Variations in Approaches to Care, health and medicine homework help

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Question Description

Choose a specific culture or ethnicity of an immigrant or refugee population.  

  • Analyze their cultural and social norms.  
  • Discuss how they experience the healthcare system in America.  
  • Include an evaluation of how both the community and market-oriented approaches to health care, as highlighted in Chapter 10 of your text, can assist your chosen culture in getting the care they need.  Provide an analysis of a multidisciplinary approach that can be used to deliver the best care to your population.
  • Discuss a program in your community, or the nearest large community, that serves immigrants and refugees.  Are the services truly accessible to a wide population of immigrants and refugees?  Identify one approach which could improve accessibility, cost, or the quality of care for the population.
Your initial contribution should be 250 to 300 words in length. Your research and claims must be supported by your course text and at least one other scholarly source. Use proper APA formatting for in-text citations and references as outlined in the Ashford Writing Center.

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10 Courtesy of maigi/fotolia Where Do We Go From Here? Learning Objectives After reading this chapter, you should be able to: •• Discuss the importance of collaboration between policy makers and vulnerable populations. •• Explain the community-oriented approach to health care. •• Define the market-oriented approach to health care. •• Specify the role that vulnerable populations should play when developing health care programs. •• Identify policies (social and economic) for health care reform that will improve health care services accessibility, cost, and quality. bur25613_10_c10_259-274.indd 259 11/26/12 2:50 PM CHAPTER 10 Introduction Introduction P olicy makers and program administrators must realize that there is often a lack of communication between those creating the programs aimed at vulnerable populations and the individuals who make up those populations. Programs won’t be useful if they do not directly address the needs of the vulnerable in ways that are accessible to the vulnerable. The best way to achieve useful program design or reform is to collaborate with the population you are trying to serve. Program designers and medical practitioners can learn a lot about the needs of those they are serving simply by asking them. By having conversations with patients and community leaders, and even by asking patients and patrons to complete surveys, policy makers, program administrators, and practitioners gain insight into the needs and wants of the vulnerable populace. Only through a coordinated, collaborative effort to address the serious issues confronting vulnerable populations can the health and wellness of said population increase to resemble those who are not classified as vulnerable. Courtesy of Digital Vision/Thinkstock Effective program planning must include communication between policy makers and the individuals who make up the vulnerable populations meant to benefit from a particular program. Critical Thinking Communication can take many different forms. Communication can include everything from formal town hall meetings to informal conversations between two people. Communication does not necessarily even need to involve talking. Describe three special populations and specify a form of communication that could be used to gather information on each group. Self-Check Answer the following questions to the best of your ability. 1. The best way for program administrators to achieve useful program design or reform is to collaborate with whom? a. the population they are trying to serve b. legal counsel c. government advisors d. academic researchers bur25613_10_c10_259-274.indd 260 11/26/12 2:50 PM CHAPTER 10 Section 10.1  The Community-Oriented Approach 2. Declarations from those in charge will be useless because ______________. a. no one will listen b. there is no food c. those in charge have not sought the council of the masses d. those in charge do not care 3. Only through a coordinated, ____________ effort to address the serious issues confronting vulnerable populations can the health and wellness of said populations increase to resemble those who are not classified as vulnerable. a. collaborative b. grassroots c. organized d. revolutionary Answer Key 1. a 2. c 3. a 10.1  The Community-Oriented Approach T Courtesy of iStockphoto/Thinkstock Several social and interpersonal factors influence a person’s sense of well-being. he key to a community-oriented approach to health policy is remembering that a person’s well-being is greatly affected by family, friends, and other social factors. In other words, discharged patients will fare better or worse depending on their individual support networks. On a larger scale, this means that health policy needs to look beyond the microlevel and consider the macrolevel factors that affect the populations being served. There are five levels of focus in community engagement: (a) the individual, (b) the social and network systems, (c) the influences of organizations to bring change, (d) the community collaborative relationships, and (e) the state and federal policies and