The Health Care Needs - Assignment Example

Health Care Delivery Issues What are the health care needs (primary care (reducing risk factors), secondary care (screenings), tertiary care (reducing complications of disease) of the individuals at risk or identified with the disease/condition/problem? i. Primary care Postmenopausal women are often being advised to do regular exercise which can help them protect against cardiovascular disease and to a certain extent osteoporosis as well. Physical exercise also has a number of known mental health benefits. Proper nutrition along with the cessation of smoking will also reduce risk of cardiovascular disease. However, there is a possible breast cancer threat though (US Department of Labor. 2007). ii. Secondary care Hormone Replacement Therapy (HRT) - Physicians nowadays recommend that if hormone therapy were used, it should be in the form of a smallest but effective dose during the shortest time possible. Premenstrual Syndrome (PMS) – As for PMS psychological treatments are recommended where necessary. iii. Tertiary care Tertiary care involves reducing side effects such as stroke, cancer and osteoporosis. Doctors give strict advice on medicines and avoidance of unhealthy habits. 2. Are there any governmental agencies involved in the care of people with this disease/condition/problem? Which ones at the local (county) state, or national level? National level Local level The National Health and Medical Research Council (NHMRC) U.S. Preventive Services Task Force (USPSTF) National Association for Premenstrual Syndrome (NAPS) Agency for Healthcare Research and Quality (AHRQ) National Institutes of Health (NIH) American Academy of Family Physicians (AAFP) The National Osteoporosis Society) American Academy of Nurse Practitioners (AANP) American Academy of Pediatrics(AAP) 3. Is there mandatory reporting of this condition/problem? How is this problem tracked in the health care system? Yes, HRT/ Menopause/PMS are common complication among the elderly women. There is no mandatory reporting requirement for these symptoms; neither is there any compulsion on patients to report it to the health care system administrators. Thus the system administrators tackle the problem on the available knowledge of reported cases on an individual basis. 4. What health plans/groups provide care to people with this condition? Menopausal women are increasingly targeted by community health care and counseling groups with intervention plans that are based on surveys intended to measure exposure, breadth and personality metrics. Of course it’s necessary to organize public awareness programs to inform HRT users of more than 5 years about the slightly increased risk of breast cancer, heart disease, and stroke than are nonusers. Women need to be aware of having proper nutrition and regular exercise to avoid osteoporosis conditions (Parnaby, 2008). 5. Describe the types of care needed (see question 1—and expand-Hospital? Ambulatory? Emergency room? Physician, Drug/pharmacist, nurse?) Cardiovascular diseases require immediate treatment. Chemotherapy treatments are recommended for cancer and related symptoms. Physicians and nurses can help avoid osteoporosis symptoms. Special treatments of gynecologists are recommended for HRT (www.pega.com). 6. Describe the costs are associated with this condition (individual direct costs and societal indirect costs-missed work and school, lower productivity). Individual health insurance should be adequate enough to cover expenses. Social indirect cost- Women who are suffering from PMS and Menopause undergo symptoms like mood swings, difficult concentrating, memory lapses, allergies, bloating, weight gain, panic disorder and irregular heartbeat which affect productivity. Serious conditions of osteoporosis, cancer conditions and cardio vascular disease need long period of treatment which missed work and school (Stoppler, 2009). Thus their productivity might be the first casualty. Even the cost burden on the Medicare/Medicaid is social cost. 7. Describe how is health care paid/financed for this condition (are people with this condition in particular types of health plans or not?) The usual method is not different from the rest. In fact patients with menopausal condition and its implications go through the same Medicare/Medicaid Health Insurance coverage for such treatments (www.iom.edu). 8. Describe any potential problems in the health insurance coverage or payment of care for patients with this condition/problem. When people’s health insurance coverage is not adequate enough to receive treatments, they have to pay out of their own wallet. In this instance people might lose their faith in medical insurance system (www.PMScure.com). 