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Management of Obesity in Primary Care Settings
The prevalence of obesity has reached epidemic levels in the United States and the human and economic toll of this condition is staggering. Besides the adverse effects that obesity has on quality of life in general, the condition is also highly correlated with a number of negative and expensive sequelae, including most especially diabetes and heart disease. While the research into the precise causes of obesity continues, most authorities agree that increasingly sedentary lifestyles and poor diet choices have exacerbated the problem. Likewise, many authorities also agree that primary care settings are the most appropriate for obesity interventions. This study proposes an experimental design in a primary care setting to evaluate the efficacy of an intervention using an activity monitor for a 6-month period in combination with other treatment protocols in reducing body mass index levels. The purpose of this study will be…
Midwifery in Primary Care
New Directions for Midwives:
Addressing Novel Primary Care oles
Looking towards the future, radical changes are sweeping the United States healthcare system with the advent of a new public healthcare system. This change and the economic reality of care should motivate all healthcare providers to question of who can best meet the healthcare needs of women. Nurse midwives are advanced practice nurses educated in the field of primary health care for essentially normal women and newborns. Their focus is wellness and health education. Once patients are introduced to the concept of a nurse practitioner and the services provided, the majority are satisfied with the quality of the care received. Evidence suggests that women, if given a choice, prefer the ministrations of a female practitioner over that of a male for their intimate healthcare needs. As a predominantly female group, nurse midwives are an excellent source of…
Rossouw, J.E., Anderson, G.L., Prentice, R.L. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 288(3):321-33.
Santoro, N., Brown, J.R., Adel, T. And Skurnick J.H. (1996). Characterization of reproductive hormonal dynamics in the perimenopause. J Clin Endocrinol Metab. 81(4):1495-501.
Santoro, N. And Randolph, J. (2011). Reproductive hormones and the menopause transition. Obstet Gynecol Clin North Am. 38(3):455-66.
Nurse Practitioner Affect the Shortage of Primary Care Physicians?
Can the Nurse Practitioner Affect the Shortage of Primary Care Physicians?
Topic Background and Issue Introduction
The objective of this work in writing is to examine the issue of whether the Nurse Practitioner can affect the shortage of primary care physicians? Specifically this work will examine whether Nurse Practitioners can improve access to care and fill the void of the primary care physician shortage. It was stated in the American College of Clinicians position statement released October 14th, 2009 that it has become clear that the American healthcare system "is in need of an overhaul. Current figures indicate that there are over 46 million people who are uninsured. This equates to 15% of nation's citizens who may not be able to access health care." (American College of Clinicians, 2009) The American College of Clinicians states that it "submits that Physician Assistants…
Division of Nursing, Bureau of Health Professions (2002) U.S. Department of Health and Human Services. R
Nurse Practitioners In Primary Care (2009) Policy Monograph. American College of Physicians. May 2009.
More Nurse Practitioners Could Take on Primary Care Responsibilities (2011) California Healthline. 29 Mar 2011. Retrieved from: http://www.californiahealthline.org/articles/2011/3/29/more-nurse-practitioners-could-take-on-primary-care-responsibilities.aspx
Nurse Practitioners as Leaders in Primary Care: Current Challenges and Future Opportunities. National Conference of State Legislatures. Louisville, KY 27 July 2010.
Over the last several years, the majority of graduating medical students (90%) has been focused on careers in specialized care. (Pickert, 2009) This is because they will make more money in comparison with doctors that are working in a primary care environment. As a result, a shortage has developed with many health care providers turning to Nurse Practitioners. These are nurses with some kind of advanced degree in Nursing. Their job is to diagnose / treat patients and prescribe medication. To fully understand what is happening requires looking at how this trend is having an impact on accountability, quality, costs / health promotion and risk reduction. These different elements will provide the greatest insights as to how Nurse Practitioners are having an effect on a health care environment.
The Current Trends with Nurse Practitioners
There is a crisis happening with many primary care providers. The number of doctors working…
Earnings of Wage and Salary Workers. (2012). BLS. Retrieved from: http://www.bls.gov/news.release/pdf/wkyeng.pdf
Physician Salaries. (2011). MD Salaries. Retrieved from: http://mdsalaries.blogspot.com/#Annual_Mean_Salary_of_Physicians_by_State_and_Specialty
Scope of Practice. (2010). AANP. Retrieved from: http://www.aanp.org/NR/rdonlyres/FCA07860-3DA1-46F9-80E6-E93A0972FB0D/0/2010ScopeOfPractice.pdf
What is a Nurse Practitioner. (2011), Nurse Practitioner Guide. Retrieved from: http://nursepractitionerguide.org/
Utilization management has in the recent past sparked heated arguments in the health sector with controversies arising as to the needs for the interventions. Medical practitioners heavily criticize the practice considering the increased workload it presents to them. Utilization management in primary care clinics presents a rigorous exercise for the patient and the medical professionals. ight from the initial patient data taking process to testing, treatment, admission, medicine prescription and discharge, the process requires precise record taking and follow of procedure (Yedidia, Gillespie, & Moore, 2000). Physicians consider the requirements stipulated in Utilization management to curtail on their autonomy and a burden in terms of the administrative work. The processes despite being rigorous and cumbersome to both the patient and the medical personnel, they influence the optimal utilization and management of health service as well as influencing a positive treatment outcome (Yedidia et al., 2000).
Utilization management covers the…
Al-Doghaither, A., Abdelrhman, B., Saeed, A., & Magzoub, M. E. (2003). Factors Influencing Patient Choice of Hospitals in Riyadh, Saudi Arabia. The Journal of The Royal Society for the Promotion of Health, 123(2), 105-109.
Al Doghether, M. H., & Al Megbil, T. I. (2004). Determinants of prescribing for the elderly in primary health care. . Middle Eastern Journal of Age and Ageing, 1(1), 1-8.
Bos, A. M. (2007). Health care provider choice and utilization among the elderly in a state in Brazil: a structural model. Pan Am J Public Health, 22(1), 41-50.
Cabana, M., & Lewis, T. C. (2000). Overcoming Barriers to using Asthma Clinical Practice Guidelines. Semin Med Pract, 3, 19-32.
Additional training in substance abuse can help to ensure that nurses are prepared to effectively deal with these types of situations. esearchers such as Jackson, Alford, Dube and Saitz assert that despite the widespread substance abuse problems in our nation, there is a considerable lack of training for primary healthcare providers in this area. Both psychotherapeutic (such as cognitive and behavioral strategies) and pharmacological (such as Buprenorphine, Methadone, LAAM and Naltrexone) interventions have shown to be successful at treating substance abuse. However, if the medical professionals making contact with these individuals are not properly trained to deal with these issues, nobody benefits.
As a primary care nurse, it is also important to know the best treatment centers for referral in the community. While most communities have Alcoholics Anonymous and other twelve step programs readily available, knowing where to refer a client for in-patient treatment is critical as well. Some in-patient…
Jackson AH, Alford DP, Dube CE, Saitz R. Internal medicine residency training for unhealthy alcohol and other drug use: recommendations for curriculum. BMC Med Educ. 2010 Mar 20;10(1):22.
Rieckmann TR, Fuller BE, Saedi GA, McCarty D. Adoption of practice guidelines and assessment tools in substance abuse treatment. Subst Abuse Treat Prev Policy. 2010 Mar 26;5(1):4
Quality Care Clinic (QCC) will aid in meeting current health needs, improving access to care, and providing high quality patient-centered care for citizens in Carson City. QCC will offer efficient, safe, effective, timely, and unbiased primary care to patients from birth to end of life. The NPs of QCC have experience in primary care and emergency room settings and will offer increased patient satisfaction due to open communication, skills in interviewing, therapeutic listening, and counseling. QCC will lease an estimated 1300 square feet of commercial real estate. Direct competitors for similar services are 10 primary care clinics and 40 physician offices. Indirect competitor is one emergency department at the local hospital. The fundamental key to success for QCC is cultivating knowledge for the public on services offered and effectively managing reimbursement for staff and NPs.
Statement of Funding Summary
To begin, the first year's costs is projected to be $125,000.…
CME,. (2015). A Quick Check-List of Medical Equipment Items for Your Primary Care Practice. Blog.claflinequip.com. Retrieved 28 October 2016, from http://blog.claflinequip.com/a-quick-check-list-of-medical-equipment-items-for-your-primary-care-practice
Hibbard, J. & Greene, J. (2013). What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs. Health Affairs, 32(2), 207-214. http://dx.doi.org/10.1377/hlthaff.2012.1061
Blood Pressure Monitoring of Hypertensive Veterans in Primary Care
Hypertension has been identified as one of the major public health issues in the United States. A significant portion of the American population has been diagnosed with this condition and are mostly treated with medications for blood pressure. According to the findings of a study that was conducted in 2008, it is estimated that 13% of active duty service members have been diagnosed with hypertension (The Diagnosis and Management of Hypertension Working Group, 2014). In addition, its reported that more than 37% of Veterans have hypertension, which makes it the most common chronic health condition among this population. While the control of hypertension has significantly improved among Veterans, there is need for more improvements in blood pressure monitoring of this population in the primary care setting. Healthcare professionals are faced with the need to enhance blood pressure monitoring of hypertensive Veterans…
Andrews, E. (2014, April 13). Blood Pressure Monitoring of Hypertensive Patients in Primary Care: Barriers and Facilitators to Ambulatory, Office, and Home Blood Pressure Monitoring in the Context of the Triple Aim. Retrieved from University of Southern Maine website: http://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1061&context=muskie_capstones
Guiliani, A.W. (2014). Assessing Blood Pressure Control in Primary Care. Retrieved from University of Kentucky website: http://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1018&context=dnp_etds
Himmelfarb, C.R.D., Commodore-Mensah, Y. & Hill, M.N. (2016, April). Expanding the Role of Nurses to Improve Hypertension Care and Control Globally. Annals of Global Health, 82(2), 243-253.
