Financial Characteristics Of Health Care

The United States healthcare industry is facing some serious long-term issues. The number of uninsured people is in millions.

You have been asked by a health care magazine to write a series of articles focusing on health care financial concepts. The articles will be included in five consecutive issues and will be geared towards readers with little knowledge of finance. You must ensure that the articles are both informative and engaging to your audience. You must also ensure that your articles relate financial principles to the health care industry.

One of the major functions of a nurse manager is managing a budget and allocating resources necessary to manage the unit or facility effectively. “Major steps in the budgeting process include gathering information and planning, developing unit budgets, developing cash budgets, negotiating and revising, and using feedback to control budget results and improve future plans”(Yoder-Wise, 2012, p. 244). The nurse manager must be able to accommodate variances and acclimate the budget in both the projections and up-to-date expenditures. Proficiency in managing a unit level budget is essential for both a favorable variance and optimal patient outcomes. Budgeting entails reviewing revenues and expenses, staffing costs, supplies, and capital equipment costs (Contino, 2001). This case study examines personnel, overtime (OT), supplies, travel, equipment, and staff education and the manner in which management can address these factors.

By the 1960s, the formation of unions help to standardized employer health benefits and the access to insurance was prevalent for workers. This system seemed to be well established as the employers, private health insurance carries, physicians and hospitals would recycle health cost amongst each other. However, there were many underlying problems with this tightly organized system. Self employed individuals, small companies, the poor, and the unemployed had no organized access to health insurance. Also, at this time the majority of elderly retirees lost their health insurance in old age when they needed it most. These underserved populations began to seek care in emergency facilities driving the cost of urgent care back on the hospital and

The US pays twice as much yet lags other wealthy nations in such measures as infant mortality and life expectancy, which are among the most widely collected, hence easily compared, international statistics. Many people are underinsured, for example, in Colorado "of those with insurance for a full year, 36.3% were underinsured."[6][7] About 10.7 million insured Americans spend more than a quarter of their annual paychecks on health care because of the high deductible polices.[8]

The United States spends far more money on healthcare than any other developed country and despite the large amounts spent the United States has the poorest health outcomes and highest risk factors (Stone, 2017). When compared to other countries the United States has the lowest life expectancy at birth, the largest population of obese, and the highest number of people over the age of 65 with chronic health conditions. Many health disparities exist in the country due to socioeconomic status. The Affordable Care Act (ACA) law was passed in 2009 and implemented in 2010 in an effort to decrease the number of people uninsured (Parekh, 2017). Since, 2010 the rate of uninsured people in the United States has

EMTALA is the Emergency Medical Treatment and Labor Act that was developed in 1985 as part of the Title IX of the Consolidated Omnibus Budget Reconciliation Act that went into effect in the year 1986 (Sara Rosenbaum, 2012). EMTALA was developed after an article was published in 1986 that documented how Cook County Hospital in Chicago was receiving patients that were “dumped” there that were unemployed, minorities, and lacked health insurance (Singer, 2014). This problem also occurred in 1983 in Dallas where over 200 patients were transferred between hospitals that were not stable (Singer, 2014). EMTALA is under the direction of the Department of Health and Human Services and was developed to address the needs of Americans

One of the primary goals of the Affordable Care Act (ACA) was to provide affordable health care coverage and increase access to affordable health care to the community. Unfortunately, since the passage of the ACA, while there has been an increase in the number of people with health care coverage, those same people do not necessarily have access to affordable health care. Currently, the public views the Emergency Department (ED) as a safety net by the community it serves; as demonstrated by the increasing number of people who continue to seek treatment in the ED for non-urgent problems. Utilization of the ED for non-urgent care contributes to the rising costs of healthcare as treatment in this setting can be upwards of three times the cost

Therefore the annual interest rate is 8% and the effective annual rate compounded quarterly is 8.24%

Concern for the care of the patient was one of the mitigating factor for our nation’s development of Emergency medical treatment and labor act (EMTALA) . Enacted by congress in 1986, Emtala was government’s way of ensuring basic screening, stabilization and care for all patients. Non participation with emtala was not an option, since the law tied in government payments to the institutions. Simply put if you want Medicare/ Medicaid payments you will abide by this law. There shouldn’t have been need for emtala since there were already safeguards for indigent patients, but they were not followed, rather seen as guidelines. With the backing of Emtala, patients had better care assurances, and guarantee of not being dismissed. The Joint Commission on Accreditation of Hospitals stated that “individuals shall be accorded impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, nationality, or sources of payment for care” It has been strongly inferred that based on the implementation of emtala, increased numbers of uninsured were using the emergency rooms as their primary source of care. The thought was those without insurance, did not seek preventative care through a primary care doctor, as they did not have way to pay for services, but still received treatment through emergency rooms.

In the early 1980’s there was increased observation by emergency room physicians that patients were being transferred or dumped from private hospitals to public hospitals based on their inability to pay. Concern for the care of the patient was one of the mitigating factors for our nation’s development of Emergency medical treatment and labor act (EMTALA) . Enacted by Congress in 1986, EMTALA was government’s way of ensuring basic screening, stabilization and care for all patients. Non participation with EMTALA was not an option, since the law tied government payments to the institutions. Simply put, if you want Medicare/ Medicaid payments you will abide by this law. EMTALA would not have been needed since there were already safeguards for indigent patients, but they were not followed, rather seen as guidelines. With the backing of EMTALA, patients had better care assurances, and guarantee of non-dismissal. The Joint Commission on Accreditation of Hospitals stated that “individuals shall be accorded impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, nationality, or sources of payment for care” It has been strongly inferred that based on the implementation of emtala, increased numbers of uninsured were using the emergency rooms as their primary source of care. The thought was those without insurance, did not seek preventative care through a primary care doctor,

In Healthcare System the role of finance is an important aspect in healthcare. In the financial role of healthcare it involves handling operations such as negotiating contracts, making cash available for expenses such as payroll and cover cost for unexpected expenses. The role of finances also makes it capable for leadership to better make plans for the future, when finances are in order organizations can better equipped to make decisions such as is the organization financial able to expand test or treatments and are they able to buy new medical equipment.

Between 1999 and 2011, the cost of health care soared 76%. US health care costs now far exceed other developed countries yet if you look at our outcomes on a variety of World Health Organization measures such as infant mortality and life expectancy, our rankings are disappointingly low. Part of the reason for this involves our health care safety net. Many Americans today cannot afford or don’t qualify for insurance. They go without needed preventative care. Our safety net for many individuals is limited to emergency, high cost care because their rights to this care are protected by EMTALA (the Emergency Treatment and Liability Act) regardless of abiity to pay.

1A. Market failure is a situation in which the allocation of goods and services is not efficient. In any given market, the quantity of a product demanded by consumers does not equate to the quantity supplied by suppliers. This is a direct result of a lack of certain economically ideal factors, which prevents equilibrium.

Government financed health care typically has more control to place limitations on care offered to patients and doctors in order to keep costs down. Since payers must try to deliver the most care for the