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Running head: HEALTH CARE COVERAGE 1
Health care coverage
Name
School
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HEALTH CARE COVERAGE 2
Healthcare coverage is a critical aspect of providing a health safety net to individuals and
their families. Health insurance provides the insured with ease of access to medical care services
and reduces the financial risks and responsibilities tied to the costs of care. Insurance cover
provides a pool from where many people can be provided with health care in a cheaper more
economical and predictable way enabling health care to be accessed in a cheaper manner. Health
insurance also provides a regulatory access to care and contributes to the standardization of the
health care services provided to individuals by the health care providers and institutions.
Vulnerable populations usually have limited economic abilities which limit them from
affording the cost of healthcare services. The vulnerable populations also may have higher risks
for disease and health care needs (Vilcu, Probst, Dorjsuren & Mathauer, 2016). Healthcare
coverage provides the vulnerable populations an avenue through which they can access health
care cheaply. Health care coverage for the vulnerable population is provided through establishing
contribution pool where the populations can contribute a small portion of money which affords
them access to a variety of healthcare services cheaply compared to out-of-pocket payments.
Providing health care coverage for the vulnerable groups also reduces the burden and
dependency ratio in the community and promotes the health-seeking behaviors by the vulnerable
populations through removing the economic barrier to health care access and hence reducing the
health disparities (Vilcu, Probst, Dorjsuren & Mathauer, 2016).
Importance of healthcare coverage to uninsured/ vulnerable groups
Healthcare coverage would be beneficial to the uninsured/ vulnerable populations
through enabling them a cheaper and more convenient health care services. Health coverage
provides cheaper access to health care by reducing the fiscal burden that out-of-pocket paying for
health care brings to the patient (Glied & Frank, 2017). Through health coverage, vulnerable
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HEALTH CARE COVERAGE 3
groups are able to afford care without having to pay out of -pocket for services provided. This
benefit of insurance ensures that the vulnerable population can access healthcare services when
in need removing any delays that might result due to their inability to pay. Removing delays in
accessing health care services for the vulnerable populations prevents adverse effects and
complications of diseases and illnesses among individuals in need and can be critical in
preventing morbidity and mortality.
Insurance coverage also provides the uninsured and vulnerable populations with access to
quality healthcare services when in need. Most insurance cover providers vet and ensure quality
service provision before approval of covered facilities or reimbursements (Vilcu, Probst,
Dorjsuren & Mathauer, 2016).The stringent process by insurance providers to audit the
healthcare services provided by their covered facilities for quality provides an advantage to the
uninsured by ensuring the quality of services. This affords the vulnerable population protection
from exploitation through unnecessary medical interventions which would either increase costs
of care without providing any meaningful health benefits.
Preferred Provider Option Plan
The PPO health insurance plan provides the policyholder with a flexibility to choose
from a pool of providers which one to seek services from (Shetty, Rivas & Hristidis, 2016). This
option facilitates access by to the patient as they get the freedom to choose their preferred
providers of choice. In this insurance cover arrangement, the policyholder has an ease of access
as different providers are contracted by the organization. Another option that facilitates access to
the patient is that the policy provides a wide choice of providers across a geographical coverage
area hence ensuring that the patient can access their health care needs from different points of
care across the country easily.
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HEALTH CARE COVERAGE 4
The PPO has a limitation to patient access in that the premiums payable to the PPO
organization are higher compared to those premiums payable to HMO organizations or other
insurance organizations (Ellis & Zhu, 2016). Higher premiums mean an increased cost of
healthcare and may lock outpatients from accessing the facility. The second limitation the PPO
service has is that it limits policyholders from accessing care from non- accredited facilities
through the introduction of additional charges in case patients do so. This provision limits
policyholder's freedom of seeking care from non-accredited facilities as such attract an extra cost
to the policyholder.
