covers.

The difference between private insurance and the “sickness fund” is that the former has age and health as determinants (Roman-Urrestarazu et al., 2018). Contrary, in the United States, a large proportion of the insurance covers are through private companies. Employers are obligated to provide the covers to their employees. One may decide to pursue their insurance coverage through the Federal Marketplace that has been facilitated by the Obamacare that was enacted in 2010.

The option is made available for persons who are not satisfied with the cover provided by their employers or whose employers do not provide any insurance covers. There is yet another alternative in the United States for the unemployed or low-income groups-Medicaid. This is run by the state and is dependent on state and federal taxes. The United States has diversified as it also has the Children’s Health Insurance Program and Medicare to cover individuals that are over 65 years (Garfield et al., 2021).

A.2.a. Discuss coverage for medications in the two healthcare systems

In Germany, the prescriptions are covered by the “sickness fund”. The only costs that one incurs for medication when covered by the sickness fund are 10% of the cost of the drug. This makes it quite affordable. However, for those on private covers, they have to pay in advance and get a refund later on. This system bears some resemblance with the situation in the United States. One thing that strikes the difference is that in Germany, prescription drugs are less costly due to collective bargaining with the buyer and seller.

This is possible as the model in Germany has only one buyer; the “sickness fund” thus drug companies do not hike their prices. The individual’s insurance cover caters to the prescriptions in the US. The pricing is done under various levels. The first level comprises generic drugs that are less costly as compared to level three that is comprised of brand-name drugs. Despite the relief of the insurance cover, brand-name drugs still are expensive. Drug prices in the United States are not controlled by the government thus the prices are unreasonably high.

A.2.b Determine the requirements to get a referral to see a specialist in the two healthcare systems.

The referral system in Germany is initiated by a General Practitioner or the patient directly to the consultant without making prior consultations with their general doctor. One can opt for the “sickness fund” or private insurance covers. Owing to long waiting times, one should check early enough. The case is somewhat different in the States. Having private insurance with a preferred provider organization allows one to seek the services of a specialist without a referral.

For health maintenance organizations, a referral is needed for one to see a specialist. A specialist may choose whether to accept public or private insurance. This implies that one’s insurance provider may bar them from accessing some specialists. Some specialists shun publicly insured patients since the reimbursement rates are low.

A.2c. Discuss coverage for preexisting conditions in the two healthcare systems

An individual with a preexisting condition in Germany is covered by insurance companies. Individuals on the “sickness fund” enjoy low costs regardless of whether they have preexisting conditions. Individuals on private plans can access health services at higher premiums in the event they have preexisting conditions. In the United States, denial of coverage or providing cover at higher premiums by an insurance company based on preexisting conditions is illegal (Huguet et al., 2019). This came into action after the Affordable Care Act of 2010. It however doesn’t apply to covers taken before the enactment.

A.3. Explain two financial implications for patients about the healthcare delivery differences between the two countries (i.e. how the patients are financially impacted)

In Germany, the sickness fund plays a major role in lowering medication costs for patients. This allows negotiations between the insurance provider and the pharmaceuticals making it a lot easier for patients. Contrary to this, there are no regulations against drug companies overshooting drug prices making it extremely expensive for the patients. One big reason why policies are not formulated is that the pharmaceutical sponsor politicians’ activities thus they enjoy their protection (Kathryn Hayes, 2021).

Another financial implication is the effect of the insurance covers on the costs of seeing specialists. As explained above, it is quite affordable to visit a specialist in Germany owing to the sickness fund. The cost is the same as that of a General Practitioner. The cost of seeing a specialist in Germany per quarter is much less as compared to the costs of seeing a general doctor in the US. In the United States, the cost of seeking health services is generally strenuous to the citizens. Much as the healthcare system in the United States has evolved over the years to be one of the world’s best, there is still room to make healthcare more affordable to its citizens.

