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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Children’s Healthcare of Atlanta has a highly unique approach to patient care. The network of hospitals have a combined number of one hundred and fifty doctors, which is more than any other hospital in Georgia. The hospital has also been listed among the nation’s best by “Doctors in America”. In addition to
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.
The author also believes that the Medicaid expansion extends beyond the politics, and has an aim to impact the life, health, and financial stability for the state and individuals. Medicaid expansion can be beneficial to many countries that have a large proportion of low-income people that are uninsured and or with disabilities. This can aid in saving the state money because much of the cost is provided and covered by the federal government, that encourages healthier behavior and results to a reduction in chronic disease due to lower health care costs. Although Texas opted out in adopting the expansion, legislators should decide on the advantage and disadvantage of participating in the Medicaid expansion to improve the welfare of the state. The expansion of Medicaid coverage will give low-income pregnant women the chance to reduce the rate in infant mortality and provide an opportunity for those that were unable to get coverage to be
Throughout the years, there have been many individuals and families who have not been able to afford healthcare. Some programs have helped to provide for those in need, but they have not provided to all needy citizens. In an effort to provide more people with the healthcare and insurance they truly need, the United States government has developed the Affordable Care Act. The act’s purpose is to expand Medicare, which was originally developed to provide for the elderly and the disabled, to those who are not disabled but are in times of financial hardship. The Affordable Care Act was originally developed to ensure healthcare to all individuals who could not afford it on their own. It would seem that the increase in the number of patients would benefit hospitals, but this act does the opposite of its intended outcome. There are more patients visiting the hospitals, but the act lowers the costs of their medical bills, which in turn decreases the hospitals’ incomes. This decreased source of income causes both the patients and the employees to find new solutions to the increased amount of issues that they now endure.
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)
“In 2010, Medicare spent an estimated $48 billion– our tax dollars – on overpayment and waste. But the most tragic victims are people who need medical care but don’t have the money to pay for it”. (Allen), Furthermore, by physician also pay a important role which have an impact on the spending as well. The doctor orders masses of procedures to show that he or she has done their due diligence in diagnosing the patient. Unfortunately, all of these unnecessary tests and procedures lead to unnecessary custodies and cost to the patient. Another example of overtreatment is the use of services or procedures that have a slight benefit over the generic, fewer costly alternative events. When different treatment options provide equal results, but one costs more than the other, healthcare money is often wasted on the more expensive option. Another factor is choosing different healthcare plan. The government will distribute an enormous amount of money to healthcare plan even though many people wouldn’t be able to afford the plan. While the government noticed that many people won’t able to afford the rates, they still providing more money to plans. Studies shown that “6,027 adults ages 19 and older in the U.S., found that a quarter of adults with at least one chronic condition who met the criteria for being underinsured didn’t fill a prescription or skipped doses due to cost, compared with 7 percent of
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.
Reforming the health care delivery system to progress the quality and value of care is indispensable to addressing the ever-increasing costs, poor quality, and increasing numbers of Americans without health insurance coverage. What is more, reforms should improve access to the right care at the right time in the right setting. They should keep people healthy and prevent common, preventable impediments of illnesses to the greatest extent possible. Thoughtfully assembled reforms would support greater access to health-improving care, in contrast to the current system, which encourages more tests, procedures, and treatments that are either
In today’s healthcare system, there are many characteristics and forces that make up the complex structure. Health care delivery is a complex system that involves many people that navigate it with hopes of a better outcome to the residents of the United States. Many factors affect the system starting from global influences, social values and culture. Further factors include economic conditions, physical environment, technology development, economic conditions, political climate and population characteristics. Furthermore the main characteristics of the Unites States healthcare system includes: no agency governs the whole system, access to healthcare is restricted based on the coverage and third party agencies exist. Unfortunately many people are in power of the healthcare system involving multiple payers. Physicians are pressured to order unnecessary tests to avoid potential legal risks. Quality of care is a major component; therefore it creates a demand for new technology. A more close investigation will review two main characteristics and two external forces that currently affect the healthcare delivery system. Furthermore, what will be the impact of one of the characteristics and one of the external forces in review with the new affordable care act 2010? The review will demonstrate the implications to the healthcare delivery system and the impact on the affordable care act 2010.
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 ...
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...
Under the Affordable Care Act one of the most important provisions is to expand health care to low income families through Medicaid. This could have an effect on over eight million people who do not have access to health care currently. However 25 states have decided against expanding Medicaid benefits, leaving 13.5 million people less likely to receive basic health care and preventative ...
Commonly throughout most countries of the world, citizens of the society at large establish the system for Emergency Medical Services. In the case that the public is not willing or capable of summoning such a service, the country often finds other emergency services, businesses, or the government and authorities who act to employ a system. In other parts of the world, the emergency medical service additionally takes on the role of transporting patients from one medical facility to an alternative one. This occurs with some frequency because once a patient is analyzed and provided care at the immediate hospital; it may be more appropriate for a variety of reasons the patient needs to move to another facility. As one can see, the relat...