regulations. Concepts that summarize social ecology theories relating to the efforts of community engagement in addressing this need are as follows: • health status, emotional well-being, and social cohesion, which are influenced by the physical, social, and cultural status of the individual or his or her environment • different effects of the individual’s health, which includes perception and financial resources available • the influence by others on the individual or group bur25613_10_c10_259-274.indd 261 11/26/12 2:50 PM Section 10.1  The Community-Oriented Approach CHAPTER 10 Community-oriented health policy works to improve health outcomes by making changes on a community level. To do this, community members should be consulted about the needs of their communities and the daily risks encountered there. This goes beyond patients to include consulting those who work directly with patients, and consulting community leaders and organizers on what issues they consider important in the identified community. Once policy makers understand what the contributing factors are, they can begin to form policy to address those factors. Problems with participation often trouble these efforts. Instead of creating focus groups, policy makers can work with physicians to build relationships with patients that encourage discourse and disclosure. Improving the physician-patient relationship not only offers a way to learn the needs of the patients but is in itself an improvement of patient care. Cross-Disciplinary Solutions Inadequate housing, high poverty levels, and low education levels can all contribute to ill health and poor health outcomes. Housing issues may include exposed asbestos that leads to lung infections, poverty reduces accessibility to health care, and low education levels contribute to poor lifestyle habits. Though they may appear to be outside the realm of health policy, the effects these and other factors discussed in this book have on health is considerable. As such, community-oriented health policy must address all such factors. The community-oriented approach involves cross-disciplinary planning and programming in order to address individual patient needs as well as to address the community factors that Courtesy of nathings/fotolia contribute to vulnerability. Health policy that takes a community-based Contributing factors to poor health can include poverty, approach should bring together substandard housing, and low education levels. agencies from many different specialties and fields. Health care providers, care management teams, social services officers, and community-based resource programs can be brought together to design programs and policies that improve patients’ chances of positive treatment outcomes. This can be accomplished through an ideology of comprehensive collaboration and sharing of pertinent health information across what had previously been silos or territories where information was held close to the vest. An example of one such program would be a hospital that discharges high-risk youth with a referral to a social worker at a local youth center. The social worker could encourage the youth to participate in the activities offered at the youth center, thereby improving the youth’s social capital and ultimately improving his or her chance of positive outcomes in life as well as health. This example illustrates the care continuum from treatment (hospitalization for illness) to long-term services (youth center involvement) and addresses bur25613_10_c10_259-274.indd 262 11/26/12 2:50 PM Section 10.1  The Community-Oriented Approach CHAPTER 10 some needs of the vulnerable youth population. Programs at the youth center should be designed to address the needs of the people it serves. One of the best sources for information about those needs is the people being served and, in this case, adults from the relevant community. Critical Thinking The community-oriented approach involves cross-disciplinary planning and programming in order to address individual patient needs as well as to address the community factors that contribute to vulnerability. What this means from the perspective of the individual is that discharged patients will fare better or worse depending on their personal support networks. On the other side of the coin, how does improved patient health benefit the greater community? Do you believe the community has a vested interest in ensuring improvements in health at the level of the individual? If so, why? Self-Check Answer the following questions to the best of your ability. 