Health Insurance in the U.S.:
Health insurance has become an important part in the modern health care system even before the American government started to discuss the issue of compulsory medical insurance. Actually health insurance has asserted itself through the ever-increasing number of customers seeking for these services as well as through advertisements. The new customers tend to share information on the benefits of health insurance with their friends. This in turn results in the increase in the number of customers seeking for health insurance as the shared information continues to shape public opinion.
Types of Health Insurance in the U.S.:
The various types of health insurance available in the United States are classified into several categories. The three main types of these insurance plans are fee-for-service or indemnity plans, Health Maintenance Organizations, and Preferred Provider Organizations. In addition to being the traditional type of health insurance, the fee-for-service or…… [Read More]
Health Insurance Portability and Accountability Act (HIPAA)
Discuss whether there has been a violation of Health Insurance Portability and Accountability Act (HIPAA)?
There are no court rulings that can shed light on the issue. However going by the given facts, it is as follows: "Dr. Williams shows Joan's medical records to a friend for advice. His friend tells Dr. Williams to contact his medical malpractice insurance carrier." The problem here is if the friend is also a medical practitioner, attorney or some person exempted under the act for disclosure. The issue is not clear. It is assumed that the friend is also a medical practitioner. In that case Williams can take a stand that there has been no violation of the act if the doctor passed on the information for consultation purposes, and this is very clear from section 45 CF 160.103 according to which a business associate could be"…… [Read More]
What this in essence means is that the patient would not be able to choose his own brands of medication; he must only buy what the committee has recommended, otherwise, he would lose out on his health insurance payments.
A woman who faced a problem similar to that mentioned above talks about her experience as a diabetic. She said that when the health insurance company stated that they would be able to pay for a higher priced drug to control diabetes, than the one that the committee recommended, she argued and fought it out with the company, until, eventually, they agreed, albeit reluctantly, to pay for the higher priced drug 'Glucophage.' Her experience was that as soon as she started on hits drug, she found to her amazement that her sugar levels had started to drop considerably, and that her vision, which had been deteriorating for quite some time, gradually…… [Read More]
However, third-party payer systems became more popular with the increased bureaucratization of healthcare, particularly with the spread of HMOs and their complex paperwork for referrals. The use of third-party payers means "the processing of payments for insurance and other duties are handled" by another agency that is responsible for collecting premium payments and issuing reimbursements (Easey 2009).
It has been alleged that the use of such third parties means that individuals not well-versed in medical needs are making decisions about when reimbursements are valid regarding treatment and care, and are often looking for reasons not to pay for care, rather than to provide customers with the medical services they require as patients. It also creates another level of red tape between the patient and his or her doctor and insurance provider. An example of such an abuse might be an individual denied coverage because of forgetting to disclose a relatively…… [Read More]
Healthy Connections Kids (HCK) is a non-Medicaid administered care program for children up to age nineteen in South Carolina, who do not have other insurance coverage and whose family unit earnings is less than two hundred percent of the federal poverty limit. HCK benefits are founded on the state health plan benefits. Kids covered under this program must be enrolled in one of the Managed Care Organizations (MCO's) who provide HCK coverage. Dental care is billed to Medicaid, but claims for all other HCK services must be filed with the MCO (SC Healthy Connections Kids (SCHIP), n.d.).
Healthy Connections Kids is for uninsured kids up to age nineteen with family wages larger than one hundred and fifty percent but less than or equal to two hundred percent of the Federal Poverty Level. They must have possessions valued at or below thirty thousand dollars. The insurance is founded on the health…… [Read More]
Health Insurance Costs
Perhaps it is simply that we all need a few good villains in our life, and with the Cold War firmly over we must look closer to home to find our bad guys. Or perhaps it is simply that there is a great deal of villainy in society, that in fact society is nothing more than an evolutionary process of ever-more sophisticated forms of villainy.
Either explanation might do to explain the rise of the health maintenance organization as a pervasive element of American society as a primary reason that the quality of health care continues to decline even as health care costs continue to rise in this country. This paper examines the relationship between HMOs and other forms of health insurance and the rising cost of American healthcare, using the area of organ donation as a means of illustrating the complexities of the issue and the…… [Read More]
Some of the other benefits of the NHI include the fact that contributions are payroll - related and, of course, as previously mentioned, the fact that the contributions are shared between the three main actors: the employer, the employee and the government. If we look at the proportions we have previously described, it seems that working in the private sector is more beneficial from this point-of-view, since the employee will only contribute with 30%. However, we should also mention that this should be related to the level of salaries in the public and private sectors.
Obviously, the salary package is almost always determined by the motivating elements that the employee is likely to include in the package. In the case of Taiwan, first of all, all employees offer access to the national insurance system, which means that each employee visiting the doctor will generally pay less than $5 for the…… [Read More]
There are many good reasons to have health insurance, and among those reasons is the fact that there is a tremendous financial risk that is linked to "unanticipated adverse health events," according to an article in the Journal of Health Economics (McLaughlin, et al., 2002). Health insurance not only helps the person that is ill or has been in an accident to get healthy again, it prevents -- at least in many cases it prevents -- financial calamity. The U.S. Department of Health and Human Services (HHS) has come out with a report that shows most families that cannot afford health insurance do not have the "financial assets to pay the hospital bills they would incur if a family member were to be hospitalized" (Glied, 2011, p. 1). In fact the HHS report reflects the fact that the majority of uninsured families have "virtually no savings or investments"…… [Read More]
Health Insurance Plans
There seem to be three basic health insurance categories. They are generally called Fee-for-Service, anaged Care or Health Saving plans, though some call them by other names. The fee-for-service plan is what many people consider the traditional type of insurance. Like automobile insurance, people choose the cover they want and pay the price for those services. Often health care providers just take this insurance and the company pays after a deductible or co-pay, which are amounts to be paid at the time of service (usually a relatively small amount).
