Health Care Utilization

With the existing trend of shortages in healthcare providers and professionals, the recruitment and retention of this type of staff in a rural area may

The Affordable Care Act was signed into law March 23, 2010 by President Barack Obama; however, the constitutionality of the law remained in question. In a controversial 5-to-4 ruling, The U.S. Supreme Court upheld the law on June 28, 2012. The ACA is thought by some as the United States health care rescue, and as its downfall by others.

The United States health-care system grapples with myriad challenges ranging from stress of an aging population, tremendous inefficiencies and rising costs. These challenges have significantly impacted access to health care services by the citizens.

Rural health professionals represent a diverse set of individuals seeking to meet the main goals of public health. Their desire to promote health and prevent disease is blocked by many barriers, due to the geographical position of their target population; yet they still persevere to serve their specified communities. Approximately twenty percent of America is rural, and rural counties are more likely to report fair to poor health. This particular population cannot be compared to its urban counterparts due the sheer amount of obstacles health care providers and patients face. Rural Americans are shaped by geography and tradition which creates a combination of factors that create disparities.

Can I accomplish my personal goals and raise a family in a rural community going to be conducive to these personal goals? These are examples of personal and professional questions that must be a part of the metaparadigm assessment for the APN. If the professional goal is to promote the advancement of healthcare within the healthcare community within the constraints of a rural setting and one can embrace the eclectic nature of living in the rural environment, then it may be the case that the APN is not limited but suited for the challenges presented by the metaparadigm. Rural healthcare has a growing need for these professionals along with the services and education they can provide. In rural America, more than 20 million Americans of the total 60 million total rural residents do not receive the care they require. (Fact sheet, 2006) In taking these factors into consideration the APN educator can be confident in the decision to practice in a rural community which will accommodate the professional advancement that is the desired effect for the educator.” Shortages of health facilities, physicians, nurses and other health care professionals in rural and isolated areas can result in individuals forgoing preventive medicine and necessary health treatment.” (Fact Sheet, 2006) When the decision is weighed in this context, factors which lure away APN to the urban setting will be neutralized to some extent.

Utilization management is described as the implementation of guidelines which reduce unnecessary use of medical resources (Kongstvedt, 2007, p.190). There are a variety of methods used to ensure costs are kept at a minimum without compromising patient care. The use of utilization management (UM) are yielding financial benefits resulting in managed care organizations (MCOs) and facilities investing more into UM programs.

In 2009, the number of people without insurance was estimated at 50.7 million (Health Policy, 2013). Many individuals and families have limited access to adequate healthcare services ultimately due to disparities in health and health care in America. Poor health outcomes and lower quality health care have been the result of unending disputes in disparities. Disparities are viewed as race, ethnicity, socioeconomic status, age, location, gender, disability status, and sexual orientation. Disparities have been recorded for many eras and, even with thorough changes in population health over a while, many disparities have continued and, in some basic facts, enlarged (Kaiser Family Foundation, 2012). These populations have a tendency to not get preventive care or early intervention services and use more expensive services such as, the emergency room. In the past, health care for the poverty-stricken have been governed more as a welfare program. This has contributed to large disparities throughout the nation in who among the underprivileged has access to what types of medical services.

The state of does California does participates in the Healthcare Cost and Utilization Project. The contact person is Amy Peterson the manager and her contact information is Healthcare Information Resource Center/Data Analysis Unit. California Office of Statewide Health Planning and Development. Her address is 400 R Street Room 250 Sacramento, CA 95811-6213. Her phone contact is (916) 326-3869 and fax is (916) 324-9242. Her e-mail address is amy.peterson@oshpd.ca.gov and website is http:// www.oshpd.ca.gov.

Men’s health has been an ongoing discussion for many years now. There have been discussions regarding the lack of men making, or keeping appointments with their physician, also acquiring a physician before receiving a diagnosis that will leave life changing results as well as seeking health care. Men have been known to refuse simply refuse to visit a doctor unless he is feverish and lying on his sick bed. Responses, such as the situation

The Affordable Care Act started changing the country’s health-care system almost from the moment it was signed into law in March 2010. It has already expanded coverage of young adults by allowing them to stay on their parents’ plans until they turn 26, outlawed lifetime limits on what insurance will cover, lowered the cost of drugs for seniors on Medicare, caused 13 million consumers to get premium rebates totaling some $1.1 billion, and expanded access to free preventive care for patients of all ages. Last summer it survived a challenge in the U.S. Supreme Court.

Historically, the United States medical system has gone through three distinct time periods. The pre-industrial, post- industrial and corporate periods indicating the advancement of medical changes. The changes developed through cultural beliefs, values, social, technological innovations, economic constraints and political opportunism. Consequently, the U. S. health care system has a challenging geographic distribution of primary care physicians and specialists.

Some of the issues and concerns may be completely new, emanating from current problems impacting their lives and finances. Others may be emanating from current and existing health policies they feel need adjustment or amendment. Yet issues related to key health care and policy reforms in which they feel that the government needs to play significant role. The expected roles more often includes financing and delivering health care, lowering rate of growth of Medicare spending and advanced planning for serious illness (Jaffe, 2009, p.1). The major issues in the past has been the insurance coverage of existing health problems which the insurance companies decided not to cover or insure a consumer with a known existing health problem or whose family members has had substantial health issues in the past. These created various problems that required public awareness and government

A physician is the trained professional or expert in the area of medicine. This field is concerned with maintaining, restoring and promoting human health through research, diagnosis and prompt treatment of the infections, injury and diseases together with other mental and physical impairments. Thus, the number of physicians in the rural areas of America has declined, which is related to the total number of graduates from the medical colleges and universities in the country and the surrounding states. In addition, the shortages are related to the number of the trained physicians, who practice medicine as the major career and then seek for employment in other country leaving America without the manpower (Rosenblatt, 2000). The number of physician in the country is measured via various parameters, which include the local population epidemiology, population demographics health care goal and policies and the types and number of other health practitioners in the system.

Changes in access to health care across different populations are the chief reason for current disparities in health care provision. These changes occur for several reasons, and some of the main factors that contribute to the problem in the United States are: Lack of health insurance – Several racial, ethnic, socioeconomic and other minority groups lack adequate health insurance coverage in comparison with people who can afford healthcare insurance. The majority of these individuals are likely to put off health care or go without the necessary healthcare and medication that is needed. Lack of financial resources – Lack of accessibility to funding is a barrier to health care for a lot of people living in the United States

The procedure of comparing requirements for medical services (“utilization”) to guidelines or principles that are considered suitable for such services, and making a recommendation built on that evaluation.