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Healthcare Utilization and Finance - Essay Example

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Topic: Healthcare Utilization and Finance Student: Course: Date: Professor: Mrs. Zwick’s costs coverage Medicare Part A This part covers inpatient care but does not cover custodial care. According to Mrs. Zwick’s case, part A will take care of the bills pertaining to the initial three days of the five days that she was hospitalized for stroke treatment…
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Healthcare Utilization and Finance
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Healthcare Utilization and Finance

Download file to see previous pages... Medicare Part B Essentially, this part covers healthcare services that are not provided for in part A of the Medicare. In Mrs. Zwick’s case, the cost of the different diagnostic tests that she underwent during her hospital stay and time of rehabilitation would be paid for in this part. Medicare Part D This last option of insurance cover deals with payment of the cost of drugs that are prescribed during a hospital stay. The antibiotics that were prescribed during the initial hospital stay will be catered for here. Moreover, the medication that prescribed upon her discharge will be also paid and by extension the walker that she required to walk around. Medicare policies and Reimbursement of Additional Care The policy by Medicare not to pay additional costs emanating from hospital acquired infections means that these cases have to be HAC (hospital-acquired complications) in terms of high cost. This in turn means that a patient with such a problem would have to be assigned to payment of higher premiums to cover the whole cost. It is however predicated upon the premise that the complication was due to secondary diagnosis and could have been prevented through utilization of evidence based guidelines. These additional policies of Medicare on hospital acquired infections means that the hospital will not get reimbursement for them (McNair, Luft, & Bindman, 2009). For instance, the antibiotics that were prescribed to her and these drugs were for urinary tract infection (UTI). With UTI being one of the complications that are not catered for by Medicare, then Mrs. Zwick and her daughter would have to pay from their pockets. Ethical Implications for Incurring Costs Related To Her Hospital-Acquired Condition The ethical implication for costs that emanate from hospital acquired infections to the concerned patients is that they have to pay for the additional cost. This is regardless of whether the infection was due to negligence on the part of the hospital or the infection just arose spontaneously. In order for clients to be shielded from this, they are forced to pay more so that in the advent that the complications that occur due to a person being hospitalized may be reimbursed by Medicare. Such a proactive move is quite unfair to the payer and the extra charge is quite punitive bearing in mind that these infections are completely out of a payer’s control when they happen. Another ethical implication is that it has to be proved beyond doubt that the hospital acquired infections were not due to negligence on the part of a hospital. This may arduous and quite challenging and it takes time (Zhan, Friedman, Mosso & Pronovost, 2006). Scenario 2 Consolidated Omnibus Budget Reconciliation Act (COBRA) Since COBRA insurance was designed to cover for people who have lost their job due to legitimate reasons, the cover is usually paid by the former employer but it is not subsidized. It follows then that the payments for health coverage premiums are remitted by the former employer in full and an additional administrative cost of two percent. However, coverage is considered under group coverage which therefore means that the cost of the premiums is still low although they are slightly higher than when the employee was working. Many of the individuals that invoke the COBRA coverage usually have a big time difference between their last day at work and ...Download file to see next pagesRead More
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