anaged Care is a newer type that essentially relies on the insurance companies having some type of agreement with doctors, hospitals and other care providers. Those who join a managed care program have choices from these services and negotiated amounts are paid to the provider for very specific services or types of treatment. In some cases, there are…… [Read More]
Employee insurance costs may at the outset look as an unimportant and dispensable expenditure, but in reality it is far from true. Research has shown that health insurance can increase overall productivity by reducing the costs associated with "Employee Absenteeism," reducing the costs of turnover, and thereby contributing to optimising the output. (Ellen O'rien). Most people lacking insurance are from the lower economic layer of the society and more than two thirds of this group are full time workers. The lack of insurance coverage implies that these poor people are putting off their medical attention until an emergency situation arises. In majority of the cases such medical emergencies could have been averted with timely medical intervention. "Many people simply put off medical care until they end up in the ER - much sicker and requiring more care than they would have had they been visiting a doctor on a regular…… [Read More]
Health Information Portability Accounting Act (HIPAA, went into effect the first quarter of 2003. Indeed, HIPAA creates federally mandated requirements regarding protected health information (PHI) that can impact any employer, regardless of its size, location or industry. Government estimates place the price tag for compliance within the public and private sectors at an estimated $22 billion. While the Privacy Rules were not aimed at regulating non-medical employers, employers who sponsor group health plans are affected, de-pending on whether the employer: (1) is fully insured or self-insured; and (2) creates or receives Protected Health Information. Protected Health Information (PHI) is defined to include all individually identifiable health information held or transmitted by a covered entity or business associate electronically or in other forms (Amatayakul, 2000). There are some exceptions. One important PHI exception is that the Privacy Rules do not apply to employment records, including medical information employers use to comply…… [Read More]
("Protecting the Privacy of Patients' Health Information," n. d.) the variations HIPAA necessitates would be sufficient and the changes would be accompanied by remarkable uneasiness in several respects. Functioning in the type of high-security setting visualized by the proposed HIPAA security regulations would imply functioning under regular surveillance and with concentration to making medical record information as being secure. hether in relation to paper or electronic form, information relating to medical record could not be any longer be left unprotected, wherein a normal observer, a thief or a snoop, could have reach to it. ("History: HIPAA General Information. Health Insurance Portability and Accountability Act," n.d.)
The Health Insurance Portability and Accountability Act -- HIPAA indicate to be one of the most confronting functional initiatives most radiologists would confront in their careers. The anticipations of HIPAA are very large and the results of failure to agree continue beyond the related financial…… [Read More]
Health Insurance and Managed Care
The purpose of this paper is to develop a game that will make it much easier and fun to not only understand, but also remember the major types of managed care plans together with their characteristics. The game is quite simple and can be played by pretty much every individual as it is applicable in understanding other concepts. The game requires two individuals or more to play, however, if one is alone, it is still applicable.
To begin with, one of the essential requirements of the game includes having paper slots in which the content being discussed is written. In this case, taking into account that there are four types of managed care plans, there will be four main slots. This will include, Health Maintenance Organization (HMO), Point of service (POS), Preferred Provider Organization (PPO), and High Deductible Plans (HDP) (ASD, 1992). The other requirement…… [Read More]
High Insurance Portability
Health Insurance Portability & Accountability Act
Some hope was given for the current legal environment to become better defined for health-care providers when Health Insurance Portability & Accountability Act (HIPAA) was passed by the in 1996. As previously mentioned, HIPAA is a monumental act that attempts to address and incorporate all three issues-- privacy, confidentiality, and security within one law. When HIPAA was passed, many applauded the portability aspects of HIPAA that allowed for continuing healthcare coverage for individuals who lost their jobs and attendant healthcare insurance. But few back in 1996 anticipated the dramatic impact that HIPAA would have later on the privacy and security of patient's health information in the United States.
HIPAA Legislation History
HIPAA legislation was passed in the year 1996. Title I of the regulation dealt with the health insurance coverage of the public and their immediate family when they lost their…… [Read More]
Misconceptions and Confusion in Healthcare Coverage Among Elderly Populations
A small podiatry practice in Northeastern Missouri becomes the scene of a tragedy which takes place in plain sight, as there is not a day that goes by where at least one or more patients will be charged for their office visit despite mistakenly believing they would be covered. Unanticipated medical costs can be devastating even for adults in their prime of their working lives, but for the elderly and infirm living on a fixed income and attending multiple physicians simply to survive, the burden of health insurance failing to cover their medical bills can be overwhelming to say the least. Approximately 75% of patients who are examined in this particular Missouri podiatry practice are over the age of 65, putting them well within the segment of society which is ostensibly enjoying their retirement years while managing a fixed income. Another…… [Read More]
access to health insurance important to our health? hat are the consequences for the American health care system when significant numbers of people go without health insurance?