9. Describe how someone in a managed care plan might be “managed” differently than someone receiving care in a fee-for-service health care system. (hint: it might help to make a table and list services provided in one versus the other and features of these 2 types of health plans) Fee-for-Service Managed Care Less cost effectiveness Doctors and hospitals are paid per service provided. There are no limits on treatment decisions, e.g. doctors and/or hospitals might order as many tests as they think are necessary. Cost effectiveness. These organizations can get lower prices from doctors and hospitals. They also reduce costs by limiting choice by providing members with a list of doctors from which to choose and lists of labs where tests can be obtained. Further doctors are provided with lists of medicines from which to choose. Benefit to the patient is less. For example, if a doctor over-charged a patient, but the insurance company didn’t agree the patient would have to pay the extra amount of money. Benefit to the patient is high. Managed care organizations would provide credit facilities. Further a fixed fee is usually charged. For example, a member might pay just $10 for every month and that amount doesnt change if the member comes in for many or none of the appointments during the month. A particular physician or doctor would not be responsible for the whole treatments. A single primary care physician is often responsible for the total care of a member. He may also act like a ‘gatekeeper’ to those additional medical services, through referrals. Healthcare delivery facilities aren’t available Healthcare delivery facilities available for benefit of the patient. For instance the whole community of nurses, physicians, therapists, pharmacists, and hospitals are all a part of the delivery system. 10. Describe any other health care organization and financing issues you expect might occur for individuals with this condition/problem. Patients with this condition might seek treatment through Medicare/Medicaid insurance plans at exclusively private individual practitioners (Harmer, 1999). However, there are many instances where patients with this condition have sought private health care services without such insurance. The net result is the patient ends up footing the whole bill. 11. Are there any issues where a Pharmacy Benefit Manager might be involved in this condition? Describe. The PBM is able to efficiently move patients to lower cost solutions by way of brand to generic drugs and from retail pharmacy sales to mail order services in a seamless, systematic manner (Heathfield, 1999). Thus he brings the low cost but right drugs to the patient who needs them. Now, there’s more that a PBM can do to improve people’s health, including focused specialty drug management, improving patient education and direct involvement and providing personal and effortless pharmacy services. 12. What primary (reducing Risk factors), secondary (screening) and tertiary (reducing complications of chronic disease) prevention is associated with this condition? Primary (reducing Risk factors) - providing effortless personalization and improve patient education and involvement (Kronenfield, 2006). Secondary (Screening) – improve patient education and involvement Tertiary- (reducing complications chronic disease) - Focused on appropriately use of prescribed drugs and improve patient education on this behalf. REFERENCES 1) United States Department of Labor. (2007). Health Care Industry Information. Retrieved February 25, 2010, from Employment & Training Administration (ETA) - U.S. Department of Labor, http://www.bls.gov/news.release/empsit.nr0.htm. 2) CMS Annual Statistics. (2009). United States Department of Health and Human Services. Retrieved February 25, 2010, from http://www.hhs.gov. 3) Insuring Americas Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science. Retrieved February 25, 2010, from http://www.iom.edu/. 4) 40,000 Deaths by “Wrong Diagnosis” Annually - And You Thought Your Doctor Diagnosed Your PMDD Correctly? Retrieved February 25, 2010, from www.PMScure.com. 5) Harmer, L. (1999). Health care delivery and deaf people: practice, problems, and recommendations for change. Journal Of Deaf Studies and Deaf Education, 4(2), 73-110. 6) Heathfield, H. (1999). Issues in the multi-disciplinary assessment of healthcare information systems. Information Technology & People, 12(3), 253-275. 7) Kronenfield, J. J. (2006). Access, Quality and Satisfaction: Three Critical Concepts in Health Services and Health Care Delivery. Research Sociology of Health Care.24, 3-14. 8) Parnaby, J. (2008). Seamless healthcare delivery systems. International Journal of Health care Quality Assurance, 21(3), 249-273. 9) Stoppler, MC. (2009). Menopause. Retrieved February 25, 2010, from http://www.medicinenet.com/menopause/article.htm. 10) PBMs need BPMS, Retrieved from February 25, 2010, http://www.pega.com/industries/healthcare/pharmacy.asp. Read More