Medicaid
Medicaid provides the freedom for states to regulate the non-mandatory services that the
person covered by the insurance can receive. Through this, the Medicaid program provides the
user the access to other essential medical services in addition to those listed as mandatory
services. The second option by Medicaid that increases access to the patient is that the cover
provides the covered person with access to preventive services. Access to preventive services
provides the patient with the advantage of mitigating disease risks and averting illness. The
Medicaid program has an option of out-of-pocket spending option which allows vulnerable
groups of people to be exempted from such co-payments while allowing the program to spread
the payments through the ability of the members to pay with those with higher incomes paying
more than those with little income.
Diagnosis Related Groups
Diagnosis Related Groups (DRGs) is a system of statistically classifying inpatient stays
into groups based on the body systems for insurance reimbursement. The reimbursement is
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HEALTH CARE COVERAGE 5
calculated based on the diagnosis and the resources utilized in treating the condition. DRG
reimburse patient care based on the patient’s length of stay and the cost associated with the
management of the condition. The implication of DRG on is that it may improve efficiency for
necessary care hence resulting in early discharge for clients hence resulting in shortened hospital
stays. On the other hand, the DRG may result in shortened stays to maximize the profits while
compromising the patient outcomes (Mihailovic, Kocic & Jakovljevic, 2016). DRG pays for the
average cost of caring for the patient within each DRG, any patient interventions that are cheaper
within the DRG provided the provider makes a profit. DRG may also result in outliers in patients
who may need more costly care for a condition within a certain DRG that is higher than the usual
or estimated cost for the DRG.
The aim of DRG was to reduce unnecessary medical interventions and improving the
efficiency of the necessary medical interventions (Mihailovic, Kocic & Jakovljevic, 2016).
However, DRGs may also incentivize providers to skip essential interventions to reduce the costs
of providing care to make profits. In essence, the DRG may then have a negative on the patient's
quality of care in a bid to cut the costs of patient care and maximize profitability.
Charity Care
The role of charity care is to ensure that the vulnerable or uninsured populations meeting
specific asset and income criteria have access to achieve inpatient and outpatient care at costs
that are reduced (Nikpay & Ayanian, 2015). The Charity care is imperative in hospitals as it
provides a financial security when caring for uninsured and vulnerable individuals as their ability
to pay is usually low. The Charity care helps the vulnerable by providing them with medical
solutions at a point of need and when they need the medical intervention best. To the hospital,
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HEALTH CARE COVERAGE 6
Charity care cautions the hospital against complete non-payment by vulnerable individuals who
need emergency interventions.
Conclusion
Healthcare is a need that is critical to achieving the complete well-being of all people.
Access to health insurance still lags despite the Accountable Care Act which advocated for
insurance access for all. Vulnerable populations are usually at increased risk for health and
disease. In ensuring safe access to medical needs for the vulnerable through such products as the
charity care the coverage provides them with access to care. The insurance reimbursement modes
such as the DRG ought to be observed and monitored closely to ensure that the patient care
quality is maintained as expected. Health coverage overall provides ease of access to health care
services as well as reducing the costs of healthcare.
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HEALTH CARE COVERAGE 7
References
Glied, S., & Frank, R. (2017). Care for the Vulnerable vs. Cash for the Powerful Trump’s
Pick for HHS. New England Journal of Medicine, 376(2), 103-105.
http://dx.doi.org/10.1056/nejmp1615714
Mihailovic, N., Kocic, S., & Jakovljevic, M. (2016). Review of Diagnosis-Related Group-Based
Financing of Hospital Care. Health Services Research and Managerial Epidemiology, 3,
233339281664789. http://dx.doi.org/10.1177/2333392816647892
Nikpay, S., & Ayanian, J. (2015). Hospital Charity Care Effects of New Community-Benefit
Requirements. New England Journal of Medicine, 373(18), 1687-1690.
http://dx.doi.org/10.1056/nejmp1508605
Shetty, P., Rivas, R., & Hristidis, V. (2016). Correlating Ratings of Health Insurance Plans to
Their Providers' Attributes. Journal Of Medical Internet Research, 18(10), e279.
http://dx.doi.org/10.2196/jmir.6475
Vilcu, I., Probst, L., Dorjsuren, B., & Mathauer, I. (2016). Subsidized health insurance coverage
of people in the informal sector and vulnerable population groups: trends in institutional
design in Asia. International Journal for Equity In Health, 15(1).