'Not my problem.' It is easy for Americans with health insurance to take such an attitude about the nearly 47 million Americans, or 16% of the population without health insurance ("Facts about healthcare -- Health Insurance Coverage," 2008, NCHC). But all Americans suffer when so many Americans are uninsured, or under-insured, or lack access to basic healthcare. Sick Americans take more leave from work, resulting in a loss of productivity. They are more likely to spread ailments -- or to wait to go to a doctor until they are critically ill, and thus place more of a financial burden upon the nation. Individuals without health insurance must often pay 'up front' for health care, and if they are unable to do so, they…… [Read More]
This could be due to the fact that the middle aged population is facing more stress, pressure and inadequate nutrition, all causes of obesity (Webb and Whitney, 2008)
In each age group, women have a decreased access to medical insurance as compared to their male counterparts. This could be explained by the fact that women are less present within the workplaces, but also by the fact that they continue to be discriminated against and offered fewer benefits (Lorber, 2009).
Women are more responsible and smoke less than men throughout their young and mature life, but they smoke more than men during their later years.
In each age group, women exercise less than men and this could also be due to the sustained discrimination of women, who are still responsible for the household chores and as such have less time for leisure and physical activity (Lorber, 2009).
4. Are the differences…… [Read More]
Health Insurance Portability and Accountability Act (HIPAA) of 1996 provided for the better management of health information as well as increased health coverage for target entities. Of particular emphasis the law has is the privacy and security of health information. Prior to the implementation of HIPAA, there was an ad hoc management of health information and health coverage is very limited. Often disparate policies and standards are used from one medical institution to another or by the different private and public organizations. HIPAA provided the standards and detailed how health information should be protected to ensure the confidentiality, integrity, and availability thereof depending on the given situation. In particular, HIPAA details a patient's access to his or her medical records based on the general principles for disclosure. Two guiding principles cover disclosure and not only to patients but to covered entities; these principles are: "(a) to individuals (or their personal…… [Read More]
Legally equired Benefits
The subject of benefits for employees is multi-faceted and sometimes controversial. Of course, there are those benefits that are legally required while others are discretionary. When it comes to the discretionary benefits, there is much talk about what is standard and customary for full-time employees and what is called for with part-time employees. This report shall answer whether firms should offer benefits to part-time workers. If they should, there are questions whether they should offer one or more things like paid time off (PTO), 401(k) retirement contributions and health insurance. While some may think it generous and perhaps even ethically required to offer such benefits to part time workers, there is also a cost-benefit dimension to this decision that business owners and managers must properly consider.
Before getting into whether the aforementioned benefits should be extended to part-time workers, one has to remember that the primary…… [Read More]
Pre-Existing Condition and Denial of Health Insurance
The focus of this work in writing is to examine whether the individual with a pre-existing health condition should be denied health insurance coverage. Toward this end, this work will examine the literature in this area of study. A pre-existing condition is "a medical condition that existed before someone applies for or enrolls in a new health insurance policy. It can be something as prevalent as heart disease which affects one in three adults -- or something as life-changing as cancer, which affects 11 million Americans.' (HealthReform.gov, 2011) A large number of the American population has health conditions that can be qualified as pre-existing conditions by insurance companies. It is reported that insurance discrimination
"...based on pre-existing conditions makes adequate health insurance unavailable to millions of Americans. In 45 states across the country, insurance companies can discriminate against people based on their pre-existing…… [Read More]
However, the company spokesman mark Schurman later said the issue was not the reform bill at all but rather it was the "…uncertainty as to what reform is going to look like" after the Supreme Court makes its ruling (Rosenthal, 1).
In Gary Langer's ABC News article he quotes from an ABC News / ashington Post poll that shows that 62% of respondents would prefer a "universal health insurance program" above the current program in which employers do or do not provide insurance. Currently, "Seventy-eight percent are dissatisfied with the cost of the nation's health care system," Langer writes (Langer, 2012, p. 1).
Some Americans who can afford health insurance put off getting it because either it is just too expensive, or the deductible has to be kept high in order to afford it -- which causes huge financial problems when a person is hurt of seriously ill. Langer's…… [Read More]
5 billion in unpaid medical claims from 2005-2007 and there was a total of $80.6 million in unpaid interest owed to providers treating Medicaid patients between July 1999 and November 2007, despite the existence of an Illinois prompt-payment law. This interest is money that should not 'need' to have been spent, since money paid for interest does nothing to improve the quality of care for recipients. Another problem is a high rate of rejection of Medicaid claims and slow processing of rejection notices -- as much as 87 days in fiscal 2006, according to one recent study (Trapp 2008).
This high rate of rejection of claims has caused a correspondingly high rate of rejection of patients with serious health complaints, including children. A The New England Journal of Medicine study published in June of 2011 found that 66% of parents who mentioned they were part of the Medicaid-CHIP (Children's Health…… [Read More]
Much like Medicaid, the state-administered health insurance program for Americans living in poverty, the CHIP (Children’s Health Insurance Program), is formally overseen by the department of Health and Human Services on a federal level. States are primarily responsible for CHIP’s everyday administration. That is why the benefits accorded through CHIP to children and their families vary between states (“CHIP,” 2017). The federal law does mandate that certain aspects of children’s healthcare must be covered, including check-ups, vaccines, prescriptions, vision care, dental care, most types of hospital care, laboratory and other screening services, and ER visits (“CHIP,” 2017). Some states require copay payments and premiums but premiums cannot exceed 5% of the family’s monthly income (“CHIP,” 2017). CHIPs is funded by a combination of federal and state funds and overseen by a combination of federal and state health agencies. Matching grants are issued to states by the federal government to ensure…… [Read More]
You paid for a single page speech. This company writes 275 words per page. You received a document of 313 words--more than you were allotted--with examples in the first two paragraphs.