The Diagnosis and Management of Hypertension Working Group. (2014, April). VA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension in the Primary Care Setting. Retrieved from Department of Veteran Affairs website: https://www.healthquality.va.gov/guidelines/CD/htn/VADoDCPGHTN2014.pdf
Bonding Process between Primary Caregiver and Their Babies
For many parents, bonding with their babies is a virtually instantaneous experience at the moment of birth, while for others the process takes longer or may never fully develop. Although it is impossible to discern when bonding will take place, the theories of researchers such as Lorenz, Harlow, Bowlby and Ainsworth provide some insights into the process. This paper provides a review of these theories and an explanation concerning the ways attachment happens followed by a discussion of a long-term effects of each type of attachment on individuals at all stages of their development. More specifically, the paper provides an overview and popular definitions of attachment, a description of the major concepts of Ainsworth's theory, and discussion concerning how attachment comes about. An analysis concerning how attachment is experienced by the infant and primary caregiver and what happens between an infant and…
How does attachment affect the developing child and the adolescent?
The implications of successful bonding and attachment between primary caregivers and their babies are profound. For example, about 10% of births in the United States are preterm deliveries and an inordinately high percentage of these preterm infants are to parents of low socioeconomic status (Huckaby, 1999). According to Huckaby, "Premature infants often present challenges to their primary care providers. They are at high risk for multiple problems, pulmonary and neurological sequelae, developmental delays, and vision and hearing disturbances" (1999, p. 368). Beyond receiving the supportive interactions needed to develop vital cognitive skills, the failing to achieve successful attachment and bonding between primary
The study by Flynn et al. (2013) is a quantitative retrospective cohort study conducted to determine what types of patients were visiting the primary care, express care and emergency department of a group practice facility over the course of a year. Patient typology was based on whether the individual required an interpreter or not and whether the patient had mental health issues. Flynn et al. (2013) stated that the purpose of their study was “to examine health care utilization patterns of adult outpatients requiring interpreters, with a focus on the PC [primary care] setting” (p. 387). They alsos identified a secondary aim, which they described as “to compare frequencies of mental health diagnoses and somatic symptoms between patients requiring interpreters and those not requiring interpreter services” (Flynn et al., 2013, p. 387). No specific research question was identified in the study, but a hypothesis was stated along with the purpose…
Flynn, P. M., Ridgeway, J. L., Wieland, M. L., Williams, M. D., Haas, L. R., Kremers, W. K., & Breitkopf, C. R. (2013). Primary care utilization and mental health diagnoses among adult patients requiring interpreters: A retrospective cohort study. Journal of General Internal Medicine, 28(3), 386–391. doi: 10.1007/s11606-012-2159-5
The results of this analysis highlight the need for hospitals to fine-tune their discharge process to reduce readmissions, and support the expenditure of additional resources for this purpose as a cost-effective intervention; as an example, author cites a hospital in Iowa that implemented a rigorous post-discharge planning process for patients with heart failure and 30-day readmission rates were reduced by 3-9% during the 3-month period following implementation.
The research showed that many elderly patients who suffer from congestive heart failure also suffer from a wide range of comorbid conditions, including diabetes and hypertension. These patients can be reasonably expected to require periodic or even frequent treatment in emergency departments and/or hospitalizations for these conditions, making the need for effective and seamless post-discharge planning especially important. In this regard, the research also showed that there are some valuable evidence-based practice guidelines available, though, that can help clinicians better coordinate post-discharge…
As well as expanding patient's abilities to obtain primary care, virtually, telemedicine can enable patients in isolated locations to see specialists. When rural patients are connected to a hospital network such as the Grinnell egional Medical Center, they are able to access high-quality physicians through some of the more advanced healthcare technology available, although this is not always possible in a local healthcare system with fewer physicians and less access to high-level technology. Technology can still enable patients in a variety of settings to keep track of vital signs such as heart rate, blood pressure, and blood sugar, and to alert their physician immediately if their readings are abnormal.
While some surgeons have even performed procedures through virtual consults, certain aspects of medicine remain challenging to provide rural patients, such as physical rehabilitative services, which may require the patient to travel to receive the full benefit of the services. Patients…
Campbell, James D. (2001, May). Introducing telemedicine technology to rural physicians and settings. Journal of Family Practice. Retrieved January 27, 2011 at http://findarticles.com/p/articles/mi_m0689/is_5_50/ai_75244766/
Spath, Patrice. (2011). Community Continuum of Care planning.
Brown-Spath & Associates. Retrieved January 27, 2011 at http://www.brownspath.com/original_articles/cccplan.htm
Issler is a patient who recently moved with his daughter-in-law who is no longer married to his son. As part of her interest in helping to take care of Mr. Issler, she noticed that he was pale and diaphoretic after a two and a half hour flight. The daughter-in-law took him to an emergency room where he was attended to by a cardiologist and set a follow-up check up for an echo cardiogram next week. Mr. Issler has complained of congestive heart failure and a history of deep vein thrombosis. The cardiologist recommended that he seeks out a primary care provider and check up of his thyroid. As the primary care provider, the patient has also expressed his uncertainties on whether he has hyper of hypo thyroidism though he has been under thyroid medication for several years. In addition to being very pale, he has a large bag of…
Bray, D.L. (n.d.). Thyroid Storm and the AACN Synergy Model. Journal of Nursing. Retrieved from http://rnjournal.com/journal-of-nursing/thryoid-storm-and-the-aacn-synergy-model
Drewes at. al. (2012, October). The Effectiveness of Chronic Care Management for Heart Failure: Meta-Regression Analyses to Explain the Heterogeneity in Outcomes. Health Services Research, 47(5), 1926-1959.
Hardin, S. & Hussey, L. (2003, February). AACN Synergy Model for Patient Care Case Study of a CHF Patient. Critical Care Nurse, 23(1), 73-76. Retrieved from http://ccn.aacnjournals.org/content/23/1/73.full.pdf
Kaplow, R. & Reed, K.D. (2008). The AACN Synergy Model for Patient Care: A Nursing
The emphasis is on normal, everyday activities provided for residents. According to the authors, however, little research has been conducted to investigate the actual effect of such activities and settings upon residents. The assumption is that such settings have a better effect that traditional institutions, but there is little empirical research to support this.
Hence, Verbeek et al. (2010) conducted a study to compare small-scale living with regular care in nursing homes in the Netherlands. Interestingly, they found no significant difference between the quality of life experienced by residents in traditional institutional settings and those in small-scale living facilities. Furthermore, there was also no significant difference in the job satisfaction levels of nursing staff between both types of institution was found. Another important aspect, namely neuropsychiatric symptoms and agitation were also significantly similar for both institution types. According to the authors, a difference was found in the satisfaction level of…
Gaugler, J.E. (2005, Mar.). Family Involvement in Residential Long-Term Care: A Synthesis and Critical Review. Aging and Mental health, Iss. 9, vol. 2. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2247412/
Lyness, J.M., Yu, Q., Tang, W., Tu, X., and Conwell, Y. (2009, Dec.). Risks for Depression Onset in Primary Care Elderly Patients: Potential Targets for Preventive Interventions. American Journal of Psychiatry. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2982671/
Simonazzi, a. (2009, Jun). Home care and cash transfers. Effects on the elderly care-female employment trade-off. Retrieved from: http://www.aiel.it/bacheca/SASSARI/papers/simonazzi.pdf
Verbeek, H., Zwakhalen, S.M.G., Van Rossum, E., Ambergen, T, Kempen, G.I.J.M., and Hamers, J.P.H. (2010, Nov.). Dementia Care Redesigned: Effects of Small-Scale Living Facilities on Residents, their Family Caregivers, and Staff. American Medical directors Association. Retrieved from: http://www.unimaas.nl/hcns/websiteVW/publications/Publication%20scans/Verbeek.%20Dementia%20care%20redesigned.pdf
Care Partnerships Will Maximize ebecca's Independence?
