The Provision of Quality Medicaid Services - Essay Example

NURSING, A CASE STUDY Introduction The provision of quality Medicaid services is one of the core responsibilities of every government in each state. However, the high pace at which the cost of providing these services has been increasing has placed challenges in balancing the state budget. This therefore calls for the need of weighing the various options for lowering the costs of Medicaid services. The various options that can help achieve this objective includes convincing the legislature to assign more funds for the medical sector, cutting benefits to Medicaid recipients, cutting reimbursements to the health providers, placing a cap on the costs of pharmaceuticals, reducing fraud and abuse, imposing co-payments on Medicaid recipients among other ways. However, evaluation of these options is necessary since each strategy adopted will produce both positive as well as negative effects. Pros and cons of the various options Convincing the legislature to provide more funding to the Medicaid program is a good idea since the funds can easily be available from the consolidated fund. Another advantage is that the approach can help obtain the best results over a long time because of the high commitment of state officers to better implementation of the program. However, there is the big challenge of convincing legislators to accept the idea. The legislators have to understand the necessity of the idea and question whether there is another approach that can help achieve the objective without providing more funds. They will also need an explanation of how the funds will be used and failure to understand may lead to rejection. The legislature will also allocate funds depending on the economic status of the country. This means that unless there is significant growth in the economy the allocation is going to be lower than the value proposed by the officials of the state Medicaid sector (Snell, 2011). The other option is cutting the benefits received by Medicaid recipients that is a fast and rapid method of lowering the cost with minimum procedures required. The process of predetermining the effect of this approach is very easy since it is easy to calculate the amount of money that is going to reduce. However, this may result to low quality services and some individuals may not access medical care at all. The overall effect will be increased suffering and public outcry. This means that the approach will interfere with the major objective of the Medicaid program to provide care to all poor individuals in the country. The public will view this approach as an indication of failure by the state to offer Medicaid services to the poor (King, 2004). The other option that can help to lower the Medicaid costs is the idea of cutting the reimbursement to the healthcare providers. In addition, this good approach is fast to implement with the lowest costs. It is also easier to calculate the effect based on the number of these workers. This method has the advantage of not placing any additional pressure on the country’s economy since it involves reducing the costs without additional funding. On the other hand, the approach will lower the quality of services offered to the people in two ways. First, the healthcare providers will lose morale leading to reduced efficiency in their service delivery and in severe conditions; it may cause strikes and demonstrations. Secondly, healthcare providers may start quitting looking for more paying jobs. This means that at the end their number will be lower than that required to provide enough services to the people. Again, this may signify a failure by the state to offer quality services to the poor members of the society. The idea of placing a cup on the cost of pharmaceuticals is a direct means of reducing the Medicaid costs since it makes the costs of pharmaceuticals reachable to the population targeted. It will also minimize the pace at which the cost of pharmaceutical increases since suppliers will have to comply with the maximum amount set by the state. Suppliers will also make efforts of lowering the costs by adopting better methods of producing and distributing their products. The idea will also help in preventing an increase in the cost of pharmaceuticals during periods of high inflation. However, this may have a negative effect in the supply of pharmaceuticals since it will discourage suppliers because it may lead to a reduction in their profits. As a means of maintaining their price margin, suppliers may decide to lower the cost of production by reducing the quality of their products. This may lead to the availability of pharmaceuticals that do not adequately solve the required health problems. In addition, suppliers will have less revenue to conduct research and innovation (Latham, 2003). The other most important step in lowering the Medicaid cost is a reduction in fraud and abuse of the Medicaid resources. This is a very efficient approach because it results to an elimination of the unnecessary costs incurred in the implementation of the program. In this approach, the Medicaid costs can reduce without pumping any additional resources to the sector but thorough proper utilization of the available resources. However, according to Hyman (2001) the process is also costly as it entails strengthening investigation and enforcement rules in the sector. The process of investigation may also interfere with the normal functioning of the whole system. In addition, the process may reduce the freedom of Medicaid service providers in the name of micro-management. Therefore, the approach requires extra care and strict examination of the factors involved to avoid interfering with the process of service delivery to the society. The other approach for dealing with the problem of increasing Medicaid costs is the imposition of co-payments on the recipients of Medicaid services. This efficient method will enable the availability of more funds for the implementation of the program direct from the people. This approach will spread the burden of providing Medicaid services in the name of cost sharing between the organization and the public. However, it may deny service to the poorest members of the society who will not be capable of making the required payments. In addition, the method cannot work in conditions requiring the provision of emergency services (Harris, Stergachis & Ried, 1990; Kovner & Knickman, 2011). Another way of reducing the Medicaid cost is by introducing good prevention programs. This will have the impact of reducing the number of emergency visits to the Medicaid room. However, the approach requires heavy campaign in educating the public about the best means of preventing these problems. Arkansas can also reduce the costs by enhancing the utilization of electronic records to reduce the costs of record keeping, data collection and analysis among other functions. However, this may require the organization to cough additional funds in training its staff members. Finally, the organization can decide to focus only on the sickest people in desperate need of assistance. This will lower the number of recipients leading to a significant reduction in the cost but will also deny some people of the right of accessing Medicaid services. Conclusion Numerous methods can help in lowering the Medicaid costs in Arkansas to help balance the state budget. The major challenge is in the process of evaluating the effectiveness of each strategy based on both the positive and negative effects to the society. The best method selected should base on efficiency in the utilization of Medicaid resources in the state. The approach should not be one, which will deny the people from accessing Medicaid services that are very essential for survival and wellbeing. References Harris, B. L., Stergachis, A., & Ried, L. D. (1990). The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Medical Care, 907- 917. Hyman, D. A. (2001). Health care fraud and abuse: market change, social norms, and the trust “reposed in the workmen”. The Journal of legal studies, 30(S2), 531-567. King, M. (2004). Medicaid: A snapshot for state legislatures. Denver, CO: National Conference of State Legislatures. Kovner, A. & Knickman, J. (2011). Health Care Delivery in the United States, Tenth Edition. New York: Springer Publishing Company. Latham, S. R. (2003). Pharmaceutical Costs. Journal of Legal Medicine, 24(2), 141-173. Snell, R. K. (2011, April). State experiences with annual and biennial budgeting. In National Conference of State Legislatures. Read More