If you want more examples, more points, and some format which you did not specify in the additional instructions, I suggest you contact the administration about additional pages for this assignment, or purchase a new order.
New instructions, such as this format you\\\\\\\'re now talking about and which wasn\\\\\\\'t in the original instructions, require a new order or additional pages.
Patient and Affordable Care
Opener: I know people whose health care insurance rates tripled in 2014, when all the components of the Patient and Affordable Care Act were enacted into law. It is worth noting that one person in particular (my neighbor) was in perfect health, had no pre-existing conditions, and had not even utilized his health care plan…… [Read More]
The dilemma is often easier to resolve once those emotions and assumptions are put into their rightful context.
For this paper, critical thinking came into play was logic. It is understood that initially the nursing profession had issues with HIPAA. These issues were practical, however, and when the law was matched up against the underlying principles and the Code of Ethics, it became apparent that the guidelines that can be used for resolving any ethical dilemma are fairly consistent. There is still some leeway for professional judgment, as Lo et al. (2005) wrote but the Code of Ethics does a strong job of filling in the blanks left behind by the legislation. Once this was pieced together, the argument for easy resolution of ethical dilemmas became clear.
American Nursing Association. (2009). Code of ethics for nurses with interpretive statements. American Nursing Association. etrieved October 17, 2009 from http://nursingworld.org/ethics/code/protected_nwcoe813.htm#3.1
Bendix,…… [Read More]
Health Insurance Consumer Knowledge
Do most people know everything about their health insurance plans?
The two plans investigated for this assignment are Blue Cross Blue Shield and Humana, two of the most widely used and recognized health insurance companies in the United States.
Do you think that in general most people know everything about their health insurance plans?
The healthcare reform act of 2009 sought to make the healthcare system in the United States more navigable for Americans and to prevent health insurance companies from taking advantage of their customers. It seems, however, that the dense amount of legal and financial information embedding in the policies published by most companies is beyond the comprehension of most Americans (Gabel et al. 1987). Most people probably are aware of their emergency and primary care coverage but might not know about other less publicized and critical elements of insurance coverage plans which may…… [Read More]
Discount Scheme for Health Insurance
No Claim Discount (NCD) Schemes are Frequency-rating systems and are commonly used in insurance. NCD schemes represent an attempt to categorize policyholders into relatively homogeneous risk groups who pay premiums relative to their claims experience. Those who have made few claims in recent years are rewarded with discounts on their initial premium, and hence are enticed to stay with the company (Boland, 2006). Depending on the rules in the scheme, new policyholders may be required to pay the full premium initially and then will obtain discounts in the future as a result of claim free years. The general insurance actuary modeling an NCD scheme would frequently use Markov chain methods to investigate how premiums and movements take place over time.
No Claims Discount scheme is a form of frequency rating used in health insurance; the practice is to consider the number of years since the…… [Read More]
California Health Insurance Exchange Website, Covered CA
Covered California (2015) describes itself as a user friendly market place that implements the federal Patient Protection and Affordable Care Act in California. Its website provides useful information to current and prospective clients - such as its history, the health insurance options it offers, how an individual can match an insurance option with their needs, and its financial reports. In 2014, approximately 1.3 million Californians used Covered California to choose health insurance, while millions others used Medi-Cal to check the health coverage they qualified for (Covered California, 2015).
The Covered California website is appropriate for a person at the eighth grade level. First it is divided to four major sections, namely; explore, apply, preview and get help, which allows the users to locate the particular section they may be interested in, in order to explore them further. The explore section clearly articulates the…… [Read More]
Q1. Personal Fitness Trackers
Even when personal fitness trackers present the same information, they can visually display the information in different ways. Regardless, the theory behind such trackers, and the ability to see how many steps, calories burned, and activity in relation to the activity engaged in the past, is that people are more motivated when they have concrete evidence of their improvement. What cannot be measured cannot be consciously changed. However, according to a study in The Lancet Diabetes & Endocrinology, in a randomized control study (the gold standard of academic research), using a fitness tracker had no effect on any measure of health or fitness (Finkelstein, et al, 2016). The fitness tracker used in this particular study was a clip-on tracker without a significant graphical interface. It is possible that the results may have been different, had the tracker been more pleasing in its presentation.
But even a…… [Read More]
" (National Conference of State Legislatures Forum for State Health Policy Leadership, 2007). However, regardless of state, the applicants have to meet certain qualifications. First, applicants have to be both uninsured and not eligible for Medicaid for other forms of state sponsored insurance. In addition, not all S-CHIP recipients have to be children; states can get waivers to use S-CHIP funds to cover adults. These other recipients are generally adults who are responsible for S-CHIP eligible children, and/or pregnant women. However, "at the end of 2005, four states had waivers to use SCHIP to cover childless adults, and nine states cover unborn children who will be eligible for SCHIP at birth as well as prenatal and childbirth services for the mother of the child." (National Conference of State Legislatures Forum for State Health Policy Leadership, 2007). The fact that states have chosen to do this reaffirms the concept that the…… [Read More]
Medicare and Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA), that by the time 2011, health care expenditure will arrive at $2.8 trillion, as well as it will bill for 17% of the Gross Domestic Product. As a result, it is no revelation that white-collar offenders observe health care deception as a rewarding effort. Certainly, the General Accounting Office ("GAO") quotes that such deception accounts for up to 10% of entire health care expense (3).