Care partnerships can help ebecca in many ways, including increasing her independence. ebecca cannot be fully independent, but her independence can be maximized via the use of ancillary services. ebecca also needs psychological and social support services as she is feeling increasingly more pessimistic about her changing condition. Given that, the care partnership should include a support group, individual psychological counseling, as well as family counseling. A support group will help ebecca receive support from others in her situation and will reduce ebecca's social dependence on her family. This way, ebecca can enjoy her sister's company and that of her husband and young children without viewing them as her only source of social support. The group will also help ebecca receive advice related to her medication situation, and the breakdown of communication between her and her husband. egarding that, the psychological counseling will be…
Care Coverage and Inequalities in the Education System
Traditional Care Coverage vs. Managed Care Coverage
Traditional care coverage is also known as Fee-for-service (FFS). Under this model, the patient pays for services that are itemized in the Invoice. The physicians gain an incentive to offer more treatments as payment depends on the quantity of care and not the quality of care. In the health insurance and healthcare sectors, traditional care coverage happens when physicians and other caregivers get a fee for each service like laboratory tests, office visit, procedure and other healthcare services. After providing services, the patient makes payments retrospectively. Traditional health coverage enables the patients to choose a healthcare provider, including a favorite hospital or doctor. The services rendered are paid for by the patient and then submits the bill to the insurance firm for reimbursement of the percentage it agreed to the insurer for the patient (Kongstvedt,…
Conchas, G. & Gottfried, M. (2015). Inequality, Power and School Success: Case Studies on Racial Disparity and Opportunity in Education. New York: Routledge
Duncan, G. J. & Murnane, R. J. (2014). Restoring Opportunity: The Crisis of Inequality and the Challenge for American Education. Boston, MA: Harvard Education Press
Beard, C., Weisberg, .B., & Primack, J. (2012). Socially anxious primary care patients' attitudes toward cognitive bias modification (CBM): a qualitative study. Behavioural and cognitive psychotherapy, 40(05), 618-633.
This study shows how traditional methods of approaching patients with information can cause confusion and thus create barriers to accessing patient knowledge in primary care settings. The study focused on working with primary care patients suffering from anxiety and how they reacted to cognitive bias modification (CBM) for that anxiety. Upon initial discussion of the treatment, most participants showed that they understood. However, it was clear by the end of the treatment that the program was not clarified enough to patients prior to treatment and that created a knowledge barrier that caused the treatment not to work as successfully as previously tested. Better methods for communicating the treatment within the primary care setting must be developed to bring down these…
Beard, C., Weisberg, R.B., & Primack, J. (2012). Socially anxious primary care patients' attitudes toward cognitive bias modification (CBM): a qualitative study. Behavioural and cognitive psychotherapy, 40(05), 618-633.
Beckman, H.B., Wendland, M., Mooney, C., Krasner, M.S., Quill, T.E., Suchman, A.L., & Epstein, R.M. (2012). The impact of a program in mindful communication on primary care physicians. Academic Medicine, 87(6), 815-819.
Cheung, P.T., Wiler, J.L., Lowe, R.A., & Ginde, A.A. (2012). National study of barriers to timely primary care and emergency department utilization among Medicaid beneficiaries. Annals of emergency medicine, 60(1), 4-10.
Crabtree, B.F., Nutting, P.A., Miller, W.L., McDaniel, R.R., Stange, K.C., Jaen, C.R., & Stewart, E. (2011). Primary care practice transformation is hard work: insights from a 15-year developmental program of research. Medical care, 49(Suppl), S28.
Health Care and Health for All:
In what the World Health Organization termed as Health for All, the International Conference on Primary Health Care in 1978 expressed the need for health workers, urgent government action, and the world community to safeguard and support health for all. In order to achieve health for all people across the globe, the Conference made various declarations including health being an essential human right and a significant world-wide social goal. One of the critical aspects towards the achievement of this Health for All initiative is primary healthcare.
Declarations on Primary Health Care:
As an essential health care service, primary health care can be made universally accessible to people and families through the full participation of the community and at a cost that the community can afford ("Declaration of Alma-Ata," n.d.). Primary health care acts as the initial level of contact of people, families, and communities…
Bassett, M.T. (2006, December). 'Health for All In the 21st Century.' American Journal of Public Health, 96(12), 2089. Retrieved from http://www.medscape.com/viewarticle/565796_2
"Declaration of Alma-Ata." (n.d.). International Conference on Primary Health Care -- World
Health Organization. Retrieved December 30, 2011, from http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf
"Global Strategy for Health for All by the Year 2000." (n.d.). World Health Organization.
ole of Family Physician
It is important for us to understand the role of a family physician before we begin our discussion on the importance of family physicians in any health care system of the community. Many reforms have been made in the health care systems of various communities all over the world. Almost all of these reforms lay their focus on the prevention as well as the treatment of any disease along with the promotion of health and management of conditions that have become a chronic problem for the patients. All of these areas are the center of the family physicians and therefore family medicine has a huge role to play in here.
In this paper, we shall look at the current health care system in Libya and see how the government and other organizations like WHO are playing their role to improve the health care system in the…
(2005). Libya country profile. Library of Congress Federal Research Division (April 2005).
(2004). Pfizer Clear Health Communication Initiative. What it Health Literacy? [Online].
(2004). The American Heritage Dictionary of the English Language, Fourth Edition; 2000. [Online].
Kates N. (1997). Psychiatry and family medicine: sharing care. Can J. Psychiatry. Vol. 42:913-14.
Provide sustained technical assistance (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003)
Evaluation of the process in rural and small communities includes: (1) scope of the project; (2) goals; (3) critical success factors; and (4) technical assistance." (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003) Community grants have been focused on the provision of 'personal digital assistant (PDA) systems in assisting with the decision support role. The initiative is stated to include: (1) development of toolkits; (2) leveraging known tools; (3) developing capacity; and (4) disseminating best practices. (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003)
Ormond, Wallin, and Goldenson report in the work entitled: "Supporting the Rural Health Care Safety Net" (2000) state: "The policy - and market-driven changes in the health care sector taking place across country are not confined to metropolitan areas. Rural communities are experiencing changes impelled by many of the same forces…
Healthcare and Healthcare Insurance Country Report: India (2004) Tata Consultancy Services and Microsoft. WebHealthCentre.com. 2004 August. Online available at http://download.microsoft.com/documents/customerevidence/7144_WebHealth_CS.doc
Expert Panel Meeting: Health Information Technology (2003) Agency for Healthcare Research and Quality (AHRQ) 23-24 July 2003. Online available at http://www.ahrq.gov/data/hitmeet.htm
Silberman, P. And Slifkin, R. (nd) Innovative Primary Case Management Programs Operating in Rural Communities: Case Studies of Three States. Working Paper No. 76 North Carolina Rural Health Research and Policy Analysis Program.
Ormond, Barbara a.; Wallin, Susan Wall; and Goldenson, Susan M. (2000) Supporting the Rural Health Care Net. 15 May 2000 Urban Institute
In the wake on new and very contentious health care reform, many firms have undergone extensive transformations. These transformations have been predicated on both cost control and quality management. In particular quality management has had a profound impact on the underlying business operations of many health care firms. For one, firms are now finding methods in which to enhance the overall patient experience while also mitigating potential loses due to negligent means. The focus on quality management has also made firms more efficient in regards to the overall delivery of service. In particular, my firm has done extensive work with reducing elderly accidents within the facility. This quality management initiative has not only reduced costs associated with accidents, but it also has enhanced the trust and patient experience of all stakeholders within the firm (Kelly, 2011).
Identify the milestone you chose in the history of quality improvement in…
1) Draper, Elaine, Joseph LaDou, and Dan J. Tennenhouse. 2011. "Occupational Health Nursing and the Quest for Professional Authority," New Solutions 21, 47 -- 81
2) Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (Eds). (2000). To err is human: Building a safer health system. Washington, D.C.: National Academy Press.
3) Kelly, D.L. (2011). Applying quality management in healthcare: A systems approach (3rd ed.). Chicago, IL: Health Administration Press
4) Lucia, Patricia R.; Otto, Tammy E.; Palmier, Patrick A. (2009). "Chapter 1
"Studies of the relationship between managed care penetration in the health care market and expenditures for Medicare fee-for-service enrollees have demonstrated the existence of these types of spill over effects" (Bundorf et al., 2004).
Managed care organizations generate these types of spillover effects by increasing competition in the health care market, altering the arrangement of the health care delivery system, and altering physician practice patterns. Studies have found that higher levels of managed care infiltration are linked with lower rates of hospital cost inflation and lower physician fees are consistent with competitive effects. "Other studies demonstrate the impact of managed care on delivery system structure including hospital capacity, hospital admission patterns, the size and composition of the physician workforce and the adoption and use of medical equipment and technologies. More recent evidence has linked market-level managed care activity to the process, but not the outcomes of care" (Bundorf et al.,…
Altman, D.E. And L. Levin. (2005). The Sad History of Health Care Cost Containment as
Told by One Client. Health Affairs, 24(1).
Bodenheimer, T. (2005). High and rising health care costs. part 1: Seeking an explanation.
Annals of Internal Medicine, 142(10), 847-54.
Access to Health Care in USA
This research paper focuses on the degree of accessibility to the health care services in the U.S.A. Accessibility refers to the ability of an individual to meet health care needs and to acquire the needed medical services on time. It then discusses the findings of the research. The suggestions for the elimination of the prevailing problems in the health care system are also given in the preceding paper.