References

• Berghöfer, A., Göckler, D., Sydow, J., Auschra, C., Wessel, L., & Gersch, M. (2020). The German health care Innovation Fund – An incentive for innovations to promote the integration of health care. Journal Of Health Organization And Management, 34(8), 915-923. https://doi.org/10.1108/jhom-05-2020-0180
• Garfield, R., Orgera, K., & Damico, A. (2021). The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid. KFF. Retrieved 10 July 2021, from https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/#:~:text=Nationally%2C%20more%20than%20two%20million,for%20Marketplace%20premium%20tax%20credits.
• Huguet, N., Angier, H., Hoopes, M., Marino, M., Heintzman, J., Schmidt, T., & DeVoe, J. (2019). Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act. The Journal Of The American Board Of Family Medicine, 32(6), 883-889. https://doi.org/10.3122/jabfm.2019.06.190087
• Kathryn Hayes, B. (2021). Politics and Healthcare: Drug Pricing Dynamics Leading Up to the 2020 Election. American Health & Drug Benefits. Retrieved 10 July 2021, from https://www.ahdbonline.com/issues/2020/october-november-2020-vol-13-no-5/3063-politics-and-healthcare-drug-pricing-dynamics-leading-up-to-the-2020-election.
• Roman-Urrestarazu, A., Yang, J., Ettelt, S., Thalmann, I., Seguel Ravest, V., & Brayne, C. (2018). Private health insurance in Germany and Chile: two stories of co-existence, segmentation, and conflict. International Journal For Equity In Health, 17(1). https://doi.org/10.1186/s12939-018-0831-

Healthcare Policy and Economics Sample Paper

Health Policy and Insurance

Various health organizations have specific policies on admissions types, criteria, and requirements. The process of hospitalization from admission to post-admission follow-up care also vary from one health organization to the other. Hospitalization can be done on an emergency or elective basis. Elective hospitalizations are based on clinicians’ orders to keep the client stay in the hospital overnight for close medical monitoring and nursing care. In both cases of hospitalizations, there are typical steps or processes which patients must undergo when seeking medical or nursing care regardless of the purpose of admission. The current discussion explores the typical hospitalization process under the ACA guidelines.

Health insurance covers medical, surgical, dental, and pharmaceutical expenses that the subscriber incurs during their hospitalizations. The details and specifics of the items covered by the insurance vary between insurance firms or companies’ policies. some companies reimburse the expenses while others pay the health organization directly. The American Affordable Care Act (ACA), enacted into law in March 2010 by President Barrack Obama, is a federal health policy that covers various areas in health, including costs. Before the implementation of ACA, patients with preexisting chronic medical conditions did not have easy access to medical coverage (Huguet et al., 2019). The journey by a patient during a hospitalization follows a defined path. However, the after-care path may vary depending on the indication for hospitalization or the results of the care. The ACA, in summary, is not an insurance scheme but a government policy regulating individual private health insurance firms and businesses related to health (U.S. Centers for Medicare & Medicaid Services, n.d.). The daily businesses of the health organization are also regulated in terms of patent protection and cost of care reduction.

Admission

Hospital admission can be classified into two broad types: emergency admission and elective admission. The ACA policy terms allow coverage for a patient admitted through both types of the mentioned admission situations. Some health organizations charge consumers for registration and the financial settlement of these charges depends on the terms of medical cover between the ACA-compliant patient and the insurance company. It is during admission that the health insurance status of the client is declared. The ACA policies seeks to ensure that all citizens regardless of age have access to a medical cover. This meant that the children and young adults under the age of 26 years are allowed to stay under their parents’ insurance covers. Elective admissions usually progress to inpatient ward admission or general outpatient care.

Emergency admission and critical care are two related processes in a typical hospitalization. Not all emergency admission end in the inpatient or critical care but most emergency admission and critical care requires close patient monitoring, thus the need for the best quality. The ACA provisions, though not all were implemented by 2019, have enabled better emergency care. The improvement in the delivery of critical and emergency care after implementation of the ACA has been associated with telemedicine incorporation, change in care systems (Rambur, 2017), and improvement of profitability of critical care centers.