As health care deception outlays taxpayers almost $100 billion a year, federal, as well as state agencies have given health care fraud tribunal a key center of attention. All through her term, Attorney General Janet Reno made impeaching health care fraud a top precedence at the Department of Justice ("DOJ"), subsequent only to brutal offenses (3).
The government focuses its pains to perceive, as well as take legal action against health care fraud…… [Read More]
Affordable Health Insurance
The Need for State Participation in Health Care Insurance Exchanges to Provide for Affordable Health Care for Millions of Americans in Need
In the United States, we have basic rights to life and liberty. Yet, many major health care companies are infringing on those rights because they are exploiting health care insurance rates, which has left millions of Americans either underinsured or not insured all together. This puts their lives directly at risk with limited access to essential care. In order to best provide for their uninsured or underinsured citizens, states need to work with the regulations of the Affordable Care Act and open up exchanges to provide for affordable health insurance to the millions of Americans who are currently in need under the ineffective system that is operating today.
In the current situation, there is a lack of affordable health insurance options.
Moreover, health insurance companies…… [Read More]
OBRA Health Insurance
How OBRA Works
Davis was terminated from his employment because of long absence from work and not because he voluntarily resigned or any gross negligence on his part. Therefore, he and his family are eligible for health insurance coverage under the onsolidated Omnibus Budget Reconciliation Act (OBRA) provided his company maintains its group health plan and still has 20 or more employees for which they currently have 100. If his former employer were to have fewer than 20 employees, then he might still be eligible for what is called mini-OBRA. The OBRA Act was put into law in 1986 in order to provide continuation of group health coverage for workers who have lost their jobs. The Act allows for the unemployed individual to avoid any gaps in coverage that would prevent them from having pre-existing conditions excluded once they were able to obtain group health…… [Read More]
Communication Memo - Protest of Health Insurance Fees
What is the purpose of your memo?
This memo presents the position of the Campus WHATEVER Club that single employees should not be charged the same insurance fees as married people paying for family coverage.
Describe your primary audience.
The primary audience is the president of the University.
Is there a secondary audience for the memo?
The memo could also be sent to the Board of Trustees, Vice President for Administration and the head of the Human Resources department, who are all responsible for decisions regarding employee insurance benefits.
Brainstorm for a few moments, jotting down points to be covered in the memo.
The proposal discriminates against single employees.
Married people with those with family coverage will incur more medical expenses and should be asked to pay additional premiums per family member. The proposal causes low morale among single employees. Some may…… [Read More]
The implication of this situation is, as employers look to defer more and more of the cost of health insurance to the employees, and as those jobs that provide healthcare benefits to employees become more scarce, the young people in America will not have access to care, and will suffer the physical neglect of that situation.
"In 1994, Congress failed to act on employer-mandated health insurance coverage. This insurance would have benefited mostly poor, working Americans -- those working in small businesses that did not provide health insurance. Medicare and Medicaid, for the most part, cover the older population and those on public assistance. Large businesses cover virtually all their employees. With few exceptions, people who are uncovered are employed by small businesses. Each year since 1994, over 1 million additional American workers, virtually all in small businesses, lost their health insurance coverage. This trend will continue because the…… [Read More]
The Cost of Instability
Access to health insurance has become a major issue in America and Elizabeth Legerski, in her article titled "The Cost of Instability: The Effects of Family, Work, and Welfare Change on Low-Income Women's Health Insurance Status" discusses the effect of being a low-income woman in relation to their access to health insurance. In her research Legerski used what she called a "secondary analysis of three waves of data from the Welfare, Children, and Families Project" A Three-City Study using a series of multinomial logistic regression models." (Legerski, 2012, p.644) This means she conducted no actual research herself but analyzed the data that was collected from another study to use for hers. The research study that Legerski used collected data from low-income families in Boston, Chicago, and San Antonio over a period of time. The data was collected through surveys given to the family's primary female…… [Read More]
Commercial Insurance, Medicaid, and MEDICARE
Commercial health insurance provides coverage to individual's medical expenses and groups. An example of individual medical expenses is private health insurance whereas an example of group health insurance is employer group health insurance. However, these insurance programs have varying premiums and benefits depending on the specific kind of plan. Moreover, individual private health insurance plans are usually more costly than group health insurance. There are several commercial insurance companies and plans that offer health insurance to individuals and groups such as Aetna and TRICARE respectively. Aetna is a group of TriWest Healthcare Alliance and Blue plans that differs from TRICARE insurance plans.
One of the similarities between Aetna and TRICARE is their purpose of providing health insurance to individuals and groups. Similar to TRICARE, one of the products and services provided by Aetna is health insurance coverage at low, reasonable prices. However, the commercial insurance…… [Read More]
HCC Life Insurance vs. Coventry
Purpose of the INSUANCE COMPANY: The purpose of HCC Life Insurance Company is to provide Short-Term Health Insurance for a period of six months. Applicants must reapply for a policy every six months. The purpose of Coventry Health Care of South Florida is to provide Health Insurance that fulfills the Patient and Affordable Care Act (Coventry, 2015). It provides insurance for a period of 12 months, after which the insured must reapply for a new policy.