Health Care: Access to Health Care in United States of America
To achieve a long-lasting life and to save oneself from major diseases it is important that people have an easy access to the medical and health care services. Access to the health care services means that individual gets timely health services to attain the best heath results. In other words it refers to the ability of an individual to meet health needs and to acquire…
Albert, R. (2009). The U.S. Health Care Rip-Off. Retrieved May 16, 2013, from http://rendezvous.blogs.nytimes.com/2013/03/03/the-u-s-health-care-rip-off/
Alex, E. (2012). Health Care Access Worsened For Americans Since 2000: Report. Retrieved May 16, 2013, from http://www.huffingtonpost.com/2012/05/07/health-care-access-urban-institute_n_1497658.html
Maria, E. (2012). Benefits of the United States Health Care System. Retrieved May 17, 2013, from http://www.ehow.com/list_7411670_benefits-states-health-care-system_.html
Maryann, B (2011). Health Care Systems: Three International Comparisons. Retrieved May 17, 2013, from http://www.stanford.edu/class/e297c/poverty_prejudice/soc_sec/health.htm
United States healthcare programs to citizens compare with the healthcare provided to residents in other countries? That question will be the focus of this paper, along with the background to the decision of major health insurance companies to support the candidacy of Republican Mitt Romney.
here does the U.S. stand in the world when it comes to healthcare?
According to a statement by the Speaker of the House of Representatives, John Boehner, the U.S. has "…the best health care delivery system in the world" (Politiface.com). Boehner, who was a guest on the CBS Sunday program "Face the Nation," was commenting on the candidacy of Mitt Romney. On the July 1, 2012 program, Boehner said he supports Romney for president because Romney "…understands that Obamacare will bankrupt our country and will ruin…" that healthcare system that the speaker believes is best in the world (politifact.com).
Meanwhile on Fox News Sunday (also…
Balanced Politics. (2009). Should the Government Provide Free Universal Health Care for All
Americans? Retrieved November 17, 2012, from http://balancedpolitics.org .
Business Insider. (2012). Health Insurance Companies Are Worried About A Romney
Victory. Retrieved November 17, 2012, from http://www.businessinsider.com .
Access to Healthcare:
For the last two decades, access to healthcare is an issue that has played a crucial role in leading the charge for health care reforms. Access to quality and comprehensive health care services is a crucial aspect for the realization of health equity and for enhancing the quality of health for every individual. Generally, the access to these services means the timely use of individual health services in order to accomplish the best health outcomes ("Access to Health Services," 2012). The achievement of the best health outcomes to access to personal health services requires three major steps i.e. gaining entry into the health care system, identifying a trustworthy health care provider, and accessing the services where they are needed.
Components of Access to Healthcare:
Access to personal health care services incorporates four major components i.e. coverage, workforce, timeliness, and services. Health care coverage is mainly provided through…
"Access to Affordable Healthcare." (2012, November 12). American College of Healthcare
Executives. Retrieved April 4, 2013, from http://www.ache.org/policy/access.cfm
"Access to Health Care." (n.d.). The Everett Clinic. Retrieved April 4, 2013, from http://www.everettclinic.com/About_Us/Legislative_Advocacy/Current_Health_Issues/Access%20to%20Health%20Care.ashx
"Access to Health Services." (2012). HealthyPeople.gov. Retrieved from the U.S. Department of Health and Human Services website: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=1
com). A certain amount of errors is to be expected, but there should not be so many that it demonstrates a certain level of skewedness about the model in its entirety. Thus, if the NHI model is the one which is selected, then it needs to be tested against a range of different scenarios. The following demonstrate some truly relevant what-ifs: what if the doctors only move half the projected volume; what if medicare slashes rates; what if competitors open a comparable program (dgapartners.com).
There are a range of factors which can change or adjust once a healthcare facility opens their doors for business. And as much as this facility is attempting to engage in a solid humanitarian effort, at the end of the day, it's still a business and people need to get paid. Thus, before engaging in further developmental activities, one needs to determine in what ways the…
Brakatu Ofori-Adjei, a. (2007). Microfinance: An Alternative Means of Healthcare Financing for the Poor. Ghana Medical Journal, 193-194.
Burnstein, L., Harris, R., & Love, L. (2012, August 30). Top Four Legal Issues to Consider When Opening an Urgent Care Center. Retrieved from Mondaq.com: http://www.mondaq.com/unitedstates/x/194082/Healthcare/Estate+planning+is+important+step
Burnstein, M., Harris, R.L., & Love, L. (2012, August 20). Top Four Legal Issues to Consider When Opening an Urgent Care Center. Retrieved from Mondaq.com:
Evolution of Health Care Information Systems
The objective of this study is to compare and contrast a contemporary healthcare facility or physician's office health care facility or physician's office operation of 20 years ago and to identify at least two major events and technological advantages that influenced current HCIS practices. The physician's office and health care facility of 20 years ago was a paper-based operation. All records were paper records, appointments were written on calendars and prescriptions were handwritten, notations on the patient's health records was done by writing on the physical paper record and all hospital orders were written by hand. During the 1970s hospital growth and expansion occurred and the expenditures for Medicare and Medicaid were on the rise. At this time mainframes were still in use and microcomputers became available and not only were they smaller but they were also less expensive. However, transformation did not come…
Costs and Benefits of Health Information Technology (nd) Evidence Report/Technology Assessment Number 132. Southern California Evidence-based Practice Center, Santa Monica, CA. Retrieved from: http://www.ahrq.gov/research/findings/evidence-based-reports/hitsys-evidence-report.pdf
Friedman, S. (nd) Facts About Health Care Information Systems. eHow Retrieved from: http://www.ehow.com/about_6117257_health-care-information-systems.html
History and Evolution of Health Care Information Systems (nd) Chapter 4. Retrieved from: http://www.slideserve.com/paul/history-and-evolution-of-health-care-information-systems
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…
Clark, Cheryl et al. "State Medicaid Eligibility and Care Delayed Because of Cost." New England Journal of Medicine, 368 (2013): 1263-1265. Print.
Ellwood, Marilyn Rymer et al. An Exploratory Analysis of the Medicaid Expenditures of Substance Exposed Children Under 2 Years of Age in California. U.S. Department of Health and Human Services, 1993. Print.
Goodnough, Abby. "October 25th." The New York Times. 25th October. 2012. Web. 29th March 2013. [ http://www.nytimes.com/2012/10/26/us/spending-on-medicaid-has-slowed-survey-finds.html?_r=0 ].
Grannemann, Thomas W. And Mark V Pauly. Controlling Medicaid Costs: Federalism, Competition, and Choice. Washington DC: American Enterprise Institute, 1983. Print.
Employer Healthcare Benefit Plans
More than half of the American population is covered by a comprehensive health plan of one type or another. That's approximately 160 million people. The programs that come under the above mentioned coverage include the likes of employer sponsored plans and other government initiatives for instance Medicaid and Medicare, a small proportion of health insurance which is purchased on individual basis may also be included in this. If we proceed to explain employer sponsored health programs, government initiatives and individual healthcare benefits individually, then briefly we can say that the employer benefit plans mostly comprise of group plans and are called "the employee welfare benefit plans"
Table of Contents
The Estimated Effects of PPACA on Coverage
The Number of Uninsured Decreases by 53%
Four Million Children Will Gain Coverage
The Individual Mandate Contributes Most to educing the Number of Uninsured
Manning W. And Marquis S, "Health Insurance: The Tradeoff Between Risk Pooling and Moral Hazard," Journal of Health Economics, Vol. 15, No. 5, October 1996, pp. 609 -- 639.
Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A, and Marquis MS, "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment,"
American Economic Review, Vol. 77, No. 3, June 1987, pp. 251 -- 277.
Pauly MV and Herring BJ, "An Efficient Employer Strategy for Dealing with Adverse Selection in Multiple-Plan Offerings: An MSA Example," Journal of Health Economics, Vol. 19,
sufficient health care for runaway teenagers is a topic of grave concern to most in the medical and social professions, both nationally and in the state of California. With limited treatment options, higher risks of STD's, HIV, and other diseases, improper prenatal care, and a lack of community care options, runaway teens receive grossly inadequate health care. This paper will address those concerns, specifically in the state of California, as well as offering possible solutions to the problem, and will examine the role of the registered nurse in the solutions presented.
It is important to note that the life of a runaway teenager is filled with health risks and danger. Marie and Cheri are just one example. They were 13 when they ran away from home in an attempt to escape a drug addicted father who sexually abused them. With only $200 between them, their food supply and housing was…
Advanced Practice Registered Nurses Council. (2004). Information on APRNs. APRNs. Retrieved from Advanced Practice Registered Nurses Council on March 03, 2003. Web site: http://www.scnurses.org/A_P_Council/aprns.asp
American Civil Liberties Union. (May 14, 2003). Letter to the House Urging Opposition to the Musgrave Amendment to HR 1925, the Runaway, Homeless, and Missing Children Protection Act. Retrieved from American Civil Liberties Union website on March 3, 2004. Web Site: http://www.aclu.org/news/NewsPrint.cfm?ID=12643&c=225
California Board of Registered Nurses. (Fall, 2003). What is the RN Scope of Practice? The BRN Report, 15(2), 7-9.
