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Discuss the interrelationships between healthcare costs, quality, and access from the Roemer model of health services systems Answer

Discuss the interrelationships between healthcare costs, quality, and access from the Roemer model of health services systems. Make suggestions on how one would maximize access and quality while keeping costs low. Now, analyze why these suggestions have not been put into place.

In order to maximize access and quality while keeping costs low, One would have to make sure everyone one has healthcare insurance, which will allow more access to healthcare upon creating more options for disabled to get to their healthcare appts. Quality would be monitoring chronic diseases and managing them so there is less hospital stays and keeping cost low would be making sure all patients keep up on preventative visits in order to keep people healthy and safe. In order to maximize access and still provide good quality services the health care system need to be designed which will allow everyone in the United States to have health coverage. In reality, this would be impossible. The reason why I say this because health service is a business which is system designed to bring in revenue for treating the sick. All employees that work in the United States pays a certain percentage toward their health care. In other words, there is a certain percentage of their income taken out from health care. People who are unemployed cannot afford to purchase health insurance every month. For example, I was laid for 2 years and 4 months, I found it very difficult to pay for health coverage. The cheapest was $330 per month. My unemployment check was $330. I did not have any money left over to buy food or pay a bill. Eventually, my unemployment ran out and I was forced to get public assistance. So, therefore, I could no longer pay for health coverage so I had to sign up for Medicaid. I had to wait two month to get medical coverage. I am a diabetic so I could not get the supplies for two months. The money I received from Pubic Assistant was just $80 a month plus food stamps for $199. I was able to buy food and pay one bill but I had to medical coverage due to the waiting period.

In this post you mention that you would lower the monthly premiums so that they would be more affordable.   What strategies would you use to accomplish this?   Who would pay for the reduction in premiums that would be experienced by Americans?

Typically, healthcare organizations, physicians/clinicians, and insurance payers charge a high dollar amount for exams and procedures due to non-payment from self pay patients, inaccurate demographic information, high cost to collect amounts and lack of reimbursement volumes. Of course there are many other factors involved, but these are a few big reasons that healthcare organizations will speak to. The access to quality health care is limited by types of insurance coverage, geographic location, and physicians themselves, as some of them only take certain payer types from primary care or specialist visits. For exams or procedures, the patients’ insurance or lack of coverage plays a critical role as terms of payment or reimbursement from the payers is not guaranteed or extremely limited due to increasing cost monitoring. Hospitals and physician clinics are strongly discouraged to schedule elective procedures that put that organization at risk for non-payment from payers. For self pay patients, strong scripting from registration or financial assistance staff is provided to try and collect payments up front with heavy discounting in order to collect as much as possible. Emergent care situations call for stabilization and patient care based on a clinicians medical judgement, but all other services are debatable between the patient and the healthcare organization.

In order to reduce the cost to accomplish Lorraine’s idea, the payers and clinicians would have to lower their costs so that the patient is paying for the majority of the cost. The last time I checked the overwhelming number of physicians and payers are not hurting for profits, so analyzing their true costs and profit margins would be a good start, lowering the payers requirements for payment would provide higher revenue flow for the hospitals and in turn lower the costs for the patients.

If we consider the fact that specific populations have different characteristics and demographics which impact healthcare delivery.   These characteristics can be such things as income, race, age, location, etc.   How do the characteristics of a specific population impact the healthcare services they demand and the services these receive?

The population that comes to my mind right away is our Spanish speaking population. In reality it is any population with English as their second language. I pointed out the Spanish speaking population my organization utilizes our Language Services department primarily for Spanish interpreters. The barrier between languages can pose significant communication issues.

Without an interpreter, physicians and medical personnel are unable to obtain an accurate past medical history, current chief complaint, signs & symptoms, allergies, current medications, etc. Also, it’s difficult to explain the plan of care to a patient and their family members if their is a language barrier. It can be difficult to convey the small things to a patient or family member; it could be something as simple as explaining where the family lounge is located in order to grab a refreshment or use the free washer and dryer that is provided to them.

I think in general, a language barrier effects the care that a patient receives. It’s truly unfortunate, but it’s definitely a reality. I am definitely a people person and I love talking to my patients, unfortunately I am not bilingual and therefor cannot carry on a conversation with someone who only speaks Spanish or any other language for that matter. I still provide the same task-oriented care to those patients (hourly checks, medication administration, vitals, etc), however the overall experience they receive is not the same.

We have several Spanish interpreters employed through our organization. Typically, we have one staffed in the ER 24 hour per day, one that is utilized for clinic appointments and the other is utilized for inpatient consults. The Spanish interpreters are amazing and they help close the gap in communication. Sometimes it can take a great deal of coordination ensuring the doctors, nurses, patients, family members and other medical personnel are all available at the same time for daily rounds or important updates, but it’s definitely beneficial. We also have interpreter phones that we use in order to get results immediately and to find an interpreter for a not as common language.