Benefits offered: Urgent Care, Hospital oom and Board, Local Ambulance, Intensive Care, Physical Therapy, Mental and Nervous Disorders, Home Health Care, Extended Care. Primary Care, Specialist Care, Other Practitioner Care, Preventive Care, Screening, Immunizations, Diagnostic Tests, Imaging, Drugs, Facility Fees (Outpatients and Hospitals), Surgeon/Physician Fees, Emergency oom Services, Emergency Medical Transportation, Urgent Care, Mental Behavior Health, Substance Use Disorders, Prenatal and Postnatal Pregnancy Care, Home Health Care, ehabilitative Services,…… [Read More]
The other necessary element in this process is procedure cost vs. reimbursement evaluation and proactive search of strong reimbursement for future volume. Analysis of the first element is crucial because it helps in ensuring that reimbursement documented in existing contracts is being effectively recorded. The information obtained during this stage can be used at any time of renegotiations or contribute to the development of effective alternative approaches. The assessment of the second element helps to determine how insurance contracts compare and to ensure reimbursement expectations are established within competitive market ranges. The third element can be used for defense in validating the need for higher reimbursement than the current offer.
Second Students' esponse:
As the use of managed care plans have increased in the past few years, there is an increased need for appropriate insurance contracting strategy. The existing managed care plans are primarily based on demand management through co-payments.…… [Read More]
All spending includes state and federal expenditures. Growth figures reflect increases in benefit payments and disproportionate share hospital payments; growth figures do not include administrative costs, accounting adjustments, or costs for the U.S. Territories.
Federal Fiscal Year: Unless otherwise noted, years preceded by "FY" on statehealthfacts.org refer to the Federal Fiscal Year, which runs from October 1 through September 30. for example, FY 2009 refers to the period from October 1, 2008 through September 30, 2009.
Urban Institute estimates based on data from CMS (Form 64) (as of 12/21/11).
From this entire chart, the entire increase in expenditure of…… [Read More]
Health Program Bronx
Racial Disparities in the Healthcare System
America's healthcare system is one of the most visible indicators of the broad array of social, economic and racial inequalities that still impact American life. For racial minorities such as African-Americans and Latinos, health outcomes are disproportionately worse than they are for white patients. This denotes a core inequality that goes to the root of our society. Outreach, education and advocacy programs such as the one described here in relation to minority populations living in the Bronx helps to provide a valuable case demonstration of this public health issue.
The pressing racial issues that are evidenced in our imbalanced healthcare system serve as the impetus for the agenda and actions taken up by the REACH Bronx organization. This action-group is actually described as a coalition of groups and demonstrates the considerable push from a wide variance of parties to…… [Read More]
S. healthcare structure do not include the unobserved disparities. This may sound very rudimentary, even silly to point out, but in by understanding that the numbers are actually worse than they appear, and that the rising costs of healthcare services re associated with both what we see and can't see, it is easier to understand how costs rise so quickly.
It is also a sobering fact that what we cannot observe is still out there, existing beyond the scope of the government and social programs designed to help people overcome obstacles to access to healthcare and health insurance. The ethnic group that is most unobserved within the bounds of many of the studies and statistics related to the disparities in the U.S. healthcare industry is non-Mexican Latinos (Bustamante, et. al., 2009). This group represents a major portion of the U.S. population that currently lacks access to healthcare. In understanding this…… [Read More]
Health eform Act
The work of Flanagan, Miller, Pagano, and Wood (2010) entitled "Employee Benefit Plan eview -- Meyerowitz, Health care eform Is Here -- Now What?" states that health care reform laws are expected to have an impact that is significant in nature and this is on the health insurance industry as well as on employee benefit issues as well. The Patient Protection and Affordable Care Act (PPACA), which was then supplemented and modified, less than one week later, by the Health Care and Education Tax Credit econciliation Act (HCEA)." (Flanagan, Miller, Pagano, and Wood, 2010) Those two laws are referred to as "Health Care eform" or "Health eform Laws." (Flanagan, Miller, Pagano, and Wood, 2010) The Health eform Laws are reported, while being extremely lengthy and in depth and very detailed to "leave open a host of issues that will have to be resolved either through agency regulations…… [Read More]
For a long time, the Health Care concern has been a centre of discussion in the society as well as among the representatives in a bid to find out which would be the best way to cushion Americans from the ever increasing burden of having to take care of themselves medically. Efforts have been made but still there is no single solution to the issue hence a combined effort between the citizens and the government is very essential in ensuring that the ultimate goal is achieved and each American has adequate Health care assurance. This is the aim of the Health eforms that was passed into law at the behest of the current president, Obama.
Provisions of the Health eform
There are several benefits that the Health eforms are expected to bring to the American population in general. One of the central changes is the fact…… [Read More]
Healthcare Financial Management
To quote Jonathan Clark at the beginning of his article, "Improving the revenue cycle can be a daunting task due to the scope and complexity of the interdepartmental process." Of the suggestions offered by the authors, which concept(s) give you the greatest insight into creating an improved evenue Cycle process in the organization where you work (or one in which you are familiar)? Be sure to identify which article or author you are referencing.
In his comprehensive advisory article to improve the medical industry's revenue capturing capabilities, entitled Strengthening the evenue Cycle: A 4-Step Method for Optimizing Payment, Jonathan Clark provides a series of sensible solutions to the ongoing dilemma of payment optimization. David Hammer also provides guidance to healthcare finance professional in his article The Next Generation of evenue Cycle Management, by reminding them that the key performance indicators (KPIs) which dictated policy in previous years…… [Read More]
People still die because they cannot afford health care, and that simply is not right in the most powerful nation on earth. People should not have to go bankrupt or lose their home because they cannot afford health insurance, and health care should be more affordable for everyone. An Indiana Congress member notes, "Expenditures on health-care lobbying last year rose to $325 million, as health-care providers, insurers, drug makers, medical professionals and others all worked to make sure their interests were served as Congress took up their issues" (Hamilton). Americans need to stop listening to lobbyists and start taking health care reform into their own hands for real health care reform to occur in this country.