California Office of the Attorney General. (2002). 2002 Reports of Missing Children by County. Sacramento, CA: California Department of Justice.
Despite of the receipt of federal funding to assist in the set-up of an insurance exchange program, the Minnesota legislature is not cooperating with the Governor Drayton's plans to design a program. Instead, in a classic example of partisan politics, the legislature is going forward with its own plans to design an exchange program. In doing so, the legislature is placing the State of Minnesota in a position of possibly losing the grant provided by the federal government. According to the grant provisions, the state must show it can operate an effective exchange program by the end of calendar year 2012 or the federal government under the terms of ACA will impose a one size fits all exchange on the state. Even the state's most conservative political groups oppose this happening and advocate that the state's executive and legislative branches cooperate in formulating an acceptable state exchange program.
Berkel, Jessica Van. "HCMC fights back against Pawlenty's GAMC Cuts." 3 December 2009. Minnesota Daily . http://www.mndaily.com/2009/12/03/hcmc-fights-back-against-pawlenty%E2%80%99s-gmac-cuts . 7 April 2012.
Gray, Virginia. "Incrementing Toward Nowhere: Universal Health Care Coveragein the States." Publius (2010): 82-113.
Harrington, Scott E. "The Health Insurance Reform Debate." The Journal of Risk and Insurance (2010): 5-38.
Minnesota Department of Human Services. "General Assistance Medical Care." 11 September 2011. http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&Redirected=true&dDocName=id_006257 . 7 April 2012.
Healthcare Economics Evaluation
This report is about a proposed healthcare economics investigation. Some early research has been done and will be described based on what was found and how it was found. The report will conclude with a proposed plan for further economic evaluation on that same topic with a great deal the expected and proper form and function of that research to be described in that section. A conclusion will wrap up the report.
Critical Appraisal of the Evidence
The author of this report has chosen how to make health care affordable and have the most amount of people possible covered in the United States as this is one of the more omnipresent issues and matters in American society in the modern time. Health care being at the forefront of the American news cycle is nothing new as it is has been a huge part of the…
Berkowitz, E. (2008). Medicare and Medicaid: The Past as Prologue. Health Care Financing Review, 29(3), 80-93.
Bovbjerg, R.R., & Schoenbaum, S.C. (2004). Malpractice Reform Must Include Steps To Prevent Medical Injury. Annals Of Internal Medicine, 140(1), 51-54.
Budget problems, Medicaid expansion main topics at SAMHSA meeting. (2012). Alcoholism & Drug Abuse Weekly, 24(32), 1-3.
CDC. (2013, March 19). CDC Online Newsroom - Press Release: October 17, 2011. Centers for Disease Control and Prevention. Retrieved March 19, 2013, from http://www.cdc.gov/media/releases/2011/p1017_alcohol_consumption.html
Palliative care has gone under a lot of changes as the years have progressed. Just like how general care has been advanced for the sick in areas such as pharmacology and medical engineering, palliative care has also been given much importance. Palliative care has been recognized as a specialty in many countries. There has been evidence that a care outlook that takes note of psychosocial, psychological and spiritual support is very effective and holds great importance in the eyes of those who are sick and their families. (Beaver et al., 2000) In simpler terms, palliative care means to relieve the sufferings of the sick and not really to make the treatment effective. (Macpherson, 2002)
Watching the movie Wit, I was truly saddened and affected by the degree of importance that is given to research these days. esearch for a horrible disease like cancer should be carried out but not on…
Beaver, K. et al. (2000) Primary care services received during terminal illness. International Journal of Palliative Nursing; 6, 220 -- 227.
Macpherson, G. (2002) Black's Medical Dictionary. London: A&C Black.
Nursingtimes.net (2009) Palliative care 1: principles of palliative care nursing and end-of-life care. [online] Available at: http://www.nursingtimes.net/nursing-practice/clinical-zones/end-of-life-and-palliative-care/palliative-care-1-principles-of-palliative-care-nursing-and-end-of-life-care/2007480.article [Accessed: 11 Jan 2013].
Wit (2001) [DVD] USA: Mike Nichols.
Healthcare: Clinical Integration
What is clinical integration
History of clinical integration
Goals of clinical integration
Importance of clinical integration
New payment models
Barriers to clinical integration
Lack of practitioner alignment
Lack of interoperability
How to achieve success in clinical integration
The future of health care systems
Physician acquisitions vs. clinical integration
HIEs -- solution to clinical integration?
Policy makers are beginning to appreciate the fact that only systemic change can effectively change, for the better, the manner of health care delivery in the U.S.; and that anything less would only alter the system's edges - with little or no substantial effect on cost-control, innovation-promotion, effectiveness of reward incentive schemes, coordination and coverage (AHA, 2010). Clinical integration has been found to be crucial to the change needed for the achievement of the aforementioned goals (AHA, 2010). Despite…
AHA. Clinical Integration -- the Key to Real Reform. Trend Watch. Retrieved from [HIDDEN]
Athena Health. (2014). History of the Clinical Integration Model. Athena Health. Retrieved from https://www.athenahealth.com/knowledge-hub/clinical-integration/clinical-integration-model.php
eHealth Initiative. (2012). The Rise of the Private Health Information Exchange and Changing Role of Public Exchanges. eHealth Initiative. Retrieved from [HIDDEN]
Fridsma, D. (2013). Interoperability Vs Health Information Exchange: Setting the Record Straight. Health IT Buzz. Retrieved from http://www.healthit.gov/buzz-blog/meaningful-use/interoperability-health-information-exchange-setting-record-straight/
Healthcare Workplaces Today Considered True Boundaryless
The concept of the boundaryless organization demonstrates a trend in healthcare and elsewhere that claims that an organization is most effective when it is collaborating with all inside and outside interests to build a dynamic workplace that works best for everyone. The challenges might simply be information sharing but it can also take the form of communication for change. The health care field is an ever changing network of core and support personnel as well as a whole pool of individual consumers that utilize services and might have an important role to play in positive change. This work will briefly discuss the historical utilization of boundaryless organization tool by looking at what techniques have been most effective for sharing information and ideas, what techniques were ineffective in the past and at how these techniques might be used in the future i.e. how these techniques…
Heslop, L., & Sim, J. (2012). CALNOC demonstrates leadership in nursing outcomes research. Australian Nursing Journal, 19(8), 32.
Magaw, T. (2012). Independent hospitals see benefits. Crain's Cleveland Business, 33(11), 8.
Maiers, M., Westrom, K., Legendre, C., & Bronfort, G. (2010). Integrative care for the management of low back pain: use of a clinical care pathway. BMC Health Services Research, 10298.
Saba, G.W., Villela, T.J., Chen, E., Hammer, H., & Bodenheimer, T. (2012). The Myth of the Lone Physician: Toward a Collaborative Alternative. Annals Of Family Medicine, 10(2), 169-173. doi:10.1370/afm.1353
Community Teaching Proposal for Primary Prevention/Health Promotion
The objective of this study is to create a community teaching proposal for primary prevention and health promotion. The work of Kulbok, wet al (2012) reports that public health nursing practice is "population focused and requires unique knowledge, competencies, and skills." (p.1) Public health nursing makes the requirement of working with communities and populations "as equal partner and focusing on primary prevention and health promotion." (Kulbok, et al., 2012, p.1)
Community teaching for primary prevention and health promotion involves educating community members about what is required to address primary prevention and promotion of health. This can be accomplished through community-wide meetings held at a central location in the community. As noted by Kulbok et al. (2012) "In the 21st century, public health nurses practice in diverse settings including, but not limited to, community nursing centers; home health agencies; housing developments; local…
Anderson, DR, et al. (2012) Primary Care Nursing Role and Care Coordination: An Observational Study of Nursing Work in a Community Health Center, The Online Journal of Issues in Nursing. Vol. 17 No. 2. Retrieved from: http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No2-May-2012/Primary-Care-Nursing-Role-and-Care-Coordination.html
Connor, N. et al. (2012) Healthy People 2020 from Theory to Practice in a Nursing Program. The University of Central Florida. Retrieved from: http://c.ymcdn.com/sites/www.aptrweb.org/resource/resmgr/tp2012_presentations/conner_aptr_tp12.pdf
Kulbock, PA, et al. (2012) Evolving Public Health Nursing Roles: Focus on Community Participatory Health Promotion and Prevention. The Online Journal of Issues in Nursing. Vol. 17. No. 2. Retrieved from: http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No2-May-2012/Evolving-Public-Health-Nursing-Roles.html
Barak concludes by suggesting that the issue and concept of diversity take on a "special urgency" in human service healthcare organizations among the organization as a whole and staff, and that the organization review its quality of service and commitment to the community in order to truly impact the lives of diverse populations.
Managing Diversity: Best Practices
H Management often works off of the ideals of 'best practices.' This concept is discussed in the next article, "Managing the Diversity evolution: Best Practices for the 21st Century Business." Aronson takes a more general approach to diversity but one that can be applied directly to the healthcare industry nonetheless. Aronson points out many of the trends previously identified with regard to diversity problems in the nation's business climate as a whole. In particular the author points out that diversity issues may stem from a number of causes including cultural differences and systematic…
Aronson, D. (2002). "Managing diversity revolution: Best practices for the 21st century."