http://dx.doi.org/10.1186/s12939-016-0436-3

Unformatted Attachment Preview

Running head: HEALTH CARE COVERAGE Health care coverage Name School 1 HEALTH CARE COVERAGE 2 Healthcare coverage is a critical aspect of providing a health safety net to individuals and their families. Health insurance provides the insured with ease of access to medical care services and reduces the financial risks and responsibilities tied to the costs of care. Insurance cover provides a pool from where many people can be provided with health care in a cheaper more economical and predictable way enabling health care to be accessed in a cheaper manner. Health insurance also provides a regulatory access to care and contributes to the standardization of the health care services provided to individuals by the health care providers and institutions. Vulnerable populations usually have limited economic abilities which limit them from affording the cost of healthcare services. The vulnerable populations also may have higher risks for disease and health care needs (Vilcu, Probst, Dorjsuren & Mathauer, 2016). Healthcare coverage provides the vulnerable populations an avenue through which they can access health care cheaply. Health care coverage for the vulnerable population is provided through establishing contribution pool where the populations can contribute a small portion of money which affords them access to a variety of healthcare services cheaply compared to out-of-pocket payments. Providing health care coverage for the vulnerable groups also reduces the burden and dependency ratio in the community and promotes the health-seeking behaviors by the vulnerable populations through removing the economic barrier to health care access and hence reducing the health disparities (Vilcu, Probst, Dorjsuren & Mathauer, 2016). Importance of healthcare coverage to uninsured/ vulnerable groups Healthcare coverage would be beneficial to the uninsured/ vulnerable populations through enabling them a cheaper and more convenient health care services. Health coverage provides cheaper access to health care by reducing the fiscal burden that out-of-pocket paying for health care brings to the patient (Glied & Frank, 2017). Through health coverage, vulnerable HEALTH CARE COVERAGE 3 groups are able to afford care without having to pay out of -pocket for services provided. This benefit of insurance ensures that the vulnerable population can access healthcare services when in need removing any delays that might result due to their inability to pay. Removing delays in accessing health care services for the vulnerable populations prevents adverse effects and complications of diseases and illnesses among individuals in need and can be critical in preventing morbidity and mortality. Insurance coverage also provides the uninsured and vulnerable populations with access to quality healthcare services when in need. Most insurance cover providers vet and ensure quality service provision before approval of covered facilities or reimbursements (Vilcu, Probst, Dorjsuren & Mathauer, 2016).The stringent process by insurance providers to audit the healthcare services provided by their covered facilities for quality provides an advantage to the uninsured by ensuring the quality of services. This affords the vulnerable population protection from exploitation through unnecessary medical interventions which would either increase costs of care without providing any meaningful health benefits. Preferred Provider Option Plan The PPO health insurance plan provides the policyholder with a flexibility to choose from a pool of providers which one to seek services from (Shetty, Rivas & Hristidis, 2016). This option facilitates access by to the patient as they get the freedom to choose their preferred providers of choice. In this insurance cover arrangement, the policyholder has an ease of access as different providers are contracted by the organization. Another option that facilitates access to the patient is that the policy provides a wide choice of providers across a geographical coverage area hence ensuring that the patient can access their health care needs from different points of care across the country easily. HEALTH CARE COVERAGE 4 The PPO has a limitation to patient access in that the premiums payable to the PPO organization are higher compared to those premiums payable to HMO organizations or other insurance organizations (Ellis & Zhu, 2016). Higher premiums mean an increased cost of healthcare and may lock outpatients from accessing the facility. The second limitation the PPO service has is that it limits policyholders from accessing care from non- accredited facilities through the introduction of additional charges in case patients do so. This provision limits policyholder's freedom of seeking care from non-accredited facilities as such attract an extra cost to the policyholder. Medicaid Medicaid provides the freedom for states to regulate the non-mandatory