Health Care Financing - Admission/Application Essay Example

Health Care Financing Affiliation: Health Care Financing There are two approaches of financing health care, that is government-financed and market-based approaches. The following questions will help go through the approaches and get a clear difference between them: 1. Who is provided access? a) In the government-financed approach; It is the state that provides health care to people. Every citizen of the nation has access for health care Treatment is based on important levels of care Patients pay for coverage via taxes as well as additional charges For example, the Medicare and Medicaid programs are financed by the government of United States. b) Under the system of market-based approach; The employers finance the health care of all their workers. It is only the workers and their children that have access to the health care The non-workers’ pay for their services or use their fund to buy the insurance for treatment The workers obtain treatment for free or at subsidized and affordable fee How much coverage is provided? In the market based system, the employer provides the coverage for prescribed drugs, rehabilitation, doctors’ services, mental health services and hospitalization. There are some employers recommend their workers to an affordable insurance cover for these services. In respect to government-financed health care, the government uses its programs to finance skilled nursing facility, durable medical care, home health care and hospice, patient care in hospitals. It also covers some of the preventive services to maintain people’s health and prevent certain sickness from getting worse. The Medicaid programs cover inpatient care, preventive care and eye care. How are the services paid? Normally, the payment for treatment is settled through paying a set fee for the service. The cost is subsidized and affordable to patients. Another form for paying treatment services provided is through reimbursement. Also, insurance cover may be taken and insurer pays for the services to the providers. For instance, to receive treatment under MCO patients pays a small amount of the fee and the managed care plan takes care of the rest. How does reimbursement apply? Reimbursement is the repayment for benefits of health care received. In this case, health care benefits are provided prior a payment for the service is made then the service provider request for reimbursement. In most cases, the reimbursement claims require the medical codes appointment to describe the diagnosis. Are there limitations on care? To keep the costs down, the health care financed by the government has put limitations on care provided to patients. It is because governments try to offer the most care required by many people at the lowest cost health care system. The incapability to afford the fee for the service may prevent some people to always visit healthcare. In addition education and language may be an obstacle to some people especially the immigrants who want to visit and acquire healthcare. In some cultures, people go for their spiritual and tradition methods first and resolve to visit a health care as a last resort if their conditions become worse. What guides care decisions for patients? Patients base their care decisions on accessibility of health care and the health literacy. The literate patients have the ability to evaluate and understand the health information. For example, the access to MD website helps literate patients by providing information regarding their health condition. Therefore, based on this information, patients can resolve to visit a health care (Askham.at al. 2008). What is the quality of the services? The life of any person is crucial. Therefore, saving it is the priority in all health care. It is in this respect that the quality of health care services is set to be safe, efficient, patient-centered, effective, equitable and timely as well as cost effective. Are there competitive options? In respect to competition, the market-based systems use the force of their competing companies to give the customer the best products. Therefore, an organization strives to give the best quality in all its activities including the health care services to improve its image and survive the competition. On the other hand, government-financed health care systems do not have the objectives for competition. The government uses other tools to maintain the health care expenses down although some of these tools hinder the progress of the medical services. How much are prevention and wellness emphasized? In 20th century, treatment could be administered when patients contracted diseases rather than putting emphasis on preventive care measures that could keep people safe from diseases. Fortunately, the trend changed in the21th century when the Affordable Care Act was passed. People are receiving free preventive services to keep and maintain their bodies safe from diseases. The health ministry is encouraging people to go for free preventive services at the health cares. Further, the government has advised the market-based health care to provide preventive care to its workers free of charge. Under the Medicare, health care law has added a free wellness annual visit to help people make use of the preventive care benefit. Also, insurers are required to cover some preventive screenings, under the Affordable Care Act, without harming the insured. How are health care costs managed and controlled? The control and management of costs of health care are done through having a cost managed care and cost sharing care. The two are found to control and manage the extra costs emanating from moral hazard. How are medical advances generated? When the government takes the initiative of financing the health care, medical advances are likely to suffer as opposed to health care financed by the company. The combination of controls for price budget ceilings and other price restrictions discourages the spending in medical research. As a result, there is a small effort to encourage innovations in government medical services. In the market-based approach, employers are willing to invest in the medical research to bring new developments to patients and doctors. Therefore, the numbers of health care innovations go up and help to improve the medical services. How is the health care reform established? The health care reform is an important health insurance plan of any country. The role federal government is to oversee the health care reform. The health care reform offers health care to any person who is not provided for by the coverage of the employer or Medicare. The reform institutes health insurance exchanges and the buyer protection. The most significant detail of this reform that the insurance carriers need to consider is the lifetime limits of each year, the elimination of rescissions as well as the removal of pre-existing conditions of all plans (Goodwin, .2010). The government-financed medical services are very cheap and affordable to patients as a treatment service is subsidized. Also, there are many benefits a patient can get from government-financed health care especially from Medicare and Medicaid programs. Further, the governmental hospitals have more medical facility and doctors than private ones. A patient can have any medical attention in one health care center. The table below shows advantages of market-based approach over government-financed approach. Table 1: advantages of market-based approach over government-financed approach Market-based approach Government-financed approach The health care innovations are more due to investing to medical research There is few health care innovation as few fund is allocated for medical research The company aims at attracting more customers and survive the completion. Therefore, more health programs are initiated without being eliminated To reduce health care cost, the government can abolish some of the critical programs such as childrens health insurance program. The patients can choose the provider of the medical service A patient cannot choose a doctor who would provide treatment There is a comprehensive coverage for doctors visit and procedures The governmental heath programs have little coverage for visit and procedures of doctors. Reference Askham, Janet Coulter, Angela & Parsons, Suzanne (2008) Where are the patients in decision-making about their own care? WHO Regional Office Denmark Retrieved March 22, 2013 retrieved from http://www.who.int/management/general/decisionmaking/WhereArePatientsinDecisionMaking.pdf Goodwin, .2010. Wayne Federal Health Care Reform Legislation Establishes Consumer Protections Health Insurance Exchanges http://www.ncmedicaljournal.com/wp- content/uploads/NCMJ/May-June-10/Goodwin.pdf Read More