Hamilton, Lee. "Who Lobbies for the est of Us?" Indiana University. 2004. 22 Jan. 2008. http://congress.indiana.edu/radio_commentaries/who_lobbies_for_the_rest_of_us.php
Montanaro, Domenico. "Kucinich Details Health-Care Policy." Firstead.MSNBC.com. 2007. 22 Jan. 2008. http://firstread.msnbc.msn.com/archive/2007/10/25/430486.aspx… [Read More]
While it may not be just to hold an organization liable, absolutely, for every instance of employee negligence, there is a rationale for imposing such liability in many cases. For example, many types of industries entail potential danger to others that are inherent to the industry.
Individual workers are not likely to be capable of compensating victims of their negligence, but the employer benefits and profits financially by engaging in the particular industry. Therefore, the employer should not necessarily escape liability for compensating all harm caused by their activities, regardless of fault in particular instances.
10.A nurse is responsible for making an inquiry if there is uncertainty about the accuracy of a physician's medication order in a patient's record. Explain the process a nurse should use to evaluate whether or not to make an inquiry into the accuracy of the physician's medication order.
Like other highly trained professionals, experienced nurses…… [Read More]
Prejudice and ethical/leadership issues with healthcare are nothing new but the fight to keep those standards and ethics on an even keel and prevent racism, bigotry and predudice of any sort including based on class, money, political ideology, nationalism, and so forth should be stomped out and eviscerated whenever it can be. People are people and should treated with dignity and respect regardless of their race, gender, beliefs and so forth. Even convicted murderers and rapists should not be treated disdain due to their actions because doing otherwise lowers the ethics and standards of the healthcare community that can and should still apply at all times.
Callahan, M. (2008). Healthcare providers constricted by financial, legislative, and regulatory issues. The Journal of Medical Practice Management: MPM, 24(3),
Cobaugh, D., Angner, E., Kiefe, C., ay, M., Lacivita, C., Weissman, N., & ... Allison, J.
(2008). Effect of racial differences…… [Read More]
Polls examining public support of the bill and specifically the public healthcare option vary significantly. ith regard to physicians, the New England Journal of Medicine surveyed over six thousand medical doctors and found there was a majority in favor of federally provided public healthcare insurance (Keyhani & Federman). Other polls have suggested an opposition to the public option (Marmor).
The public option would provide an affordable alternative to the current private health insurance options and would provide impetus for competition and positive change. hether "America's Affordable Health Choices Act of 2009" will be passed is currently uncertain. hat is certain is that the healthcare and health insurance system is currently not sufficient to provide healthcare support for nearly 48 million uninsured Americans. Alterations need to be made to increase access and affordability for those individuals who desire health insurance.
The healthcare and health insurance system in the United States…… [Read More]
On the contrary, a comprehensive medical care solution that tackles the main issues driving up health care costs in America is possible. The main problem experienced by the average American is that health insurance premiums are cost prohibitive for the middle-class, but being uninsured can bankrupt a family forced to deal with even a minor catastrophic illness. Therefore, a national health insurance program has to be part of the solution. However, one cannot overlook the role that unpaid medical bills and exorbitant malpractice premiums also play in the modern healthcare crises. As a result, the solution must include a way to reduce malpractice premiums through tort reform, and a way to reduce the percentage of medical bills that go unpaid. The proposed three-prong approach would tackle all of those issues, without forcing any unwilling person to participate in a nationalized healthcare program.
American Tort Reform Association. "Medical Liability…… [Read More]
Healthcare spending by the New York State persistently surpasses its earnings. That difference continues to be expanding and is also anticipated to broaden unless of course there happen to be severe, continuous modifications in spending budget actions. Lieutenant Governor ichard avitch, in "A 5-Year Strategy to Deal with the State of New York's Spending budget Deficit" released during March 2010, approximated this structural disproportion within the state's spending budget to become no less than $13 billion. The structural inequality isn't simply the consequence of the economic downturn that started during 2007, and a commonly strengthening economic climate is not going to get rid of it.
To help the State of New York in providing the solutions and dedication to quality that its residents rely on, structural modifications are needed. The aim of this paper is actually to summarize one particular realignment - solving an outright inequity involving the state as…… [Read More]
(Menzel, 1990, p. 3) Fisher, Berwick, & Davis alude to the idea of integration in health care, with providers linking as well as creating networks of electronic medical records and other cost improvement tactics.
