The modern healthcare sector remains one of the most important aspects of the evolution of our society. The fact is that the health of the nation depends on the efficient functioning of the given sphere and its ability to provide care to all individuals who have need for it. However, the peculiarities of the modern healthcare, medicines, technologies used to examine patients and diagnose illnesses, precondition the extremely high price for certain services. In this regard, the question of reimbursement becomes extremely topical for the healthcare sector as there are numerous attempts to improve the existing approach and attain lower prices along with better results. Anyhow, the current system peculiar to the USA could be considered extremely …show more content…
The given system is imperfect; however, there is still no other alternative for care providers to obtain money. For this reason, the following patterns could be used. For instance, in case a patient has a medical insurance, a care provided will be paid by the company that cooperates with an individual and guarantees that in case some medical problem appears, funds will be transferred to a medical care unit to assure that the needed treatment will be initiated. Moreover, when a patient falls into a certain category that gives a right to use medical benefits, all spending should be covered by the government that is responsible for the introduction of such special conditions for people with different problems ("Hospital health care payment mechanisms," n.d.). Finally, a person might pay by himself/herself; however, it is the rarest way to pay care providers as traditionally the sum is …show more content…
The fact is that very often the question of payment and reimbursement comes along with ethical concerns. In case a patient is not able to afford treatment, he/she could be deprived of an opportunity to obtain care. For this reason, an ethical dilemma appears ("Healthcare reimbursement & changing rules," n.d.). Thus, a nurse manager always works close to patients aligning cooperation with them and determining their main needs. At the same time, this specialist is also responsible for determining the payment model that could be chosen to pay caregivers and guarantee that treatment will be initiated. In this regard, they should be ready to consider the most appropriate way of reimbursement and whether a patient could use it or not. The given task is very important for the functioning of any healthcare unit as it guarantees that funds needed for its further development will be
This implies patients and their families should pay for convenience, travel costs, parking, day care and loss of
Based on the information provided determine the priority order in which the clients should be seen and the reasoning behind the nurse’s
Steven Brill’s Bitter Pill: “Why Medical Bills Are Killing Us,” by Angelina Salikhbaeva Summary: Steven Brill in the article “Bitter Pill: Why Medical Bills Are Killing Us” clarifies his opinion about the costs of healthcare services in the United States. The author writes about different stories of how families become bankrupt or unable to pay the total cost of the treatment to the US hospitals and related medical facilities. According to Steven Brill’s article, the US hospitals prescribe too much health care to patients.
Did you realize that as per the Agency for Healthcare Research and Quality around 700,000 to1 million patients fall in hospitals each year. 11,000 of these falls result in death. This increases hospital costs to more than $14,000 extra dollars and the patient’s length of stay is increased by an extra 6 days. This is considered a hospital acquired condition. Medicare and Medicaid do not reimburse hospitals for this!
For this paper, there are 2 interviews required that are related to the nursing careers. The two interviews that were conducted were from a Charge Nurse, and from a Head Nurse. Each of the interviews are discussed in detail below, separately. The charge nurse is a person who has the duty of a specific department in a healthcare institution for their assigned shift.
Discuss the ethical implications of “medical necessity” in patient care. Ethical Implications of Medical Necessity When it comes to medical necessity can often refers to the determination that is made for the insurance purposes. For example, If the patient has a condition that is chronic or terminal, the treatment could be considered medically necessary whether then the patient can afford the treatment or not. Networked doctors may face ethical dilemmas when recommending treatment or specialist referrals. When it comes to medical necessities it can be controversial, it can be the use of marijuana when there can be others that are more a moral ethical in which it can be in manage care and network providers.
Health care in Canada is delivered through a publicly funded health care system, meaning that the financing of the system is designed to meet the cost of all or most of the health care needs from a publicly managed fund. Health care in Canada is funded at both the provincial and federal levels. The financing of health care is provided through taxation from personal and corporate income taxes. Some provinces also use sources such as sales tax and lottery proceeds (Allin).
Our position in the market will be a full-service medical reimbursement business with individual pricing. As stated previously, our goal is one-stop shopping for medical practices when it comes to administrative functions. Reliance Medical Management, LLC Electronic Claims Service 's policy is to customize our charges based on the work we do, and the needs of each office. We find that each practice is unique and, therefore, we do not quote a "standard charge" for services.
Two-Tier health care system would benefit Canadians because it would be more efficient, retain doctors and shorten the wait time. Chernomas’ magazine provides information about the Canadian health system that is authorized by the Canada Health Act(CHA) that controls 3 subsectors, administration, hospitals and physicians. The overall economy is stable with the shares of the hospital and physician cost but the share of the health care cost are increasing and the “public” subsectors have a decline in the shares that they spend on health care. The increase in of health care expenditures is due to the private-for-profit sector that is outside the scope of the public system. The use of health care is questionable because of many new and expensive drugs and the decline in inpatients in Canada.
Relevant legal and ethical considerations, focusing on the 4 main ethical principles and how each of these apply to this case using research evidence. Focusing on the ethical theory of Beauchamp and Childress, it is considered one of the most fundamental elements for beginning a discussion in the Not for resuscitation (NFR) debate. (Fornari, 2015). The four main ethical principles, autonomy, non-maleficence, beneficence and justice hold the grounding block for issues of this nature. End of life care is an imperative characteristic of acute stroke nursing, as stroke mortality rates remain high, regardless of enhancements in the health care industry.
The healthcare system of Australia can be defined as a multi-faceted network of several different parties, including private and public providers, services, participants, and supporting mechanism. There are four types of healthcare institutions in Australia. The first type of healthcare institution is Clinic, which is usually small. They can vary in size but typically provides fifty up to five hundred beds for their patients. These kinds of hospitals cover the healthcare needs such as routine medical and surgical problems.
One of the dominant factors that could motivate intervention in healthcare by the government is equity factor. This factor is being boosted through the implementation of user fee system. The user fee system tends to promote equity through price discrimination, that is, charge the poor less than the rich for a given health service or product. Obviously, price discrimination contributes to the market failure had been seen as an economic rationale to encourage
In palpable markets, information is often not only difficult to come by but also restricted by those who hold power – and locating this “equilibrium” price is an arduous if not impossible task. The market for medical services may best exemplify this. In the medical market, prices vary depending on one’s HMO, whether they have insurance or not, and the facility performing the service – among other factors. Even if one could find the theorized “equilibrium” price for a medical service by painstakingly extracting all pricing information. One must ask if the same service is being provided at that given price?
Health care cost has seen to increase gradually as years go by. This has been influenced by major factors such as political influence, emerging chronic diseases, new procedures that are coming up including the technologies being invented for treating illnesses, pricing of medicines and treatment is not regulated and when treating ailment their may arise repetition of tests or a patient gets over treated for a particular ailment. The cost of healthcare has increased due to chronic diseases such as cancer and diabetes etc. The lifestyle people are living in this generation has led to the development of diseases that are expensive to treat or has led to there being over treatment in such for a cure of a particular ailment.
Julian is able to recognize which patients, and which of the three divisions: gastroenterology, cardiology, and oncology is using more of a variety of resources, since some patients do require more medication, lab work, and therapeutic treatment, based on the patient’s diagnoses. The information from the third system will provide Dr. Julian the ability to recognize and distinguish that not all patients require the same amount of care, some patients due to their diagnosis require different level of nursing care, some more than others. With this third approach Dr. Julian will be able to have a more precise cost of care service given to the different patients based on their necessities. The information provided by both second and third system will provide Dr. Julian with a more efficient way to control costs. She will now able to see the differences in costs among the divisions using the second and third approach.