Lowering monthly premiums is a great idea and of course the problem would be the implementation of this idea. A possible suggestion that is being utilized now in certain hospitals is a tier payment system. Employees that make the min to 30,000 pay a certain amount, then 31,000 to 50,000, and so on. There is a program at my hospital that covers your deductible expenses as well as your out of pocket expenses if you only make a certain amount of money and have a certain family size. For example, if you only make 30,000 a year and have a family size of 4, and are single, you would qualify for this benefit.

Another idea, is a form of socialized healthcare that the current administration is striving to change. We already pay a certain amount into Medicare and for programs such as Medicaid, so instead of the pot of taxes going towards these two separate groups, how about having a large pot that it goes into.

The way this would work:

  1. Cut Medicaid programs altogether – they are being taken advantage of severely and instead of a person trying to get a job with benefits, they work to stay on the program.
  2. Give every single American basic healthcare. You must be an American citizen (with a valid social security number!!!).
  3. All preventative care would be covered 100%. (All well child checks, vaccinations, and yearly adult physicals as well as all dental preventative cleanings and a yearly eye exam).
  4. You would get 3 sick doctor’s visits a year. These include all general illnesses such as the flu, colds, ear infections, generalized pain, headaches, etc.
  5. You get 2 specialized visits a year. These include: ENT, Ortho, Neuro, Psych (mental health), Rheumatologist, etc.
  6. All emergency care visits that deal with lacerations, asthma attacks, chest pain, shortness of breath, MVAs, limb loss, severe headache, severe loss of blood, etc. would be covered 100%. This includes hospital stays for recovery and necessary lifesaving surgical procedures. If you try to come into the ER and only have the flu or a cold, you will be charged. This will hopefully get people to think twice before they use the ER as a doctor’s office.
  7. All pregnancies and the birth itself is covered 100% until the second child. The well visits, medications, ultrasounds, testing, hospital stay, etc. Baby is covered as well. After the birth of your second child, you will be expected to pay 50% of the cost. After the birth of your fourth child, you will be expected to pay 100% of the cost.
  8. You get 2 minor procedures and 1 major procedure (unless it resulted from an emergency accident) covered 100%. Minor procedures: vasectomy, Lasik, dental surgery, gall bladder removal, hernias, etc. Major LAVH, tumor removal, exploratory lap, etc.
  9. If you wish to purchase more coverage, then you will have those options and we can use the capitalist system that we all love.

Of course, this is just an idea and it is not perfect. It will require a board at multiple levels – kind of like a judicial board (Supreme Court of Indiana and then the Supreme Court of USA).

The reason that hospitals have to charge so much for items when consumed outside of the hospital by first generation customers is two-fold;

1) Hospitals have to have individual per-patients packaging which is very expensive. This single-use packaging is very expensive but extremely necessary to avoid cross-contamination and for use in isolation rooms.

2) Price per units are an average of the cost of the item as it is consumed in the hospital. This means that the average includes what the item cost after the best insurance reimbursement to the direct payment and indigent patients. Is many seem like a lot of money but it is the average cost per unit.

Ok I lied there is a third. The cost of the manpower for receiving, stocking, direct care personal, sanitation, etc. also adds to the cost. The product touches many hands before it is in your nurses hand ready for use.

When people think of the segment of the United States population most dependent on the health care safety net, they may first imagine the urban poor in crowded emergency rooms at urban public hospitals. Although this group no doubt has serious health care problems, residents of rural areas may, in fact, have greater health care needs and face access barriers that are no less substantial. Rural populations are generally older, poorer, and have lower levels of education than their urban counterparts. There are far fewer hospitals and physicians in rural communities; the time it takes to travel to health care providers is often greater and public transportation less available. These problems may be magnified in rural areas far distant from any urban center. As the federal government gives states greater responsibility for designing health policies, the fundamental differences between rural and urban areas as well as among different types of rural areas will need to be recognized. Although state policymakers need to understand the differences that exist between rural and urban areas within their borders in order to design effective policies, most national data sets containing the relevant heath care information (e.g., the National Health Interview Survey [NHIS] and the Medical Expenditure Panel Survey [MEPS]) do not allow for this type of substate geographic analysis.

 

This information gap can be filled in part by the National Survey of America’s Families (NSAF), a survey of children and adults under the age of 65 in over 44,000 households that is being conducted as part of the Urban Institute’s Assessing the New Federalism (ANF) study.1 The NSAF provides representative information on the nonelderly population for 13 ANF focal states and for the nation as a whole.2 Among a broad range of demographic and economic data, the NSAF contains information on insurance coverage, health status, access to care, and use of health services. Of the ANF states, only eight have substantial rural populations; this brief presents state-level data for these states – Alabama, Colorado, Michigan, Minnesota, Mississippi, Texas, Washington, and Wisconsin.3

 

http://www.urban.org/publications/309533.html

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