Access Of Health Care And The Hot Spotters Program

Financial burdens greatly limit the system’s accessibility; however, many in the U.S. are unable to fully utilize either option. Census estimates from 1999 indicate that 43 million Americans live without health insurance even though 75 percent of them have a full-time job or live in a household with at least one member working full-time (Mueller, , 5) In addition to the totally uninsured, census estimates also reveal that approximately 42 million other people in the U.S. are underinsured. This means that they have some insurance, but are still unable to afford all of their needed prescriptions, tests, visits to physicians, or hospital

It is not just the poverty-stricken population that can’t afford insurance. The cost of U.S. health care and insurance is out of reach even for those who do not live in what we technically classify as “poverty”. By the 2003 Federal Poverty Guidelines, released by the U.S. Department of Health and Human services, poverty

Money plays a huge role in access, therefore it is a vital issue to discuss. Within the current system, lack of money results in lack of health care, which leaves thousands of people without any health care coverage. Between 2001 and 2005, the number of people paying for health insurance increased 30%, however income only raised 3% (Health Care Problems). Adequate income is a necessity and unfortunately that is not present. According to the National Conference of State Legislatures, the average annual premium across the country is $16,000. Currently, the average annual income in the United States is $51,107. Mint Money Management suggests that about 4-6% of one’s total income should be spent on insurance, including life, disability, and health insurance. However, the averages in the United States show that the average person spends about 31% of their income on health insurance, which is not financially beneficial. When this rise in health insurance is not parallel to the inflation of income, innocent people are left without a method to achieve health care. There is a program for those who can’t afford health insurance out of pocket nor have access to it, and that is called Medicaid. Issues still exist with the program. There is only so much funding, which leaves many still uninsured. Additionally, people with Medicaid have difficulty

Despite the countless advanced in technology and the abundance of health care organization popping up all over the place, whether they are free standing clinics, hospitals, urgent cares or etc, many people still lack the ability to receive quality health care. This has become a concern throughout the world, but especially a more vocal concern for residents of the United States in the past few years. In this paper we will discuss the reasons preventing access to quality health care and how we can overcome the many obstacles that stand in our way to provide quality health care to many who lack it today.

The U.S. health care system faces challenges that indicate that the people urgently need to be reform. Attention has rightly focused on the approximately 46 million Americans who are uninsured, and on the many insured Americans who face rapid increases in premiums and out-of-pocket costs. As Congress and the Obama administration consider ways to invest new funds to reduce the number of Americans without insurance coverage, we must simultaneously address shortfalls in the quality and efficiency of care that lead to higher costs and to poor health outcomes. To do otherwise casts doubt on the feasibility and sustainability of coverage expansions and also ensures that our current health care system will continue to have large gaps even for those with access to insurance coverage.

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

The dysfunction of the American health care system implies that not everyone has access to the right medication and medical treatment. Middle-class families and chronically ill patients do not always have access to health care, and when they do they do not receive adequate treatment with regards to hospitalization and medical services or quality of service. The lack of payment reform results in

The patient centered medical homes (“PCMH”) approach “focuses on keeping people well, managing chronic conditions like diabetes or asthma, and proactively meeting the needs of patients.” According to the Arkansas Department of Health, chronic diseases like cancer heart disease or diabetes affect approximately over fifty percent of adult Arkansans. Yet chronic diseases are often preventable. The high rate of chronic diseases can partly be attributed health insurance coverage—“when people don’t have health insurance they tend to avoid seeing doctors. People

In a survey conducted in 2003, it highlighted that the recurrent problem is the reimbursement rate from Medicaid to the physician (O’Shea, 2007). The Center for Studying Health System Change (HSC) show that 21% of physicians that state they accept Medicaid have reported they will not accept a new Medicaid patient in 2004-2005(O’Shea, 2007). This number would only logically be assumed to have risen in 2013 A survey conducted by the U.S. National Health reported that researchers have found two standout trends among Medicaid beneficiaries: they have more difficulty getting primary care and specialty care and they visit hospital emergency departments more often than those with private insurance (Seaberg, 2012). The lack of primary and specialty care access is mostly contributed to the following barriers; unable to reach the MD by phone, not having a timely appointment with the MD and lastly unable to find a specialty MD that will accept Medicaid. In a recent report released by the Partnership to Fight Chronic Disease, it stated that about 30% of Medicaid patients experience “extreme uncoordinated care”, there is a strong correlation between this situation and higher Medicaid spending and less quality of care given (Bush, 2012). After January 1st 2013, healthcare providers have experienced a 2% reduction in payments for Medicaid beneficiary, this will only create more of a problem for these patients to seek the

Patients with long-term, chronic illnesses like Mr. Davis’s, care can be very costly, especially when the patient is unable to maintain routine medical care or visits and medications. Without routine medical care and maintenance medications, patients like Mr. Davis tend to have more frequent emergency room visits and hospitalizations; increasing costs for state and local government as well as tax payers. Though Mr. Davis is able to receive care during an emergency room visit, the providers are not fully aware of his health history and are only able to provide a temporary fix of his symptoms and not address his health care needs.

The healthcare system has come under heavy criticism from experts from all over the world. According to Schroder, 44% of the population has no access to the healthcare system. (Schroder, 2003) There are many clinics which charge are free of cost or are charging lesser fees, but all of these are burdened and do not have the capability to meet the requirements. There are certain ethnic communities that are by enlarge poor who are of the opinion that they have been deliberately been left out of the healthcare system. These have led to the

Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.

In the current U.S. system the free market prevails and companies, in this case, major insurance providers “compete” for business. This competitive business approach should in theory drive costs down. For some reason, however, an argument can be made that it has produced the opposite result in profiteering. The nation’s largest insurer, UnitedHealth, boasted over a 10 percent revenue increase in 2013 according to Forbes (2013). Health insurance affordability contributes to the disparity in access to health care, as evidenced by the fact that there are millions that are still uncovered. A greater majority of certain minorities lack both health insurance and the financial resource to seek out either health care or insurance. While insurance companies reap huge profits the percent of private sector companies offering health insurance has dropped to less than 50 percent (Kaiser, 2013). There is decidedly a lack of coordination of care for this at risk population as well, since treatment is rendered sporadically and with continuously changing providers. The last major challenge is that of improving the quality of health care. According to a 2010 report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG), an estimated 13.5 percent of Medicare beneficiaries experienced adverse events during their hospital stay and an additional 13.5 percent experienced a temporary

Every individual in the world deserves to enjoy health and wellness. Maintaining or achieving proper health needs enables individuals to be productive at work and leisure. Traditionally, many people have had barriers obtaining adequate healthcare due to economic constraints or personal inconveniences. Despite impressive technological advances in medicine, the challenge of delivering quality healthcare to the Americans continues to be debated amongst the nation’s political and healthcare leaders. The aging baby-boomers and the increased number of uninsured people add to the equation of population growth which results in limited access to primary healthcare for the entire public. On the

US health care expenditures have been rising quickly over the past few years; it has risen more than the national financial system. Nonetheless a number of citizens in the US still lack appropriate health care. If the truth be told, health care expenditures are going to continue to increase; in addition numerous individuals will possibly have to make difficult choices pertaining to their health care. Our health system has grave problems that require reform, through reforming, there is optimism that there will be an increase in affordable health care and high-quality of care for America. Medicaid, Medicare and private sector insurances are all going through trials and tribulations because of