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Problems with emergency room overcrowding
Problems with emergency room overcrowding
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Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.
Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the over utilization of hospital emergency rooms. This is a direct result of not having a primary care physician and/or family doctor who is the main source of healthcare delivery for an individual and/or entire family The traditional Medicaid program does not offer, or require, recipients to choose a primary care physician like, its counterpart, Medicare. Medicare still operates under the traditional fee-for-service methodology and does not require beneficiaries to identify and primary provider as well as having direct access to specialty services. This allows a cost sharing approach which results in higher out-of-pocket expenses and does not cover drug or prescription benefits.
In an effort to offer better healthcare services and access as well as reduce costs the federal government allowed the States to turn to managed care and proposed a mandatory statewide implementation for the Medicaid population. In order to make major changes like these, states have to request waivers of Medicaid regulatio...
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...sive.(Practice Trends)." Clinical Psychiatry News 33.2 (Feb 2005): 88(1). Academic OneFile. Thomson Gale. University of Phoenix. Retrieved February 25, 2013 from:
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5. Roohan, Patrick J., Anarella, Joseph P., & Gesten, Foster C. (July-August 2004)
Quality oversight and improvement in Medicaid managed care.(Quality Assurance Reporting Requirements ). In Journal of Public Health Management and Practice, 10, p321(9).
6. Wang, Cheng, Villar, Maria Elena, Mulligan, Deborah A., & Hansen, Toran. (Nov 2005) Cost and utilization analysis of a Pediatric Emergency Department Diversion Project. In Pediatrics, 116, p1075(5). Retrieved July 11, 2013, from InfoTrac OneFile via Thomson Gale:
Things that will determine the cost of care provided at an urgent care clinic are:
There has been a shortage of physicians, lack of inpatient beds, problems with ambulatory services, as well as not having proper methods of dealing with patient overflow, all in the past 10 years (Cummings & francescutti, 2006, p.101). The area of concern that have been worse...
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
Niles, N. J. (2014). Basics of the U.S. health care system (2nd ed.). Retrieved July 14, 2016, from http://samples.jbpub.com/9781284043761/Chapter1.pdf
Since the initiation of the Affordable Care Act in 2010, Americans have been put back in charge of their individual health care. Under this new law, a health insurance marketplace provides a haven for individuals without insurance to gain coverage. Just this year, citizens found out early whether they qualified for Medicare or the CHIP formally known as the Children’s Health Insurance Program. So much is to be learned about the Affordable Care act and this paper provides the roles of the different governmental branches, along with other important factors associated with this law.
In order to make ones’ health care coverage more affordable, the nation needs to address the continually increasing medical care costs. Approximately more than one-sixth of the United States economy is devoted to health care spending, such as: soaring prices for medical services, costly prescription drugs, newly advanced medical technology, and even unhealthy lifestyles. Our system is spending approximately $2.7 trillion annually on health care. According to experts, it is estimated that approximately 20%-30% of that spending (approx. $800 billion a year) appears to go towards wasteful, redundant, or even inefficient care.
Despite the established health care facilities in the United States, most citizens do not have access to proper medical care. We must appreciate from the very onset that a healthy and strong nation must have a proper health care system. Such a health system should be available and affordable to all. The cost of health services is high. In fact, the ...