1. Community-oriented health policy works to improve health outcomes by making changes on what level? a. community b. macro c. micro d. individual 2. Problems with participation often trouble the efforts of policy makers. What is one of the best ways to raise participation levels? a. Talk to focus groups. b. Look at housing data (sales, property values, etc.). c. Work with physicians to build relationships within the community. d. Look at how many voters are in the area. 3. Health care providers can be brought together to design programs using what ideology? a. comprehensive collaboration b. business as usual c. keep the information we have to ourselves d. continuum of care Answer Key 1. a 2. c 3. a bur25613_10_c10_259-274.indd 263 11/26/12 2:50 PM Section 10.2  The Market-Oriented Approach CHAPTER 10 10.2  The Market-Oriented Approach A s discussed in earlier chapters, the United States’ economy is built on the concept of the ideal free market, unlike the single-payer systems found in countries such as Canada and Great Britain. In other words, the U.S. health care system is marketoriented, meaning it relies on competition between care providers to strive for quality and control cost. However, it must also meet the needs of health care consumers, who may not be knowledgeable enough to know what they need because of uncertainty of health and outcomes, as well as a sense that asking questions means questioning doctors’ authority. One disadvantage of a market-oriented health care system is that because health care is often a necessity, people have little opportunity to shop around for the best service and prices. This issue is particularly pronounced in economically depressed areas where access to health care is limited. To address this, America’s health care delivery system is evolving and may have never been so prominent an issue as during the lengthy debates over the Patient Protection and Affordable Care Act of 2010 (PPACA). Even if the health care system is part of the free market economy, governments have an interest in ensuring affordable access to all citizens for two reasons: (a) Federal and state governments fund public payer insurance plans, and (b) an unhealthy population costs the country money. As such, the way Americans finance health care, both now and in the future, is at the forefront of the debate over health care reform. Changing the Health Care System One of the many goals of health care reform is to achieve near-universal coverage for all U.S. citizens and a safety net for accessing health care for all people. In an attempt to do this while managing costs, state and federal governments have tried implementing incentive plans to help employers cover the cost of health insurance with tax cuts and other rewards. Other attempts have disincentivized employers from not offering health insurance to employees by fining certain businesses that don’t have employee health coverage. Business owners often rail against both methods, arguing that it should not be the responsibility of employers to ensure universal care coverage. Courtesy of gchutka/iStockphoto Health care reform strives to achieve adequate access to and coverage of health care for all people, regardless of citizenship status. bur25613_10_c10_259-274.indd 264 Program plans should be evaluated based on these coverage concerns, as well as how they close the coverage gaps from public to private payers by equalizing the provider reimbursement structure and the use of large risk pools to determine pricing. Plan coverage and need and effectiveness norms 11/26/12 2:50 PM Section 10.2  The Market-Oriented Approach CHAPTER 10 and definitions that dictate what procedures and services are covered at what levels for which conditions should consider the care continuum model and provide coverage for services across the entire continuum. Plans that use a community rating, which is broad population grouping for computing risks and premiums, allow for more coverage for more people at less cost. The alternative, experience rating, uses a small group of eligible people and encourages denying coverage to the most vulnerable, as they are most likely to cost the insurer money. Some plans use carve outs to cover high-risk patients and pay for some patients’ disproportionately high costs. The difficulty with these plans comes when trying to find a fair way to cover patients’ needs and offer fair reimbursement for service providers without driving up premiums. The use of insurance premiums as a means of paying for health care is problematic. Premiums fail to consider varying economic abilities of enrollees to pay premiums and service co-pays. Under the current methodology, health insurance premiums do little to minimize financial barriers to health care, especially in ways that seem tangible to the consumer. As health insurance premiums rise, more and more Americans are allowing their coverage to lapse. Many have also seen their office visit and pharmacy co-pays increase simultaneously. The monthly costs associated with maintaining insurance coverage often seem more immediate than the risk of a catastrophic health event. People living on fixed incomes and those living in poverty have been found to be the most affected by increasing insurance premiums and co-pay costs. Payer systems that include progressive payment scales based on financial need and ability provide more equitable financial access to health care. In fact, cost sharing has been found to limit access to preventive care more than limiting the need for treatment. While patients are struggling to afford health care coverage and services, providers are struggling to stay open or to make profits. The free market system encourages all service providers in every field to strive for profitability, often to the point of diminishing services to raise profit margins, as in the case of physician practices limiting the number of Medicaid patients they will treat because Medicaid often does not reimburse at as high a level as private payer insurance. Even health care providers who still focus on serving patients find it difficult to run a facility when insurance