Medicare, the Uninsured, and International Healthcare Review
Western Governors University
Medicare, the Uninsured, and International Healthcare Review
Healthcare and healthcare reform are hot topics of debate in today 's society. As the population grows and life expectancy increases, the nation faces many challenges in providing healthcare benefits to the people. “According to the report, titled Income, Poverty and Health Insurance Coverage in the United States: 2010, 49.9 million Americans or 16.3 percent of the total US population had no health insurance in 2010. That percentage represents a slight increase on 2009’s figures, when 49 million citizens or 16.1 percent of the population was uninsured” (Gamser, 2011).
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Medicare Part D is the prescription drug plan. There are various options under this portion of Medicare and depending on the one that your mother has chosen would base the amount of coverage that she would receive for prescription medications. This does not necessarily cover the full cost of the prescription medications; there are deductibles and copayments that must be met.
The hospital acquired urinary tract infection that Mrs. Zwick developed during her hospital stay is not covered by Medicare. Research of an article in Medical News Today states: “Starting in 2009, Medicare, the US government 's health insurance program for elderly and disabled Americans, will not cover the costs of "preventable" conditions, mistakes and infections resulting from a hospital stay. So for instance, if you are on Medicare and you pick up a hospital acquired infection while you are being treated for something that is covered by Medicare, the extra cost of treating the hospital acquired infection will no longer be paid for by Medicare. Instead, the bill will be picked up by the hospital itself since the rules don 't allow the hospital to charge it to you” (Paddock, 2007).
Healthcare acquired infections (HAI) not only contribute to exorbitant amounts of financial burden on the healthcare system but also attribute to staggering numbers of
Findings from Squires and Blumenthal (2016) showed that only 8.9 percent of Americans are now uninsured, and since the Affordable Care Act went into effect in 2010 there are 20 million more Americans who now have health insurance and access to affordable care.
pressure ulcer developing while in the hospital and Medicare not reimbursing for the cost of the care of that ulcer, it
Medicare is trying to create incentives for hospitals to keep from making patients sicker, instead of healthier, during their inpatient stay. Hospital-acquired conditions (HACs) can lead to poor patient results
In October 1, 2008, the CMS adopted a non-reimbursement policy for certain "never events, which are defined as non-reimbursable serious hospital-acquired conditions (Sollecito & Johnson, 2013, p. 25). Examples of “never events” include surgery on the wrong body part; foreign body left in a patient after surgery; mismatched blood transfusion; major medication error; severe “pressure ulcer” acquired in the hospital; and preventable post-operative deaths (Center for Medicare & Medicaid Services, 2008)
Enforcing this act in the healthcare facility is necessary for healthcare administrators to be aware of facilities that receive patients, provide care, and cease unnecessary transfers to avoid the lack there of. “This means if a patient arrives at a hospital that accepts Medicare, the hospital isn’t allowed to refuse patient care, and this protection also requires healthcare providers to assess and stabilize all patients regardless of financial status”, (American Health Lawyers Association.
In other words, ever since the Affordable Care Act was passed, millions of Americans have insurance. This can be worrisome to non-profit hospitals due to the large number of patients. For example, there are far more patients than there are physicians, which causes the quality of care for these patients to diminish. Physicians cannot keep up with the amount of patients they need to see as well as give every patient 100% of their attention it is simply impossible. Therefore, hospitals may start to implement a policy where only certain insurances can be seen at the hospitals, excluding emergency situations of course, while others have to either see there primary doctors or specialists. In other words, physicians are discharging patients too early, which cause a large amount of them to be readmission. Therefore, this is costing the hospital millions of dollars as well as affecting the patients’ overall health. If there was a stricter policy on who can and cannot go to the hospital than patients may start to receive better care and non-profit hospitals can focus on their main mission and that is to treat the people of the community with a high and effective quality of
Medicare is a federal health insurance program for people over the age of 65. It also covers particular people who may have a disability and people who have End-Stage Renal Disease. There are four different parts to the Medicare program. These parts include hospital insurance, medical insurance, Medicare advantage plans, and prescription drug coverage. The program, since being created, has helped to fix many different problems, as well as help the elderly and other persons to receive health insurance.
In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals had to manage efficiently the treatment provided to a client and reduce the client’s length of stay (Jacob & Cherry, 2007). Case management, or internal case management “within the walls” of the health care facilities was created to streamline costs while maintaining quality care (Jacob & Cherry, 2007).
In the United States, more than forty million people are without health insurance. Of these people, many are employed by firms that do not offer coverage and many others fall just below the poverty line. Many are poor but still do not qualify for Medicaid. At least twelve million of those without health insurance are children. Reliable sources indicate that the number of uninsured people could rise as high as sixty million by the year 2010.
1. Over 41 million Americans have no health care insurance according to the U.S. Bureau of Census.
This savings would be a direct result of decreased overpayment by Medicare to hospitals, physicians and insurance companies (Perez, 2013). As a result, Centers for Medicare and Medicaid is incentivizing increased quality care in hospitals. Consequently, hospitals are not getting reimbursed for hospital acquired conditions. In addition, CMS is penalizing hospitals for readmissions (Bauchner, 2015). Lawmakers are expecting resounding savings related to CMS expectations. The short term savings of more than $200 billion through 2016 (CMS, 2015). As a result, hospitals are in a paradigm shift from volume based care to value based care. The expectation is that hospitals will reduce waste and decrease inappropriate waste which will result in savings that be used for other therapies (Bauchner,
While it 's difficult to estimate the exact number of Americans without health insurance at any given moment, most credible sources place this figure at between 40 and 45 million. In other words, one American in seven lacks even basic health insurance coverage ("How Many Americans Really Do Not Have Health Insurance?" n.d.).
The impact of Centers for Medicare and Medicaid Services (CMS) payment denial on the healthcare system is it has forced physicians and nurses to be more diligent, hyper vigilant, and take more responsibility in care the care of patients. As nurses we all know that turning and positioning q2h helps to prevent pressure ulcers, CMS no longer pays for pressure ulcer tx that occurred after admission. CMS is making the facilities take the loss and the facility has to pay for the treatment because they didn’t prevent. The same goes for hospital acquired infections, the facilities have to pay for the tx.
By 2010, approximately 45 million Americans did not have access to any form of health care insurance; with more than 45 million being underinsured.
2. Deductibles and copayments aside, Medicare does not cover many things that Mrs. Jackson and other chronically ill people need, such as medications, transportation to doctors’ appointments, and, as was the issue this day, adult diapers. According to HCFA rules, Medicare covers only services or supplies that are “medically necessary.” What are your thoughts, comments and concerns? (Up to 2 pts) Why are there so many gaps in coverage for poor people? (Up to 2 pts) What would you do if Mrs. Jackson was your mother? (Up to 2 pts)