Inpatient and Outpatient Care

A typical inpatient admission means that the clients have to spend at least one night under the care of professionals in the wards. This happens to patients with medical or surgical conditions that require close monitoring and the clients cannot care for themselves at home. Various chargeable medical and surgical services are offered at the inpatient care. In a typical hospital setting, these include but are not limited to laboratory services, nursing care, physician consultation, medical procedures, surgical operations, bed and bedside procedures among other services. Outpatient care majorly involves specialist consultation, lab services, minor surgical procedures, and nursing care among other minor one-day processes. Outpatient hospitalization does not require the client to spend the night in the hospital under the caregivers’ custody

Medical Investigations and Radiology

Lab services typically offered mainly include clinical investigative tests, follow-up monitoring tests, and pathology diagnostic tests. Imaging tests or investigations form a major interest for most insurance companies. The costs of imaging and radiological investigations such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound Scan (USS), PET scan, Bone scan, among others are very high. Moreover, the costs of these radiological and imaging tests vary from one health institution to the other. Before the implementation of the ACA, the payment for radiological and medical procedures was based on the fee-for-service model. This forced the legislators to rewrite the codes relating to charging patients on radiological procedures in the 2014 Radiological Society of North America (RSNA) meeting.

The new financial model for chargeable radiological services is value-based, hence justifiable. This has promoted a regulated system where the insurance companies cover radiological and procedure fees based on their values (Gerst, 2021). However, this has created controversy in quality assessment to justify the value-based system (Vasko & Basu, n.d.). Radiological tests are commonly used in current healthcare not only for investigation purposes but also for intervention and treatment purposes. Another diagnostic and interventional procedure with implications in healthcare is the endoscopy. Endoscopy procedures are performed by physicians in most cases and their charges are relatively high. For this reason, some healthcare insurance providers have strict regulations on endoscopy procedures.

Specialist Consultation

Consultation during hospitalization can be done in the outpatient clinic or during consultant reviews in the inpatient admission. According to Glied et al. (2017), the probability of consumers under the ACA accessing specialist care has increased under the new Affordable Care Act from 47.1% to 87% for insured consumers. This means that access to specialist caregivers had improved for Americans compliant with the ACA regulations. Private practitioners have been greatly affected by the reduction in fee-for-services that was common before the ACA due to changes in payment methods.

However, the out-of-pocket payments continues to rise, especially among consumers who already had medical covers before ACA but had to default because of an increase in their premiums (Glied et al., 2017). There has been a reduction in reimbursements from the Centers for Medicare and Medicaid Services. The value-based payment criterion has improved the quality of specialist consultation services while levying penalties on physicians who do not meet certain practice quality levels (American Medical Association, 2017). This has promoted patient protection to a greater extent.

Discharge, Aftercare, and Follow-up

The process of discharging hospitals paves way for administrative processes such as billing. This is the point where all care services provided to the patient are billed and forwarded to the insurance provider for reimbursements. When the patient is stable enough to take care of themselves or there are extra-hospital care methods that can be provided by the paramedics or heath affiliated institutions, the patient is discharged to start their journey to recovery. With current advancements in healthcare, remote health monitoring is used to care for stable patients with chronic medical conditions. The ACA directs the insurance firms to cover for patients with preexisting chronic medical conditions.

This means that whether the disease occurred before the patient took cover or thereafter, the insurance company has no right to reject their application to for medical cover. As such, insurance providers are obliged to cover the care provided after discharge from the hospital. A patient suffering from substance addiction or mental condition is also taken care of under the ACA policies. Management of these patients during the rehabilitation process is part of the hospitalization care whenever they are referred to a rehab institution (Steffen, 2019).  Even without a referral from a medical hospital institution, the health insurance firm has no right to decline medical cover for mental and substance abuse patients.

Patients may also be referred to an external pharmacy to buy prescription medication. Sometimes, the required prescribe medication may not be available in the health institution or the institution may not be having a pharmacy (Manchikanti et al., 2017). The patient may be required to buy the drug either as an off-label medication or approved medication for the purpose. The ACA in its aim to provide affordable care, regulated the process of prescription medication. The costs of prescription medications before ACA implementation varied greatly and were mostly unregulated. Pharmacists and pharmaceutical companies would charge different amounts for these medications thus raising the overall cost of healthcare.