companies and public payers are constantly negotiating prices. Many among America’s most vulnerable who use public payer health coverage have experienced a significantly diminished number of care providers who will accept public payer coverage. This is because many states have lowered the physician reimbursement rates well below what private payers have negotiated. Under these terms, it is in the providers’ best interests to limit the number of public payer–enrolled patients and maximize the number of private payer–enrolled patients to increase profits. The American public payer system relies on micro-oriented means to limiting reimbursement. As America struggles to solve problems with the medical care delivery system, policy makers should consider the macro-oriented means used to limit reimbursements in other countries that boast more universal coverage and accessibility. Physician reimbursement isn’t the only area where service costs are rising. It is generally believed that it is not patients but rather physicians who create high demand for expensive procedures and services. Because they are responsible for writing the orders, physicians are also consumers of health care services. Cost containment includes managing increasing physician fees and also minimizing the number of expensive services called for by physicians. Policy makers may find it difficult to balance cost containment without disincentivizing the necessary treatments of patients on Medicare and Medicaid. bur25613_10_c10_259-274.indd 265 11/26/12 2:50 PM Section 10.2  The Market-Oriented Approach CHAPTER 10 Health maintenance organizations (HMOs) are a type of insurer that uses a prepaid system to arrange care for covered patients. Because they make prepaid agreements with providers, HMOs are often a less expensive insurance option. Prepaying helps with cost containment by insuring against rising costs for a specified amount of time, because the services are paid for before they are rendered. Because HMOs have a reasonable idea of their revenue for the year (premium dollars per member) and how many members they have to serve, prepaying allows them to keep costs down in order to make profits. Though consumers of HMO plans have reported satisfaction with the premiums and copay costs associated with HMOs, they have reported less satisfaction with the standard of care received. Annual numbers on HMOs usually show that they lead in preventive care and reduced number and lengths of hospital stays. Whether that is because HMO patients use more preventive care or because providers are less likely to recommend expensive therapies for HMO patients is unclear. The PPACA attempts to create universal coverage balanced with affordability. The law includes a mandate that every person must have health insurance by 2014 or pay penalties. Penalty monies should be used to help cover the costs associated with uninsured patients seeking emergency medical attention. Such cases drive up the cost of health care and health insurance for every person in the United States. With the cost of health insurance climbing, universal coverage can be achieved only if premiums are affordable for all people. In an attempt to harness the power of the free market and increase health insurance coverage across the nation, the PPACA created the American Health Benefit Exchanges (Henry J. Kaiser Foundation, 2010c). These marketplaces will be administrated by state governments and will provide standardization and competition in the health insurance market. The point is to make it both more affordable and easier for individuals to purchase their own health insurance instead of relying on employers and government programs. This is a market-oriented approach that relies on the free market ideal. At the time this book was written, the insurance exchanges were not yet open; it will be many years before their overall effectiveness can be measured in terms of efficiency, openness of the marketplace, and cost containment. Critical Thinking The text says that government should be highly interested in solving the health care crisis because an unhealthy population costs the country money. If individuals pay for their own health care, how does an unhealthy population cost the country money? bur25613_10_c10_259-274.indd 266 11/26/12 2:50 PM Section 10.3  Improving Accessibility, Cost, and Quality CHAPTER 10 Self-Check Answer the following questions to the best of your ability. 1. Premiums fail to consider varying economic abilities of enrollees to pay for what? a. premiums and service co-pays b. direct costs of health care c. emergency transportation fees (ambulance, etc.) d. indigent persons who use health care services 2. Because they make prepaid agreements with providers, what type of organization is often a less expensive insurance option? a. labor unions b. family health centers c. PPOs d ...
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ASIAN IMMIGRATION POPULATION
The Asian community comprises of three different groups; the Pacific Islanders, the
South East Asians and the East Asians such as the Chinese. These communities are grouporiented and strongly emphasize on family connection as the major source of identity and
protection. The children are supposed to abide by laws defined by the parents. ...

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