Universal Health Care Essay Example | Topics and Well Written Essays - 750 words

Universal Health Care - Essay Example The current system of healthcare basically seeks community and society influences to make healthcare better for the average consumer, but some critics who advocate universal healthcare say that the system of managed care is run not by concern for the customer, but by the bottom line of profits. It is therefore not a community healthcare organization necessarily, but a consumer one. â€Å"Patients expect the managed care provider to help them manage their relationship with their health plan. Providers should supply patients with information about health plan changes by their employer and assistance in discussing their health plan preferences with their employer. The provider can encourage patients to take responsibility for their relationship with the health plan, but also should have processes in place to assist the patient in working with the health plan to address issues such as care denials or other service issues† (Tomczyk, 2002). This addresses customer service principles rather than general wellness. consumer care, such as currently existing programs like Medicaid and Medicare that provide programs that increase accessibility for the poor and elderly. Other countries such as Canada have made medical care universally accessible to everybody in the country. Accessibility, as well as education, is an important goal. If a person is poor or elderly, they are going to be less likely in the US to get quality healthcare and have insurance, and in many cases, it is a problem of access as well as opportunity. For poor minority immigrant families for example, â€Å"reducing Medicaid eligibility for these children will not necessarily save money as long as children remain eligible for costly emergency care† (RAND, 2002). Many immigrant families find it hard to navigate the existing pattern of federalized programs on a state and local level in terms of eligibility and access. educational programs

Medical Financial definition of terms Research Paper

Medical Financial definition of terms - Research Paper Example The PMPM is used in the analysis of the parameters of the different health status of the patients. The PMPM feed paid to the health home care providers is determined by several factors (Wodchis, Hirth & Fries, 2007). The health home program in the New York Medicaid adjusts the PMPM that is paid to the health care providers according to the enrollment volume, region, and the case mix. There are plans to incorporate the patient’s functional status in the near future by the New York Medicaid program as one of the determinants of the consideration in paying the Health Home providers. The New York Medicaid program provides for payment of a case finding Per Member per Month bill, which is a cheaper amount. â€Å"The case finding PMPM is provided during the first few weeks of the program to cater for reimbursement of engagement and outreach services† (Centers for Medicare and Medicaid services, 2011). The provisions of the New York Medicaid are that the billing of active medic al care management of the enrolled patients is only made when a health care manager is assigned to the patient. â€Å"The New York Medicaid health home program has various managed care plans, which give the guidelines for the payment if the contracted medical professionals† (Centers for Medicare and Medicaid services, 2011). ... cost of medical care in Medicaid, the capitalization is used to ensure that all medical expenses including the payment of the providers and the expenses of purchase of drugs are paid for and accounted for (Centers for Medicare and Medicaid services, 2011). Acuity score in Case Management Medicaid â€Å"The term acuity score in case management stands for the levels into which patients are assigned depending on their health status† (Sparer, Brown & Cover, 1999). In Medicaid, a specified criterion is used to categorize patients into levels with point values called equity scores which very according to the life area that the condition of the patient is allocated to. The acuity score of the patient is assigned under two life areas. These are the basic and medical needs. Each one of the life areas has different levels with corresponding points or acuity scores (Sparer, Brown & Cover, 1999). According to Meade and Pope (2007), in Medicaid, the first level of the basic needs life area has one point and it includes various basic needs. These are sustenance items such as clothing and food. The Medicaid provides that the items in this level are made available through the means of the patient. The second level in the basic needs life area has an acuity score of 4 points. The needs in this level are for the sustenance of the patient. According to the provisions of the Medicaid program, the patient should be able to meet these needs with occasional assistance. â€Å"This means that emergence assistance is not required in this level. The assistance needed to perform the ADL by the patient who scores 4 points is usually weekly† (Meade & Pope, 2007). The third level of the basic needs life area is where the acuity score of the patient is six points. At this level, the patient requires