What is The Origin of Government Involvement in Healthcare Provision?
Writte in a Q & A format. It is imperative that with all answered questions where another author’s concepts, statistics, numbers, or graphics that the source be both cited and referenced. All references should be complete and in APA formatting. Answers should be succinct and appropriate responses to the questions asked. Paraphrasing the questions in your answers will help ensure that you will answer all parts of each question. 1. Milestones, Titles 18, 19, and 21 Discuss the origins of government involvement in health care delivery in the United States. What were some of the key milestones and their impacts? What are Titles 18, 19, and 21 and describe their relationships to the milestones? 2. Managed Care Managed care is a very broad term and means different things in different markets; explain why. Describe your own local market in terms of managed care intensity. 3. Industry Standards What is a benchmark? How are they used in health care? How may they help us improve the quality of care, access, and allocate funding? Give an example of a: • Clinical benchmark • Financial benchmark • Operational benchmark 4. Providers of Health Care Who are the providers of health services? Who are considered the mid-level providers? Where do allied health providers fit in the realm of patient care? Provide at least two examples of each level and type of health provider, i.e., physicians, mid-level, and allied health. Describe their roles, credentials, training, authority, and limitations in regard to patient care. HINT: The MD and DO are in the driver’s seat. 5. Ambulatory Care What trends are we seeing in the most common forms of physician medical practices (clinics) and other ambulatory care at this time? Describe the changing forms of physician practice and ambulatory care in the U.S. as a result of managed care. Support your answer. 6. Hospital Organization Cite and briefly describe the roles of the three primary sources of power in modern U.S. hospitals. Which do you feel has the greatest amount of power? Support your decision with examples and primary sources.
Name:
Institution:
Date:
Q.1
What is The Origin of Government Involvement in Healthcare Provision?
Before 1920 doctors had minimal knowledge about diseases to provide useful care and, therefore, did not charge much. Only few employers offered health insurance and most patients paid out of pocket. Doctors began learning about diseases and effective ways of treatment and started charging higher fees than people could afford and wanted to treat patients in hospitals due to the improved technology that added to the costs and this worsened with the advent of the global recession. To ease the problem, Baylor Hospital created the Blue Cross to help pay hospital bills. The Blue Shield insurance grew for doctors as it protected the doctor’s interests and pay (Shi & Singh, 2009).
Blue Cross and Blue Shield success attracted other insurers and labor shortages in WWII encouraged employees to offer insurance. Therefore, employers provided insurance and government to provide tax incentives to the employers and this was during a time when countries were shifting towards national health insurance. The new private insurers insured the richest individuals and the Blues followed them and neglected the poor and the sickest in order to maximize profits. When J.F.K was elected IN 1960 THE U.S moved towards national health insurance by first sponsoring the elderly hence the introduction of Medicare and Medicaid an involvement of government in health provision (Shi & Singh, 2009).
What are the key milestones?
The key milestones include enactment of the Medicare and Medicaid in 1965, enrollment of over 19 million individuals in 1966, extension of Medicaid to include individuals with disabilities for those under 65 years, the passing of the HMO Act in 1973, establishment of HFCA, and broadening of the Medicare program (Niles, 2011).
What are Titles 18, 19, & 21 and their Relationship to the Milestones?
Title 18 is health insurance and for the aged and disabled under Social Security Act, title 19 covers Medicaid and establishes regulations for Medicaid, and Title 21 is the state children’s health insurance program. These are related to the milestones and their establishment helped the US government go through the milestone and provide universal care (ssa.gov, 2014).
Q.2
Why Does Managed Care Have Different Meanings?
Managed care plans are health insurance plans that have arrangements with certain doctors, hospitals, and other professionals in the healthcare system to provide a myriad of services depending on the type of at reduced cost. Today in the United States the different have the federal authority to implement the delivery system for managed care. The federal authorities in these states can three types of authorities that they can use to implement the managed care systems that are state plan authority, waiver authority [section 1915 (a) and (b), and waiver authority. In addition, the plans implemented provide varying services; therefore managed care has different meanings depending on the implementing authority and type of plan provided (Samuels, 2012).
What is the Local Market’s Managed Care?
In my locality, the managed care is provided through the Medicaid and CHP state plan. The Medicaid has three managed care programs that are STAR, STAR+PLUS AND health. The plans are expanded to extend to the HHSC in order to develop a system of payment that is dependent on performance, therefore, rewards outcomes and enhances efficiency
Q.3
What is a Benchmark?
A benchmark is a standard that is set and used to determine the quality the quality or level of performance of other similar things or activities. It is an alternative that is feasible to a portfolio against which performance is measured that is a standard used for measurement (Society for Human Resource Management, 2010).
How are Benchmarks used in Health Care?
Professionals in health care are obligated to ensure uniform provision of high quality care health service. Quality here being the degree to which health services for individuals and the whole population increase the likelihood of desired health outcomes and consistent with current knowledge in the profession. Benchmarking in health care is used on different levels. Performance benchmarking is used to compare the levels of performance in order to identify gaps in performance; process benchmarking identifies the root causes leading to superior performance, and benchmarking in clinical practice is used to compare healthcare structures and sharing best practices in clinical practice. Finally, competitive benchmarking is used to inform how well a health care system is performing compared to its competitors. These are all geared towards providing quality care (Lovaglio, 2012).
How do Benchmarks Improve Quality of Care, Access, and Allocation Funding?
By identifying the gaps in performance and identifying the causes for superior performance, the healthcare system can incorporate the necessary improvements by covering the identified gaps with the identified cause for improved performance hence improve the quality of care. In addition, by sharing and comparing the structures of health care, the system can identify and share better clinical practices which will improve the quality of care and make savings on the costs of providing care and hence increase accessibility to care. This will, in addition, improve its efficiency in operation and effectiveness hence receive the higher allocation of funds that will in turn expand the healthcare system hence improve accessibility. Finally, through competitive benchmarking, the system can employ approaches to improve quality and access of funding that will give it competitive ad...