Civil Rights Journal, 6(1):46
Barak, M.E.M. (2000). "The inclusive workplace: An ecosystems approach to diversity
Management." Social Work, 45(4):339
Contracts with doctors often contain a clause which doesn't allow the doctors to discuss
Health care 7 with their patients financial incentives to deny treatment or about treatments not covered by the plan (Glazer, 1996). This has caused many consumers, especially those with chronic illnesses, to form organizations with the American Medical Association and physician specialty groups to promote legislation forbidding "gag rules" (Glazer, 1996). One group, Citizen Action, has 3 million members and "has been lobbying in state legislatures for laws that would require plans to disclose how they pay their doctors; give patients the right to choose specialists outside the plan; and provide appeals for patients who get turned down for expensive treatments" (Glazer, 1996).
The doctor-patient relationship is also affected if a patient must switch to a new doctor under managed care. Having a longterm relationship with a primary doctor is important because he or she is…
Bennett Clark, Jane (1996, July). What you should ask your HMO.
Kiplinger's Personal Finance Magazine. pp. 92-93.
Glazer, Sarah (1996, April 12). Managed Care. CQ Researcher, 6,
Koop, C. Everett (1996, Fall). Manage with care. Time. pp. 69.
educed costs for medical education would be the second to last alternative that would be likely to be effective. First, reducing the costs of medical eduction, through tax incentives and tuition caps, may make the medical field more attractive to some students; however, even with these in place, the costs would still be so significant that many potential future doctors would be still turned off from the profession. In contrast, free medical education would likely be very effective in recruiting students to pursue the medical profession. This would likely be especially attractive to good students who weren't good enough to receive significant scholarship money to help offset their education. However, this would be the most expensive alternative to implement for the United States. This cost could be offset by the service these doctors give, in exchange, for government-run medical facilities, but the infrastructure alone to this type of innovative plan…
Fox, R. & Abrahamson, K. (Oct-Dec 2009). "A critical examination of the U.S. nursing shortage: Contributing factors, public policy implications." Nursing Forum, 44(4). p. 235-244.
Ganley, B. & Sheets, I. (Jul 2009). "Educational innovations: A strategy to address the nursing faculty shortage." Journal of Nursing Education, 48(7). p. 401-405.
Medical student debt. (2011). Retrieved January 9, 2011, from http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacy-policy/medical-student-debt.shtml .
The Patient Protection and Affordable Care Act. (No date). Retrieved January 9, 2011, from http://dpc.senate.gov/healthreformbill/healthbill04.pdf .
Managed Care Health eimbursement Systems in the United States
With health care costs skyrocketing consumers and health insurance companies alike are seeking solutions to the growing crisis in health care within the United States. This crisis revolves primarily around the lack of coverage that exists for millions of Americans. Employers are more and more dropping out of traditional health insurance programs and seeking new ways to provide employees with health care services. In response to the climbing costs of health care many reimbursement and health care cost containment programs are being developed.
There are many health care reimbursement programs available to patients that provide some form of medical care cost containment and coverage. Among the most popular of these or at least the fastest growing are managed care reimbursement programs. Managed care reimbursement programs are becoming more the norm rather than the exception to the rule.
Managed care programs have…
Barron, B.A. "The price of managed care." Commentary, 103(5):49
Camperell, K.J. & Mitchell, R.A. (1995). "Managed health care accounting." Journal of Accountancy, 179(4):68.
Cauchi, R. "Making the best of managed care." State Legislatures, 27(6):22
Dranove, D. (2000). "The economic evaluation of American health care: From Marcus
nurses deliver evidence-Based care?
Define main ideas within the title supported from the literature
Nurse instructors confront many hurdles in the present healthcare environment. Educational methods, philosophies, and the content of curricula is required to reviewed to cater to the requirements of the professional nurses who would practice in the coming millennium. (Kessenich; Guyatt; DiCenso, 25) Evidence-based practice or EBP has currently emerged to be a remarkable attribute in nursing literature along with a key impetus in restructuring nursing practice. (Elizabeth; Pyle, 64) Evidence-Based Nursing or EBN is the strategy by which the nurses formulate clinical conclusions applying the best available research evidence, their clinical skill and patient prioritization. (Evidence-Based Nursing: University of Minnesota) It could be narrated as the meticulous, unequivocal and judicious application of the current best evidences in formulating decisions about the care of individual patients. When clinicians formulate health care conclusions for a population or group…
Asking Clinical Questions: Introduction. Retrieved from http://www.poems.msu.edu/InfoMastery/Questions/Questions.htm Accessed on 18 June, 2005
Beyers, Marjorie. About Evidence-Based Nursing Practice. Nursing Management. October, 1999. Vol: 11; No: 1; pp: 103-105
Code of professional Conduct. Retrieved from http://www.nmc-uk.org/nmc/main/publications/reqForPre-regNursing.pdf Accessed on 17 June, 2005
Cronenwett, L. Research, Practice and Policy: Issues in Evidence-Based Care. Journal of Issues in Nursing. February 19, 2002. Vol: 7; No.2; pp: 57-61
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…
Bernstein, A.B., Hing, E., Moss, A.J., Allen, K., Siller, A., and Tiggle, R. (2003). Health Care in America: Trends in Utilization. Hyattsville, MD: National Center for Health Statistics.
Birenbaum, A. (2002). Wounded Profession: American Medicine Enters the Age of Managed Care. Westport, CT: Praeger.
Birenbaum, A. (1997). Managed Care: Made in America. Westport, CT: Praeger.
Committee on Health Care Access and Economics Task Force on Mental Health (2009). Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration. The Official Journal of the American Academy of Pediatrics, March, 30, 2009, pp. 1248-1251.
Within this section of Chapter One, a historical perspective of NHS will be provided. This discussion will identify problem areas that have emerged in relation to NHS with an attempt made to address the manner in which such problems have historically influenced reform efforts.
With the passage and associated provisions of the NHS Act of 1946, NHS was implemented in the UK in 1948. The NHS Act of 1946 served as the means by which a pattern of health service finance and provision was established in the UK following World War II (Baggot, 1998). According to Baggot, on the basis of the Act, the principle of collective responsibility by the state for the establishment of a comprehensive health service system was introduced, allowing for the planned use of services by the entire population at no cost. It was also intended that equality of access to services would be…
Baggott, R. (1998). Health and Health Care in Britain. London, Macmillan,
Barlow, M. (1998). The Fight of My Life. Toronto: Harper Collins
BMA Central Consultants and Specialists Committee (1990). Guidance on Clinical
Directorates London: BMA.
Indeed many of the "rotating staff may have never been on a transfer" and in addition most transport vehicles "are not conducive to carrying out active interventions on patients" -- a situation that can lead to serious medical complications during transfers (which often take place in late-night hours) (Ahmed, p. 503). Moreover, less than one in three NHS hospitals followed the procedure of checking the compatibility within the ambulance and it's "mounting system" prior to moving the patient (Ahmed, p. 504). All of these concerns are worth noting by U.S. healthcare professionals, lest similar situations may occur and put patients in jeopardy.
Should every American healthcare provider be required to publish performance data in an online account -- information that relates to the clinical outcomes of his services as well as a record of patient satisfaction? That is a pertinent question because that is the new rule that all NHS…
Ahmed, Majeed a. (2008). Risk management during inter-hospital transfer of critically ill
Patients: making the journey safe. Emergency Medical Journal, Vol. 25, 502-505.
Ali, Adam M. (2009). The personalization of the British National Health Service: empowering
Patients or exacerbating inequality? The International Journal of Clinical Practice, 63(10),
To analyze and compare the U.S. healthcare, internationally, it is important to know what really constitutes a good health care system. The U.S. Institute of Medicine describes this quality as, "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." This system, in its broad sense, should comprise of two main branches of preventative and curative medicine, both of which should cover different aspects of health, such as travel medicine, school health, occupational health, mental health, reproductive health and so on. Furthermore, a well established health care system does not act independently but in co-ordinance with other industries, such as the agricultural industry. Therefore, since a well developed nation has better access to proper sanitation, housing and adequate nutrition, it is more likely to have a better developed health care system. Other factors,…
Atrash, H.K., Alexander, S., & Breg, C. (1993, Feburary 05). Maternal mortality in developed countries: not just a concern of the past Obstetrics and Gynecology, 15(3), Retrieved from http://www.inamay.com/?page_id=86
Docteur, E. & Berenson, R.A. (2009, August). How does the quality of u.s. health care compare internationally?. Timely Analysis Of Health Policy Issues, Retrieved from http://www.urban.org/uploadedpdf/411947_ushealthcare_quality.pdf
Health care for all: a frameworkfor moving to a primary care-based health care system in the United States. (2011). American Academy Of Family Physicians, Retrieved from Kurt, H. (2008). A success story in american health care: eliminating infections and saving lives in michigan. Healthreform.gov
Mark A., S., McGlynn, E.A., & Brook, R.H. (1998). How good is the quality of health care in the United States? The Millibank Quarterly, 76(4), retrieved from http://www.milbank.org/760401.html
Healthcare Disparity in Georgia
HIV infection continues to be a substantial trouble in Bibb County, Georgia. This illness substantially impacts lots of areas and Bibb County shares among the greatest HIV rates in America. One reason Bibb County deals with greater rates of infection is due to the high minority populace. Likewise, high levels of poverty and joblessness can make it tough for an individual to keep his/her health plan and access their primary-care service provider and acquire the required therapy for HIV. Social preconception likewise extends unfavorable mindsets of the community and can force the individual from looking for therapy or even testing for HIV.