In consequence, this will limit poor adults finding the proper treatment since many doctors do not accept Medicaid patients. High rates of uninsured populations were associated with lower primary care capacity (Ku et al., 2011). Thus, expanding insurance coverage can support more primary care practices in rural areas and can help equal the gap in primary care positions. The impact of not expanding affects APRN practice by limiting them to practice in areas where they are needed the most. This not only affects APRNs from practicing without a physician supervision but also limit those that need coverage for basic preventive measures to reduce non-paying visits to the emergency room. Ensuring access to care will be contingent upon the ability to attain progress from insurance coverage and primary
Medicaid is a broken system that is largely failing to serve its beneficiary’s needs. Despite its chronic failures to deliver quality health care, Medicaid is seemingly running up a gigantic tab for tax payers (Frogue, 2003). Medicaid’s budget woes are secondary to its insignificant structure, leaving its beneficiaries with limited choices, when arranging for their own health care. Instead, regulations are set in order to drive costs down; instead of allowing Medicaid beneficiaries free rein to choose whom they will seek care from (Frogue, 2003)
Do you enjoy paying medical bills? Healthcare accounts for about 1/6 of the entire economy, more than any other industry. Researchers find that the spending on health care totals about $2.5 trillion which is about 17.5% of America’s gross domestic product: a measure of the value of all goods and services produced in the United States (New Health Insurance). It covers money paid to health care providers such as hospitals, outpatient centers, veterans’ affairs and other clinics, doctor and dentist practices, physical therapists, nursing homes, home health services and on-site care at places such as schools and work sites. Also included are retail sales of prescription and nonprescription drugs, premiums paid to health insurers, and revenues of makers of medical devices, surgical equipment and durable medical equipment such as eyeglasses, hearing aids and wheelchairs. It also counts out-of-pocket payments by consumers for health insurance premiums, deductibles and co-payments, along with costs not covered by insurance. Healthcare is one of the biggest economic problems Americans are facing. Medical care and health insurance expenses are impacting the lives of many Americans today. The focus problem, which once was uninsured Americans inability to pay for their medical care expenses are no longer a problem that is affecting only those who are uninsured, but is also steadily becoming a problem for those with health insurance. The problems of health care are affecting many American people: the uninsured/underinsured and insured, the unemployed and working, children and retirees, single individuals and families, men, women and small businesses. The list goes on. These problems can be solved in a dramatic reform to socialized healthcare. ...
The contentious debate about our healthcare system is an epitome of the ongoing political circus in America. With the 2012 elections looming just around the corner, we can expect the vitriol to rise rapidly. Our country spends twice as much on health care per capita compared to other developed countries. The current system is so dysfunctional and projected spending will increase every year, putting an unbelievable strain to our fragile economy. Majority of health care dollars spending are channeled on to patients with chronic illnesses, many of which can be prevented. Unfortunately, medical doctors practicing preventive care are being squeezed out of the equation. The shortage of primary care doctors in America is inevitable because of limited income, lesser prestige, and fewer opportunities.
Nearly every American can agree that our current health care system needs reforms. Primarily do to the fact that 45.7 million Americans are without health insurance. That's approximately 16 percent of Americans who sometimes have to do without healthcare, or face crucial financial responsibility. The main issues are admission to healthcare, and the affordability of health care. Before 1920, doctors didn't know enough about diseases to really provide useful care to sick people. Therefore the...
The U.S. healthcare system is very complex in structure hence it can be appraised with diverse perspectives. From one viewpoint it is described as the most unparalleled health care system in the world, what with the cutting-edge medical technology, the high quality human resources, and the constantly-modernized facilities that are symbolic of the system. This is in addition to the proliferation of innovations aimed at increasing life expectancy and enhancing the quality of life as well as diagnostic and treatment options. At the other extreme are the fair criticisms of the system as being fragmented, inefficient and costly. What are the problems with the U.S. healthcare system? These are the questions this opinion paper tries to propound.
I believe that if you asked a group of people to list off issues regarding an emergency department then they would say long wait times throughout the process and being moved around to different areas of the emergency department. From what I have heard the long waits can be associated with waiting to get back to a room, waiting to see a nurse, waiting to see a doctor, waiting to go to radiology or lab, waiting on results, waiting to be discharged, or waiting to be admitted. All of these things in my opinion add up to one main problem, which is patient flow through an emergency department. In my opinion being able to have a controlled patient flow allows for improved wait times and decreased chaos for patients. So there are a few things
Wedding, D., & Corsini, R. J. (Eds.). (2014). Current psychotherapies (10th ed.). Belmont, CA: Brooks/Cole, Cengage