services that the person covered by the insurance can receive. Through this, the Medicaid program provides the user the access to other essential medical services in addition to those listed as mandatory services. The second option by Medicaid that increases access to the patient is that the cover provides the covered person with access to preventive services. Access to preventive services provides the patient with the advantage of mitigating disease risks and averting illness. The Medicaid program has an option of out-of-pocket spending option which allows vulnerable groups of people to be exempted from such co-payments while allowing the program to spread the payments through the ability of the members to pay with those with higher incomes paying more than those with little income. Diagnosis Related Groups Diagnosis Related Groups (DRGs) is a system of statistically classifying inpatient stays into groups based on the body systems for insurance reimbursement. The reimbursement is HEALTH CARE COVERAGE 5 calculated based on the diagnosis and the resources utilized in treating the condition. DRG reimburse patient care based on the patient’s length of stay and the cost associated with the management of the condition. The implication of DRG on is that it may improve efficiency for necessary care hence resulting in early discharge for clients hence resulting in shortened hospital stays. On the other hand, the DRG may result in shortened stays to maximize the profits while compromising the patient outcomes (Mihailovic, Kocic & Jakovljevic, 2016). DRG pays for the average cost of caring for the patient within each DRG, any patient interventions that are cheaper within the DRG provided the provider makes a profit. DRG may also result in outliers in patients who may need more costly care for a condition within a certain DRG that is higher than the usual or estimated cost for the DRG. The aim of DRG was to reduce unnecessary medical interventions and improving the efficiency of the necessary medical interventions (Mihailovic, Kocic & Jakovljevic, 2016). However, DRGs may also incentivize providers to skip essential interventions to reduce the costs of providing care to make profits. In essence, the DRG may then have a negative on the patient's quality of care in a bid to cut the costs of patient care and maximize profitability. Charity Care The role of charity care is to ensure that the vulnerable or uninsured populations meeting specific asset and income criteria have access to achieve inpatient and outpatient care at costs that are reduced (Nikpay & Ayanian, 2015). The Charity care is imperative in hospitals as it provides a financial security when caring for uninsured and vulnerable individuals as their ability to pay is usually low. The Charity care helps the vulnerable by providing them with medical solutions at a point of need and when they need the medical intervention best. To the hospital, HEALTH CARE COVERAGE 6 Charity care cautions the hospital against complete non-payment by vulnerable individuals who need emergency interventions. Conclusion Healthcare is a need that is critical to achieving the complete well-being of all people. Access to health insurance still lags despite the Accountable Care Act which advocated for insurance access for all. Vulnerable populations are usually at increased risk for health and disease. In ensuring safe access to medical needs for the vulnerable through such products as the charity care the coverage provides them with access to care. The insurance reimbursement modes such as the DRG ought to be observed and monitored closely to ensure that the patient care quality is maintained as expected. Health coverage overall provides ease of access to health care services as well as reducing the costs of healthcare. 7 HEALTH CARE COVERAGE References Glied, S., & Frank, R. (2017). Care for the Vulnerable vs. Cash for the Powerful — Trump’s Pick for HHS. New England Journal of Medicine, 376(2), 103-105. http://dx.doi.org/10.1056/nejmp1615714 Mihailovic, N., Kocic, S., & Jakovljevic, M. (2016). Review of Diagnosis-Related Group-Based Financing of Hospital Care. Health Services Research and Managerial Epidemiology, 3, 233339281664789. http://dx.doi.org/10.1177/2333392816647892 Nikpay, S., & Ayanian, J. (2015). Hospital Charity Care — Effects of New Community-Benefit Requirements. New England Journal of Medicine, 373(18), 1687-1690. http://dx.doi.org/10.1056/nejmp1508605 Shetty, P., Rivas, R., & Hristidis, V. (2016). Correlating Ratings of Health Insurance Plans to Their Providers' Attributes. Journal Of Medical Internet Research, 18(10), e279. http://dx.doi.org/10.2196/jmir.6475 Vilcu, I., Probst, L., Dorjsuren, B., & Mathauer, I. (2016). Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. International Journal for Equity In Health, 15(1). http://dx.doi.org/10.1186/s12939-016-0436-3 Name: Description: ...
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