The very best protection against HIV is enlightening the general public about the illness. outine testing for HIV is vital too. The first intervention would be to associate with a regional testing center and have the ability to check people as well as inform…
Centers for Disease Control and Prevention (CDC). (2008). HIV / AIDS among youth. Centers for Disease Control and Prevention. Retrieved July 24, 2011, from http://www.cdc.gov/hiv/resources/factsheets/PDF/youth.pdf
Hamilton, D. (2011). What constitutes best practice in healthcare design? The Health Environments Research and Design Journal 4(2), 121-126. Retrieved from http://www.herdjournal.com/ME2/Default.asp
Maurer, F.A., & Smith, C.M. (2009). Community/public health nursing practice: Health for families and populations (4th ed.). St. Louis: Elsevier Saunders.
Bachanas, P., Morris, M., Lewis-Gess, J., Sarett-Cuasay, E., Flores, A., Sirl, K., et al. (2002). Psychological adjustment, substance use, HIV knowledge, and risky sexual behavior in at-risk minority females: developmental differences during adolescence. Journal Of Pediatric Psychology, 27(4), 373-384. Retrieved from MEDLINE with Full Text Database.
Access to Healthcare
Ensuring Access to Healthcare
The healthcare industry has been subject to a vast number of changes just in the last few years and the system is quickly evolving. One of the most influential changes that the healthcare system has been exposed to would certainly be the Affordable Care Act. This legislation has greatly expanded the number of citizens who are able to purchase affordable health insurance in the Healthcare Marketplace and in most cases there is a government subsidy to help offset the costs to families. Furthermore, many states have expanded the Medicare system to include more low income families bringing another demographic into the healthcare system.
The Affordable Care Act will have significant implications for many different demographics in the community. For example, thanks to the Affordable Care Act, more than $14 million was awarded today to 45 school-based health centers across the country allowing the…
Haynes, D. (2008, September 13). What Nurses Want. Retrieved from The Washington Post: http://www.washingtonpost.com/wp-dyn/content/article/2008/09/12/AR2008091203367.html
HRSA Press Office. (2011, December 8). Affordable Care Act support for school-based health centers will create jobs, increase access to care for thousands of children.
National Association of School Nurses. (N.d.). Making the Case. Retrieved from National Association of School Nurses: http://www.nasn.org/portals/0/advocacy/Making_the_Case.pdf
ProCon. (2014, February 5). Should All Americans Have the Right (Be Entitled) to Health Care? Retrieved from ProCon: http://healthcare.procon.org/
health care in the United States has been the source of heated debate for a number of years. Although the publicity surrounding the issue has been considerable and made to look like it is a recent problem facing the nation, the problem, in reality, has been on the horizon for nearly a century. During President Woodrow Wilson's administration, efforts were unsuccessfully made to pass national legislation regarding the delivery of health care in the United States and the issue has appeared periodically on the national agenda ever since (Lepore, 2009). Finally, on March 23, 2010, among massive controversy, the Affordable Care Act, through the massive efforts of the Obama administration, became law.
Despite the passing of the Affordable Care Act, health care in the United States remains dismal for a large percentage of American citizens. Although there were a number of significant provisions in the Act that took effect nearly…
Anderson, R.M. (2001). Improving Access to Care in America. Los Angeles: University of California.
Boehm, G. (2005). Debunking Medical Malpractice Myths: Unraveling the False Premises behind Tort Reform. Yale Journal of Health Policy Law & Ethics, 357-369.
Lepore, J. (2009, December 7). Preexisting Condition. The New Yorker .
Shi, L. (2003). Delivering Health Care in America: A Systems Approach (3rd Edition). Burlington, VT: Jones & Bartlett Publishers.
Healthcare Finance: hat is the break-Even analysis approach and its application in health care organizations?
Unfortunately, hospital and health care budgeting of resources has become increasingly important in this cost-conscious era of health care. The last decades of cost-controlled medicine have required fiscally conscious approaches to the healthcare for many organizations, often at the expense of patient services. A financial analyst must strive to minimize this, yet still keep the organization afloat. A segment that does not make money or at least break even for the health care provider may have to be eliminated.
Health care facilities may take longer to break even on their initial investment than other forms of businesses. Also, the break-even period for primary care is different compared to tertiary care. Still, developing any break-even action plan begins with a clear understanding of any significant shortfalls against benchmark, with a special focus on provider productivity in…
Halley, Marc D. & Lloyd. (Nov 2000) "How to Break Even on an Acquired Primary Care Network." Healthcare Financial Management. Retrived 17 Apr 2005 at http://www.findarticles.com/p/articles/mi_m3257/is_11_54/ai_66936335/pg_2
Scope of Training
Large health care organizations will undoubtedly have a large scope of training. The investments and systems approach is beneficial for companies who can realize economies of scale. Through economies of scale the unit cost for each selective individual trained decreases. This ultimately allows the cost of investments and systems to be spread throughout the entire organization. The systems approach is particularly beneficial as it creates and distills consistent behavior throughout the entire organization. Each individual that is trained is usually receiving and absorbing the same information as their peers. This insures the continuity of the business and its underlying operations. The scope will depend primarily on the needs of the business. In some instances, training may involve the entire health care organization while in other instances; it may only require a select department. In either case, investments in systems allows for the most efficient use of…
1) Draper, Elaine, Joseph LaDou, and Dan J. Tennenhouse. 2011. "Occupational Health Nursing and the Quest for Professional Authority," New Solutions 21, 47 -- 81
2) Fang, D., Wilsey-Wisniewski, S.J., & Bednash, G.D. (2006). 2005-2006 enrollment and graduations in baccalaureate and graduate programs in nursing. Washington, DC: American Association of Colleges of Nursing
3) Levsey, K.R., Campbell, D., & Green, A. (2007). Yesterday, Today, and Tomorrow; Challenges in Securing Federal Support for Graduate Nurses. Journal of Nursing Education, 46(4), 176-183
4) Lucia, Patricia R.; Otto, Tammy E.; Palmier, Patrick A. (2009). "Chapter 1
Health Care Cost and Quality
The objective of this study is to examine the relationship between health care cost and quality. This study will select one public agency and one private agency and differentiate their roles and major activities in addressing cost and quality in health care and analyze current and projected initiatives to improve quality while simultaneously controlling costs. This study will additionally conduct a synthesis of indications for staff nurses and advanced practice nurses, including evidence-based practice, relative to cost and quality.
There are many initiatives presently underway to meet the growing need of health care for a population that is greatly under-insured and many that are uninsured.
U.S. Department of Health and Human Services eport
According to the U.S. Department of Health and Human Services (2014) "Medicare is improving the way it pays for physician services. The Center for Medicare and Medicaid Innovation (Innovation Center) is exploring…
Advanced Practice Nursing: A New Age in Health Care (nd) American Nurses Association. Retrieved from: http://www.nursingworld.org/functionalmenucategories/mediaresources/mediabackgrounders/aprn-a-new-age-in-health-care.pdf
Health Care Costs (2014) Agency for Healthcare Research and Quality. Retrieved from: http://www.ahrq.gov/research/findings/factsheets/costs/health-care/index.html
A 21st Century Health Care Workforce for the Nation (2014) U.S. Department of Health and Human Services. Retrieved from: http://aspe.hhs.gov/health/reports/2014/HealthCare_Workforce/rpt_healthcareworkforce.pdf
(ennie; Fontanarosa, 2006)
Apart from financial reasons, millions are not bale to access healthcare due to a lot of barriers inclusive of geography, racial differences and immigrant status. The people who do not have access to required care, that might comprise incapability to get primary care chronic care, specialist care, or emergency care stand at risk for severe health consequences. As per a recent report, absence of health insurance was linked with considerably lowered application of recommended healthcare services for cancer prevention, cardiovascular disease threat reduction, and diabetes management within the lower-income as also higher-income adults. Apart from the concerns, trouble, and stress directly associated to their illness, patients those who lack insurance or are underinsured also encounter increased levels of debt, threatening calls from collection agencies, anxiety, and possible insolvency. (ennie; Fontanarosa, 2006)
Impact of reform measures on the nursing profession:
The U.S. healthcare system is considered among the…
Granger, David; Young, Audrey. (1999) "Healthcare and the Underserved: America's Poor and Managed Care." Project of the Standing Committee on Health Policy: American Medical Student Association. Retrieved 10 September, 2007 at http://www.amsa.org/pdf/hlthcareunderserved.pdf
N.A. (2002, Jun 1) "Collective bargaining in the nursing profession: salient issues and recent developments in healthcare reform" Hospital Topics. Retrieved 10 September, 2007 at http://goliath.ecnext.com/coms2/summary_0198-95081_ITM
N.A. (n. d.) "Nursing's Agenda for Healthcare Reform." The American Nurses Association
Inc. Retrieved 10 September, 2007 at http://www.needlestick.org/readroom/rnagenda.htm
Lee is only the first step in the process of building a team that is able to cover all aspects of Mrs. Lee's care. The team approach involving a social worker, nurse, physician, pharmacist, and physical therapist affords Mrs. Lee a full range of professionals attending to her various needs.