Conclusion

The processes of typical hospitalization revolve around chargeable services and the requisite medical products in every health institution. The type of care determines the duration of stay and the overall cost the patient would have to incur at the end of care. Most patients in the US would pay for this care using health insurance cards. If unregaled, the health institutions would charge whatever amount they deem appropriate for the services, and the insurance firms would charge the premiums according to the fees charged by the hospital.

Therefore, the ACA was signed into law to regulate these discrepancies and ensure affordable care costs. Services provided to the patient under the ACA are regulated by the policy until after the discharge. Among the important care aspects regulated by ACA include the rehabilitation, mental health treatment, and costs of prescription medications.

References

• American Medical Association. (2017). Federal funding for the Medicaid program should not be capped: AMA. Ama-Assn.Org; American Medical Association. Retrieved February 26, 2021, from https://www.ama-assn.org/practice-management/medicare-medicaid/federal-funding-medicaid-program-should-not-be-capped-ama
• Gerst, S. (2021). Accountable care organizations could dramatically affect radiology practice. Diagnosticimaging.Com. Retrieved February 26, 2021, from https://www.diagnosticimaging.com/view/accountable-care-organizations-could-dramatically-affect-radiology-practice
• Glied, S. A., Ma, S., & Borja, A. (2017). Effect of the ACA on health care access. The Commonwealth Fund. Retrieved February 26, 2021, from https://www.commonwealthfund.org/publications/issue-briefs/2017/may/effect-affordable-care-act-health-care-access
• Huguet, N., Angier, H., Hoopes, M. J., Marino, M., Heintzman, J., Schmidt, T., & DeVoe, J. E. (2019). Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act. The Journal of the American Board of Family Medicine, 32(6), 883–889. doi:10.3122/jabfm.2019.06.190087
• Manchikanti, L., Helm, S., Ii, Benyamin, R. M., & Hirsch, J. A. (2017). A critical analysis of Obamacare: Affordable care or insurance for many and coverage for few? Pain Physician, 20(3), 111–138. https://www.ncbi.nlm.nih.gov/pubmed/28339427
• Rambur, B. A. (2017). What’s at stake in U.s. health reform: A guide to the Affordable Care Act and value-based care. Policy, Politics & Nursing Practice, 18(2), 61–71. https://doi.org/10.1177/1527154417720935
• Steffen, L. (2019). Intensive rehabilitation for post-acute rehabilitation services: The impact of value-based regulatory change on service delivery. Journal of Healthcare Finance, 45(3). https://www.healthfinancejournal.com/~junland/index.php/johcf/issue/view/31  
• U.S. Centers for Medicare & Medicaid Services. (n.d.). Essential health benefits – HealthCare.Gov glossary. Healthcare.Gov. Retrieved February 26, 2021, from https://www.healthcare.gov/glossary/essential-health-benefits/
• Vasko, C., & Basu, P. (n.d.). PPACA is unlikely to dramatically affect imaging volume, but a deeper cost focus is probable. Radiologybusiness.Com. Retrieved February 26, 2021, from https://www.radiologybusiness.com/sponsored/1065/topics/imaging-informatics/ppaca-unlikely-dramatically-affect-imaging-volume-deeper

Healthcare policy and identify the impact economics

Healthcare policy and identify the impact economics

• Select a healthcare policy and identify the impact economics, political, and legal/ethical issues had on the development of that policy
• At Least 2 references within 5 years (At Least 1 reference must be the course textbook• At Least 250 words

Read (Outcomes 1, 3, 6, 7):

Chapters 7-13 (8 hours)

• Mason, D.J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy & Politics in Nursing and Health Care, 7th Edition. St. Louis, Missouri, Elsevier

Lecture (Outcomes 1, 3, 6, 7)

• The Policy Process
• Political Analysis and Strategies
• Health Policy, politics, and professional ethics
• Communication skills for success in policy and politics
• Conflict Management in Healthcare
• Using the Power of Media to Influence Health Policy and Politics
• The United States Health Care System

ORDER THROUGH BOUTESSAY

Healthcare policy and identify the impact economics Instructions

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the
• Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.

LopesWrite Policy

• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

• Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
• Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.