The United States and other nations over the last twenty or so years, have begun a sweeping change in health care delivery, regarding the manner in which health information is input, stored and accessed. Computer use in the medical industry has greatly increased over the last thirty years the culmination of this is fully networked electronic medical record keeping. (Berner, Detmer, & Simborg, 2005, p. 3) the electronic medical record trend began in the largest institutions first, as hospitals and large care organizations attempted to reduce waste and improve patient care, while the adoption has been much slower among physician's practices and smaller medical institutions. (Hillestad, et al., 2005, pp. 1103-1104) Prior to this time medical…… [Read More]
Health Care eform:
One of the major topics that have had a long history in the United States is health care reforms, which has been characterized by huge debates. Following decades of failed attempts by various Democratic presidents, a new law was enacted by President Obama to overhaul the country's health care system. The enactment of this legislation came after a year of harsh partisan combat with the purpose of ensuring access to health care insurance for millions of Americans. In addition to being the most controversial topic, health care reform law was the largest single legislative accomplishment of President Obama. Notably, this legislation will cost America's government approximately $940 billion over the next decade based on an analysis by the Congressional Budget Office. The office has also estimated that the law will lessen federal deficit by about $138 billion during the same period and a further reduction of the…… [Read More]
Health Care Reform Federal Deficit
The American Health Care Crisis and the Federal Deficit
The United States spends more than any other country on medical care. In 2006, U.S. health care spending was $2.1 trillion, or 16% of our gross domestic product. At the same time, more than 45 million Americans lack health insurance and our health outcomes (life expectancy, infant mortality, and mortality amenable to health care) are mediocre compared with other rich democracies. We spend too much for what we get.
Nothing is new about these sobering realities. The Nixon administration first declared a health care cost crisis in 1969. Four decades later, the United States still has not adopted systemwide cost controls because the politics of health care make it extraordinarily difficult to control costs. I explain below why this is so (Marmor, et al., 2009).
The starting point for understanding the politics of cost control is…… [Read More]
As a result, millions of Americans remain unable to bear the heavy financial toll of medical expenses. Indeed, the problem of a lack of insurance for many is related to the problem of the cost of healthcare. So confirms the article by Consumer Reports (CR) (2008), which finds that "health-insurance premiums have grown faster than inflation or workers' earnings over the past decade, in parallel with the equally rapid rise in overall health costs. Industry spending on administrative and marketing costs, plus profits, consumes 12% of private-insurance premiums." (CR, 1) This reiterates the case that the undue imposition of costs by the healthcare industry -- a reflection of a free-market industry with little to no regulatory oversight -- has negatively impacted the accessibility and quality of healthcare for many of the poorest users.
Moreover, these users are most vulnerable to the long-term economic damages provoked by unexpected healthcare costs. So…… [Read More]
(Health Insurance Coverage, 2009). This is just a little higher than what was reported in the state of Pennsylvania over the last two-year period, which was at 25% (Krawczeniuk, 2009). "The number of uninsured rose 2.2 million between 2005 and 2006 and has increased by almost 8 million people since 2000" (Health Insurance Coverage, 2009).
Most Americans are provided with health insurance coverage through their employers. But in today's society employment is no longer a guarantee of health insurance coverage. "As America continues to move from a manufacturing-based economy to a service economy, and employee working patterns continue to evolve, health insurance coverage has become less stable. The service sector tends to offer less access to health insurance than the manufacturing sector does. Further, an increasing reliance on part-time and contract workers who are not eligible for coverage means fewer workers have access to employer-sponsored health insurance" (Health Insurance Coverage,…… [Read More]
" (Arnold & Reeves, 2009). ith medical services price at the present time, illness or some kind of complicated to medical services may take people deprived of health insurance years to reimburse for bills that are medical. Furthermore, I believe that individuals who lost their jobs also are uninsured for the reason that their employer gave health insurance is no longer paying for them. I understand that based on the statistic; there are "way too many around 1 million workers that have lost their health reporting in the first three months of 2009. I think that helping people buy health insurance coverage with low-cost with offering the health plans options for the uninsured is the healthcare reform that is really needed now. In this way, individuals that are without health insurance will be able to afford paying their medical insurance to uphold their well-being.
In conclusion, with the increasing rapidly…… [Read More]
Healthcare Legislative Bill
The expanded and improved Medicare for all Acts
The Expanded and mproved Medicare for All Act was introduced to the House of Representatives in 2009 and seeks to lobby for the implementation of a common single-payer health care system throughout the United States o0f America. The bill if enacted would require that all medical care costs be paid for automatically by the government instead of private insurances for the same. The move will significantly alter the role of private insurance companies as merely offering supplemental coverage especially when the kind of medical care sought is not all that essential (McCormick, 2009).
With the Expanded and mproved Medicare for All Bill, the country's national system will be paid for through taxes and the monies that will replace the regular insurance premiums. Proponents of the bill argue that by eliminating the need for private insurance companies in the national…… [Read More]
At which point, the overall costs of care will be passed on to the tax payer in the form of higher taxes. This leads to a decrease in the overall quality of care and it will not slow the price increases, as the government seeks to restrict access to these services. Then, when the program becomes broken (such as: what is happening to Social Security) removing or reforming the bureaucracy is nearly impossible. (Messerili, 2010)
A second argument that many critics make about universal health care is: it will stifle innovation. Whenever, the government is running any kind of program, they will place a large number of restrictions and regulations on the industry. When this takes place, you are causing some of the best and brightest minds to seek careers in other fields, as the restrictions from the government are too cumbersome. A good example of this would be: the…… [Read More]
Healthcare in the United States: Where We Have Been, Where We Are Going
The current healthcare crisis in America is not one that happened over night. It is one that has been building for more than a quarter century. There was a time in America when healthcare was a stellar institution: research, cures, technological advances, and treatments. The focus of healthcare was maintaining and improving the quality of life. Then, during the early 1980s, managed care became an entity between the physician, the patient, and the healthcare provider of hospital services. It began subtly, but has, today, become one of the most aggressive and successful business ventures of our time; and it has been the unmaking of a once stellar and progressive American institution.
Managed care is a "distinctly American" product (Birenbaum, 1997). It was legislation introduced by the Nixon Administration with the intent to regulate healthcare and to maintain…… [Read More]