Although Mrs. Lee has a number of problems that need to be addressed the one problem that must be addressed immediately is her elevated blood pressure. Hypertension is an important risk factor for the development and worsening of many complications of diabetes and an elevated blood pressure is like walking around with a detonated bomb. Within moments, and with little warning, a diabetic patient can suffer a stroke or heart attack as a result of an elevated blood pressure. Well over fifty percent of diabetics suffer from hypertension and proper treatment of hypertension can minimize most of the tangential problems…
Calle-Pascual, A.L. (2002). A preventive foot care programme for people with diabetes with different stages of neuropathy. Diabetes Research and Clinical Practice, 111-117.
Caminal, J. And Barbara Starfield, et. al.(2004). The role of primary care in preventing ambulatory care sensitive conditions. European Journal of Public Health, 246-251.
Deichmann, R.E. (1999). Improvements in Diabetic Care as Measured by HbA1c After a Physician Education Project. Diabetes Care, 1612-1616.
Epstein, M. (1997). Diabetes and hypertension: the bad companions. Journal of Hypertension, 55-62.
Health Care Plans
Types of Health Insurance
This type of insurance is also known as a traditional or fee-for-service plan. The benefit of an indemnity plan is the flexibility; this plan allows members to choose any doctor or hospital. However, members must pay an annual deductible and then a percentage of each medical bill. Although these plans offer the greatest freedom to select any doctor, they are usually the most expensive option.
Typically, the member or the provider sends the bill to the insurance company. These plans usually have an annual deductible before the insurer starts paying. Once the deductible has been met most indemnity plans pay a percentage of what they consider the "Usual and Customary" charge for covered services. The insurer generally pays 80% of the Usual and Customary costs and the member is responsible the other 20%, known as coinsurance. If…
Rich, R.F. & Erb, C.T. (2005). The two faces of managed care regulations and policy-making. University of Illinois at Urbana-Champaign. Retrieved July 30, 2011, from http://igpa.uillinois.edu/system/files/WP114.pdf
"The Types of health insurance." (2011). Health insurance guide. Retrieved July 30, 2011, from http://www.healthinsuranceadvice.org/types.html
A patchwork of laws provided narrow privacy protections for selected health data and certain keepers of that data." (Administrative Simplification in the Health Care Industry) Therefore, new technologies such as relational databases have simplified the data gathering and maintenance processes of all types of healthcare related data like the physician information process. It is not unheard of today for healthcare and insurance providers matching or 'sinking data' on a monthly or quarterly basis because of the availability of better communication capabilities as well as compatible database comparison processes.
Even the doctors themselves have access to providers' systems and databases today. Through automatic telephone systems, business to business Internet portals, and tape or disk delivery processes, all of a physician's personal, office and patient information can be updated easily. In many cases, the entire process including security and confirmation is a completely hands free operation. In other words, without human intervention,…
Administrative Simplification in the Health Care Industry. Ed. HIPAA. Health and Human Services. 23 Oct. 2004 http://www.hipaa.com/.
HMO Patients Can Contact Their Doctors Electronically as Blue Shield of California Expands Online Communication Services. Ed. Unknown. October 29, 2003. Relay Health. 23 Oct. 2004 http://www.relayhealth.com/rh/general/news/newsRecent/news49.aspx .
Hoffer, Prescott, and McFadden. Modern Database Management. 7th ed. Add City: Add Publisher, Add Year.
Day treatment programs can provide services at less cost because the patient goes home at night after being treated during the day, which often is used for rehabilitating chronically ill patients (Sharfstein, Stoline, & Koran, 1995, p. 249). The mere fact of having more choice benefits some patients by giving them more say in their care.
Patient-focused care involves a method for containing in-patient costs for hospitals and for improving quality by "restructuring services so that more of them take place on nursing units rather than in specialized units in other hospital locations, and by cross-training staff on the nursing units so that they can do several 'jobs' for the same small group of patients rather then one 'job' for a large number of patients" (Kovner, 1995, p. 186). Kovner notes a number of barriers to this type of care. One reason has been that hospitals have not had to…
Doctors Say Managed Care Strains Patient Relationships (1997, June 9). Westchester County Business Journal 36(23), p. 24.
Kovner, a.R. (1995). Hospitals. In Jonas's Health Care Delivery in the United States, a.R. Kovner (ed.), pp. 162-193. New York: springer Publishing.
Moore, G.T. (1991,
April 24). Let's provide primary care to all uninsured Americans ? now! JAMA, pp. 2108-2109.
Federal ole in Healthcare
There are two very entrenched camps in the universal health care debate as well as regarding what the federal role in healthcare should be. It is clear that the private and employer-based system is not serving the American public as well as it should be but scandals and problems with the Veteran's Administration (VA) and Medicare are proof positive that the government cannot be the driving force either. While both of the major suggested approaches to solving the crisis of uncovered people and the lack of portability of employer-based healthcare are both problematic each in their own way and a more balanced approach is necessary to give people the assistance they need but without toying with the private market for insurance in too protracted a way.
The federal role of healthcare has probably been an issue on some level or another since the 1930's when…
Corbett, J., & Kappagoda, M. (2013). Doing Good and Doing Well: Corporate Social
Responsibility in Post Obamacare America. Journal of Law, Medicine & Ethics, 4117-21. doi:10.1111/jlme.12032
An assessment of what businesses could or should be responsible for after the passage of the Affordable Care Act, aka ObamaCare.
Gottschalk, M. (2011). They're Back: The Public Plan, the Reincarnation of Harry and Louise, and the Limits of Obamacare. Journal Of Health Politics, Policy & Law, 36(3), 393-400. doi:10.1215/03616878-1271009
Healthcare Data Compare Healthcare Grade of Maryland to Florida
Healthcare grades: The Commonwealth Fund
The Commonwealth Fund grades all states on access to healthcare, avoidable hospital use and costs, healthy lives, and prevention and treatment. For example, Pennsylvania ranks 12 on access: nearly
percent of nonelderly adult patients are insured and 92% of children. Florida has around 74% and Maryland around 83% of adults insured and 82 and 91% of children, approximately. In Pennsylvania, 86% of at-risk adults have had a checkup within two years versus 87 and 88% in Florida and Maryland respectively; 90% of patients in PA have not had to forego seeing a physician within the last two years because of cost versus 84% in Florida and 89% in Maryland (approximately). The low rates of insurance coverage in Florida reflect higher unemployment and poverty rates, combined with a higher percentage of workers who labor part-time and do…
State scorecard. (2011). Maps and Data. Retrieved September 26, 2011 at http://www.commonwealthfund.org /Maps-and-Data/State-Data-Center/State-Scorecard.aspx
All figures are rounded up or down, based upon the available data
future of health care delivery in anada, the country that you intend to practice medicine.
The anadian health care's most significant issue is it's disconnect of communication between medical practitioners and patients, on the one hand, and the different hierarchies and departments of medical care on the other.
The Primary are Advisory ommittee, for instance, reported last year that primary care services are becoming more fragmented with fewer doctors being sufficiently motivated enough to involve themselves in the full range of services such as hospital-based services, emergency services, or obstetrical services. Meanwhile, the health care team, including nurses, nurse practitioners, pharmacists, Physiotherapists, family doctors, and others are not structured or trained to fill in the gaps and collaborate in order to meet the needs of patients -- or even to attempt to meet these needs. The Government of Newfoundland and Labrador has taken steps to improve in this area and…
Commission on the Future of Healthcare in Canada http://www.gov.nl.ca/publicat/Commission_Health_Care_041502.pdf
Simpson, J (Oct 4, 2012) Jeffrey Simpson: The real problem with Canadian health care. National Post.
Where, it will reduce the total amount by $138 billion in ten-year. This is despite, the fact that $950 billion is going to be spent implementing such changes. What this shows, is that when implementing the strengths of the French system with that of the American system, you can have high quality health care services and maintain costs.
Health Care ill to Cut Deficit. (2010, March 18). Retrieved April 12, 2010 from Reuters website:
Tired of Waiting for Your Doctor. (2006, November 20). Retrieved April 12, 2010 from MSNC website:
Dutton, P. (2007, August 11). France's Model Health Care System. Retrieved April 12, 2010 from oston.com
Foley, T. (2009, March 8). 5 Questions about French Health Care. Retrieved April 12, 2009 from Change.org website: http://healthcare.change.org/blog/view/5_questions_about_french_health_care
Foy, A. (2009, September 10). Give Me Liberty or Give Me Health Care. Retrieved April 12, 2010 from American…
Health Care Bill to Cut Deficit. (2010, March 18). Retrieved April 12, 2010 from Reuters website:
Tired of Waiting for Your Doctor. (2006, November 20). Retrieved April 12, 2010 from MSNBC website: