In chapter four, the main topic is about different healthcare. Managed care is restructuring the healthcare system by keeping the cost low and manage the number of patients. Medicare supports people at the age of 65 and up, disabled, entitled to Social Security benefits of Railroad Retirement benefits. It is a federal program that’s designed to support free choice in healthcare. Medicaid is is also a federal program that provides health assistance to the indigent. There are some cases of fraud that involves medicare and Medicaid. The Health Care Quality Improvement Act is a peer review of a physician from other healthcare professionals. It was created to prevent malpractice and improve patient care. This chapter also informs you about forms
Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.
The Health Insurance Portability and Accountability Act, most commonly known by its initials HIPAA, was enacted by Congress then signed by President Bill Clinton on August 21, 1996. This act was put into place in order to regulate the privacy of patient health information, and as an effort to lower the cost of health care, shape the many pieces of our complicated healthcare system. This act also protects individuals from losing their health insurance if they lose their employment or choose to switch employers. . Before HIPAA there was no standard or consistency for the enforcement of the privacy for patients and the rules and regulations varied by state and organizations. HIPAA virtually affects everybody within the healthcare field including but not limited to patients, providers, payers and intermediaries. Although there are many parts of the HIPAA act, for the purposes of this paper we are going to focus on the two main sections and the four objectives of HIPAA, a which are to improve the portability (the capability of transferring from one employee to another) of health insurance, combat fraud, abuse, and waste in health insurance, to promote the expanded use of medical savings accounts, and to simplify the administration of health insurance.
Healthcare has been a topic of discussion with the majority of the country. Issues with insurance coverage, rising costs, limited options to gain coverage, and the quality of healthcare have become concerns for law makers, healthcare providers and the general public. Some of those concerns were alleviated with the passing of the Affordable Care Act, but new concerns have developed with problems that have occurred in the implementation of the new law. The main concerns of the country are if the Affordable Care Act will be able to overcome the issues that plagued the old healthcare system, the cost of the program, and how will the new law affect the quality of the health delivery system.
Niles, Nancy J. Basics of the U.S. Health Care System. Sudbury, MA: Jones and Bartlett, 2011. Print.
The United States (U.S.) has a health care system that is much different than any other health care system in the world (Nies & McEwen, 2015). It is frequently recognized as one with most recent technological inventions, but at the same time is often criticized for being overly expensive (Nies & McEwen, 2015). In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) (U. S. Department of Health & Human Services, n.d.) This plan was implemented in an attempt to make preventative care more affordable and accessible for all uninsured Americans (U.S. Department of Health & Human Services, n.d.). Under the law, the new Patient’s Bill of Rights gives consumers the power to be in charge of their health care choices. (U.S. Department of Health & Human Services, n.d.).
A very notable goal is to make healthcare affordable for all Americans and at the same, improving the quality and efficiency in which healthcare is conducted. Many look at this act and notice the key benefits that are provided for all Americans, and are interested to find other improvements that help everyday ...
The healthcare reform debate has been politicized in the United States for many years where there have been deliberate efforts by various stakeholders to ensure that they push for the reforms that are in line with the cost-benefit aspects that they have already envisioned. In this paper, I will attempt to prove that the reforms that have been witnessed in the healthcare in the recent years have not been effective and helpful to the society as a whole. When President Obama came into office, he promised to oversee great reforms in the healthcare which is his government he face much priority in the social policy aspects. The congress managed to pass the Patient Protection and Affordable Care Act (PPACA).
Niles, N. J. (2011). Basics of the U.S. health care system. Sudbury, MA: Jones and Bartlett.
Stephen Jonas, Raymond G, Karen G, “An Introduction to the US healthcare System” 6th Edition, Page 118, 25 May 2007
Health care is one of the most debated issues in the United States today and it 's necessary to understand the basics of this problem. Approximately 50 million people living in the United
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
Healthcare Policy has been through many ups and downs over the years. The first United States legislature to involve healthcare dates back to 1798, when “The Act for the Relief of Sick and Disabled Seamen” was adopted. This approach is not very different in how healthcare works today. The act called for a 200 cent tax on seamen in order to pay for their health care. But it wasn’t until 1912, when President Theodore Roosevelt campaigned on a platform to adopt a single national health service. Finally a program called Medicaid was adopted to insure low income families, and in 1966, Medicare was adopted, guaranteeing health care for those over the age of 65 who paid into the system. Finally, The Affordable Health Care for America Act was introduced in 2009, and while it has changed and been revised a few times since then, it is th...
As I’m coming to the twilight of my undergraduate degree at Charter Oak Stat College, I’ve chosen to write about the Affordable care act so I can better understand the reality of today’s healthcare system from the facilities, providers and patients point of view. I feel understanding this information will help me create an environment that can adapt and accelerate through the transition due to the affordable healthcare act’s broad impact on healthcare as it was once known and practiced. I feel whether I move forward as a nurse, provider or administrator, this information will be invaluable.
“Medicare and the New Health Care Law — What it Means for You.” (2010). Medicare Publications, http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf
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.