Delay In Health Care

Rising health care costs became an issue after the Medicare and Medicaid programs were formed in 1965 and have continued to be a factor in the United States economy since then. “By1970, U.S. government expenditures for health care services and supplies had grown by 140%, from $7.9 billion to $18.9 billion.”() By the 1990s the annual increase in the government health care expenditures was finally brought under control and has fluctuated between a 5% and 8% increase each year since then. This essay will discuss the different factors contributing to the rising costs of health care in the United States, as well as how the cost of health care affects the accessibility and quality of medical care throughout American history.

In “The American Health Care Paradox”, Elizabeth H. Bradley and Lauren A. Taylor explore why the American health care system achieves mediocre results, despite spending a higher percentage of its gross domestic product than any other country in the world on health care. They explain that health care is more than just getting medical treatment, but there are social factors that affect a person 's health. The authors claim that more government spending on medical treatments is not the solution to the health care paradox, but we should focus more on social needs that have a greater impact on health. Case studies and interviews with physicians, other health care providers, and social service providers are used to support the authors’ claims. Though the authors do not explicitly state the path they believe the American health care system should follow, they give examples of foreign health care systems and domestic health care projects that may point in the right direction.

The first characteristic of the US health care system is that there is no central governing agency which allows for little integration and coordination. While the government has a great influence on the health care system, the system is mostly controlled through private hands. The system is financed publically and privately creating a variety of payments and delivery unlike centrally controlled healthcare systems in other developed countries. The US system is more complex and less manageable than centrally controlled health care systems, which makes it more expensive. The second characteristic of the US health care system is that it is technology driven and focuses on acute care. With more usage of high technology,

After the Affordable Care Act (ACA) was enacted in 2010, much of the uninsured population in the United States were finally given the access to health insurance (Shi & Singh, 2015). Prior to the passing of the Act, those who did not have insurance still managed to seek medical attention, whether paying for medical care out of their own pockets or seeking the assistance of government programs. As reported by the U.S. Census Bureau, in 2013, 13.4% of the population in the U.S. were uninsured during the entire year (Smith & Medalia, 2014). Still, a great number of uninsured who sought medical care were unable to pay for those services, this is referred as uncompensated care. In 2013 the cost incurred from

The impact that policies have on occupational therapy does not stop at the Affordable Care Act, there are many other policies that can have the same positive affect on patients everywhere. The problem does not lie within the policy in this particular situation, the problem lies in the people who have not taken advantage of the Affordable Care Act and have enlisted for health coverage. By enlisting in this coverage, people have access to vast amounts of services, that can help them tremendously in

Raymond, a 78-year-old man living in a motel, is found by the housekeeper lying on the floor of his room, semiconscious. The motel manager calls 911, and Raymond is taken to the closest emergency room, where he lies on a gurney in the hallway for 6 hours before a physician examines him. Because it is unclear what is wrong with him and he cannot speak coherently, the physician admits him to the hospital for observation. Later, when it is determined that he had suffered a stroke; he is discharged to an inpatient rehabilitation facility that has no knowledge of his medical history including his current medications for hypertension and high cholesterol. He dies there several weeks later.

However, this causes a financial burden. Medicare is a program which provides insurance benefits to all individuals aged sixty-five and older, including younger people with disabilities (Grabowski, 2007). Medicare covers few long-term care services and Medicaid covers the rest of the huge amount. “Policy options include capitation, pay-for-performance, and federalization, in which federal government would assume the Medicaid’s costs for the dually eligible population” (Grabowski, 2007). Medicaid and Medicare programs do not sufficiently cover acute and long-term care services, an example. After the injury the disability process takes long. There is a language barrier, institutional barrier, and ratio cost-sharing. Also, cost shifting within health care settings, and cost shifting across health care settings needs major improvements. Policy holders should expand their critical

Texans are being short changed by the proposed Medicaid cuts. Legislature has told the Texas Health and Human Services Commission (HHSC) that they must cut $350 million from the Medicaid funding over the next two years. In order to abide by the legislature’s demands, the HHSC has proposed cutting the reimbursement rates for pediatric physical and occupational therapists on average by 10 to 25 percent. And pediatric speech therapists would face cuts of 16 to 27 percent. Many feel that these cuts to the therapy payments have little to no effect on the services that children with disabilities receive. These individuals say that following the orders will assist in reducing the therapy rates and will reduce the practice of excess therapy. On the opposing side, it has been expressed that cutting therapy funds that the State of Texas provides has the potential to cause individuals within the pediatric population to lose crucial therapy services. The planned cuts have the risk to jeopardize the potential of our nation’s young. The cuts also make many agency’s that currently provide occupational, physical and speech therapy vulnerable to closures and lay-offs.

If your therapy is approaching the cap, but your doctor feels you can benefit from additional therapy, he or she can inform Medicare that it is medically necessary for you to continue. Hopefully, Medicare will

“The occupational therapy provided by Niagara Therapy LLC from 7/29 to 09/15/15 was not supported by records as medically necessary/standard of care. The medical necessity of ongoing therapy depends upon making measureable progress in functional goals. The documentation does not support that this patient meets this criteria. The patient received 12 visits through 7/27/15 and improvement in function was not documented. Also, there is a lack of literature support for long term OT for this patient’s condition. The patient could have continued a home program after 7/27/15. Occupational therapy after 9/15/15 would not be supported as medically necessary due to the lack of documented progress and lack of support for the efficacy of long term therapy over practicing skills with a home program.”

The underlying issue is the financial challenges and lack of resources SNF’s face, in a growing elder population, that results in razor-thin operating margins from a series of cuts over the last five years, a gap between care people receive and the care they deserve and further reductions to the profession that threaten access to health care in rural areas (AHCA, 2016). In 2012, MedPAC estimated the overall operating margins of SNF’s at 1.8 percent reflecting Medicare, Medicaid, and Private Pay sources of funding operating at negative levels (AHCA, & NCAL, 2016). In addition, AHCA estimated on any given day, 78 percent of residents receiving care in an SNF depend on Medicare or Medicaid to pay for their care (2016). Furthermore, an estimated

Describe minutes of therapy that can be billed to Medicare part A and what cannot?

Waiting for medical attention is not a friendly process. The process can have serious consequences for both patients, and those working within the healthcare system (Barua, Esmail, & Jackson, 2014). Delaying access to health care may cause increased pain and suffering in patients and could even lead to severe mental health consequences (Barua, Esmail, & Jackson, 2014). Waiting for health care can also lead to economic consequences, such as reduced productivity, reduce the ability to work for an individual

As parts of the health care system improve and other parts regress, people are beginning to argue that the system may stay terminally broken. While most agree the system is broken, the real disagreement is whether or not it is ‘terminally’ broken.

It would be difficult to have a patient that was too afraid to see the doctor for a pain they were feeling and when they finally do come in, finding that it is a serious condition and too late to do any treatment. Perhaps if the patient had come in earlier, the problem could have been fixed and they could have recovered. I will have to try to understand that some culture do not allow the use of doctors except for extreme case or many even at all. While it may be hard to see another culture’s view on why it would be acceptable to delay seeing a doctor, I will have to put my judgements aside and help the patient in any way that I am