Week Twelve 4/5/15 to 4/11/15: Health Care Financing

HCfinance

Health Care Financing

This week we will talk money and healthcare. The main concern regarding health care is what will something cost. Projections by the Congressional Budget Office (CBP) estimate that the total spending on healthcare will double by the year 2035; and will consume more than 30% of the gross domestic product (GDP) (Longest, 2012).

Medicare and Medicaid remain the biggest of the fiscal challenges for the United States (U.S.) (Longest, 2012). As stated in a previous posts, the Affordable Care Act (ACA) has created the Innovation Center (a segment of Medicare & Medicaid Services) in order to test new health care payment and service delivery models to improve quality of care; and decrease healthcare expenditures for Medicare & Medicaid beneficiaries (U.S. Department of Health & Human Services, n.d.). Currently, the Innovation Center is evaluating 18 major payment and service delivery models. Some of those models are as follows:

  • Partnership for Patients: Aims for 40% reductions in hospital acquired conditions; and a 20% reduction in readmissions.
  • Strong Start for Mothers and Newborns: Reduce risk of complications and long term healthcare problems for expectant mothers and newborns (U.S. Department of Health & Human Services, n.d.).

Financing and Death with Dignity

Death with Dignity participants will never receive federal monies to pay for lethal prescriptions. In Oregon, the Death With Dignity Act does not specify who pays for the services; and payment is determined upon individual insurers. Insurance companies cannot view lethal prescriptions as a suicidal act during the decision phase of payment (Oregon Public Health Division). If Medicaid is the insurer, only state funds can be utilized (Oregon Public Health Division, 2014).

Financing and End-of-Life

A saving grace for people seeking some form of comfort care at end-of-life is that Medicare Part A does pay for hospice services. The requirement for hospice services include:

  • Two physicians (e.g., following and a hospice physician) confirming a terminal diagnosis (6 months or less)
  • Agreement to accept comfort vs. aggressive treatments
  • Patient (or MPOA) signature providing consent to hospice services

It must be stated that the ACA is now allowing that patients under 21 years of age can seek curative (aggressive) treatments while in a hospice program without the worry of being discharged or paying out-of-pocket for hospice services (Medicaid.gov, n.d.).

Final thoughts on Healthcare and Financing

According to the World Health Organization the goal is for universal health coverage to ensure that all people of the world have the health services they need without suffering financial hardship (WHO, 2015). Some staggering statistics provided by WHO:

  • One billion people cannot receive needed health services
  • 150 million people suffer financial catastrophe upon receiving health services
  • 100 million people are pushed below poverty line upon receiving health services (WHO, 2015).

Please watch this eye-opening video about financing health care. What are your opinions about health care and financing?

http:////www.youtube.com/watch?v=ozcRK688GMs

References

Centers for Medicare & Medicaid Services (n.d.). About the CMS innovation center. Retrieved from http://innovation.cms.gov/about/index.html

Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Medicaid.gov (n.d.). Hospice benefits. Retrieved from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/hospice-benefits.html

Oregon Public Health Division (2014). FAQs about Death with Dignity Act. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf

United States Department of Health and Human Services (n.d.). HHS FY2015 budget in brief. Retrieved from http://www.hhs.gov/budget/fy2015-hhs-budget-in-brief/hhs-fy2015budget-in-brief-cms-innovation-programs.html

World Health Organization (2011, July 6). WHO: Financing health care. Retrieved from https://www.youtube.com/watch?v=ozcRK688GMs

World Health Organization (2015). Universal health coverage. Retrieved from http://www.who.int/mediacentre/factsheets/fs395/en/

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4 thoughts on “Week Twelve 4/5/15 to 4/11/15: Health Care Financing

  1. mcivic2015

    For such a controversial topic, I had never considered who reimbursed for the payment of these services. It seems astonishing to me that insurance and medicaid will pay for hospice services and prolonging a life if the insured person would rather choose to die from lethal prescription. I am not passing judgement on what is right and wrong, but wonder if the ethical and legal implications of paying for a lethal prescriptions is too much of a concern for insurance companies to cover dying with dignity.

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  2. herendirav

    Leslie,
    I really like your opening statement this week, “The main concern regarding health care is what will something cost.” I can’t tell you how many times I have had patients/family members tell me about situations they have been in that warranted medical treatment, yet they were adamant to seek help, due to the costs associated with medical care. I think that additional efforts are needed in the community to properly educate patients on the importance/ value of preventative care. Preventative care can help decrease risks of chronic illness, which can lead to higher healthcare associated costs. According to the CDC (2013), Americans use preventive services at about half the recommended rate. This may be why potentially preventable chronic diseases (heart disease, cancer, diabetes) are responsible for millions of premature deaths among Americans every year. The ACA has made many of these preventative services much more accessible to patients, by requiring private health plans cover some of these recommended screenings without a deductible, but are patients aware of these changes? I think that the use of running a national media campaign on preventative care, would help reach some of these individuals that are weary of seeking care due to financial hardships.

    Reference
    Centers for Disease Control and Prevention. (2013). Preventative Health Care. Retrieved from http://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/preventivehealth.html

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  3. SHEllis

    First, your closing statistics are astounding. It is unbelievable how many individuals do not have access to affordable and quality healthcare. For me, the right to healthcare seems like such a basic and inevitable right, yet there are so many disparities impacting access both in America and across the globe.

    Second, I am so glad you included information about the Affordable Care Act allowing pediatric patients to seek curative treatments while enrolled in hospice. As a pediatric oncology nurse, I have been indirectly involved with palliative care consultations and referrals for at home and inpatient hospice programs. Recently, I had a young patient admitted to a hospice program, but his parents were still able to bring him to our clinic for routine platelet transfusions. I found myself wondering about how this was allowed because hospice usually requires patients to forego aggressive measures as you indicated. Of course, nor my colleagues or I minded, as a death related to a platelet count of less than ten thousand certainly was not what we wanted for this patient. You answered my question, so thank you for that!

    In these situations, there is no cut and dry solution, which is why I think it important to allow competent adults the opportunity to choose death with dignity. None of us know how we would react in such situations. I think as more states adopt Death with Dignity laws, increased insurance reform will likely follow, increasing its availability to Americans.

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