Finally I will discuss any weaknesses inherent in the healthcare accreditation process. I will use course provided material and personal research to make my case. Hospital Licensure, Certification and Accreditation Hospital accreditation is not the same as licensure or certification. Licensure is required to operate as a hospital and overseen by state government officials. Certification affords hospitals to participate in federally funded Medicare and Medicaid programs.
In this journal, I will be reflecting about how insurance companies, hospitals, and patients can use Cost-benefit analysis for sustaining a life. First and foremost, Insurance companies routinely use cost-benefit analysis in healthcare to set policies and decide whether to approve claims. Many companies have blanket policies on general treatments, to either approve or deny them. If the cost is unacceptably high and the benefit is marginal or low, the company may deny treatment. In the event of an appeal, it can perform a more rigorous analysis of the situation.
Module 1 Chapter 2 Case Interwest Healthcare Group Jennifer Rhoads Saint Leo University Module 1 Chapter 2 Case Interwest Healthcare Group The nonprofit Interwest Healthcare uses a management information system to track data pertaining to patient intake, treatment and release. Data contained in the management information system is used to compile data to analyze on treatment costs as well as to generate reports mandated by the federal government for providing funds to Interwest Healthcare. The chief financial officer, Vijay Singh, has convinced the chief executive officer, Cynthia Manzoni, that data entry errors by hospital administrators and staff members are a threat to validity of the management information system reports. Hospital employees believe that patient care requires employee attention and that while errors unfortunate, they are an inevitable side effect of hospital staff’s dedication to minimize the impact to patient care. Interwest Healthcare provides a good to the public.
Under this type of plan, a patient may see providers outside the plan, but the patient pays a higher portion of the fees: Preferred provider plan 12. Which of the following is mandatory for certain health professionals to practice in their field? Licensure 13. The National Practitioner Data Bank: Is accessible only to hospitals and health care plans 14. Licensure to practice medicine is done by: Each individual state 15.
3. Describe how U.S. health care is financed and the benefits and limitations of employer-sponsored health insurance, Medicare and Medicaid on delivery of health care services. 4. Locate and critically evaluate proposed and existing statutes, rules, and regulations which define the boundaries and nature of professional nursing practice. Guided Study: 1.
Socialized Medicine in America What is Socialized Medicine? And how do Americans benefit from this program? The American Heritage Dictionary (4th ed., 2002) defines socialized medicine as “a system for providing medical and hospital care for all at a nominal cost by means of government regulation.” This leaves room for considerable craftsmanship in the construction of socialist systems. Indeed existing socialized medical systems in, for example, Great Britain and Cuba conforms to this definition, but are far from monolithic. Basically Socialized Medical systems are designed to eliminate the insurance industry and marginalize profit while providing health care for all.
Social Factors Affecting the Delivery of Healthcare Social Factors Affecting the Delivery of Healthcare Access to care can be defined as the ability to obtain needed, affordable, convenient, acceptable, and effective person health services in a timely manner (Shi & Singh, 2010). In regards to the health care delivery system in America, one would be ignorant to believe that everybody has equal and parallel access and utilization of our health care system. Significant inequalities in health care and status exist across varying income groups, social classes, and ethnic groups. Due to these inequalities in health status, major challenges are facing the distribution of health care among certain groups, if not all, Americans. In order to improve the nation’s health and end the disproportion in health care to vulnerable populations, the social determinants of health must be addressed foremost in order to achieve an understanding of the issues that are affecting so many Americans and what must be done in the fight toward equality in the U.S. health care delivery system.
• Overview of the different Medicare and Medicaid services Medicare covers the services such as lab tests, surgeries, and doctor visits (CMS.gov). Supplies such as wheelchairs and walkers that are considered medically necessary are also covered (CMS.gov). Other services covered are the following: Hospital Care Skilled Nursing Facility Care Nursing home care (as long as custodial care isn’t the only care needed) Hospice Home health services (CMS.gov) Medicare health plans cover: • Medicare Cost Plans • Demonstrations/Pilot Programs • Programs of All-inclusive Care for the Elderly (PACE) • Medication Therapy Management (CMS.gov) Medicare coverage is based on 3 main factors (CMS.gov): 1. Federal and state laws (CMS.gov). 2.
Application: Characteristics of the U.S. Health Care Delivery System Harry Smith Jeanty Walden University MMHA-6100-2 U.S Healthcare Delivery System May 12, 2013 Introduction The main focus of this assignment is to describe some distinguishing characteristics such as “delivery and financing” of the United States health care delivery system, and to moreover describe and determine their involvements in the healthcare system. The United States healthcare delivery system can be best described as an inexactly composed system of parts that are intertwined. According to Shi and Singh (2008, p.4), “the system is like an instrument containing loose composed parts such as payments, financing, delivery, and insurance mechanisms that remain in the same place, but yet loosely joined”. The U.S healthcare system is an alliance of both private and governmental
Medicare operates with 3% overhead, non-profit insurance 16% overhead, and private (for-profit) insurance 26% overhead (Journal of American Medicine 2007.) The health care system in the United States is broken. Proposed fixes abound. But in order to fix the system successfully we must first understand how, why and where it's broken ( www.healthcareproblems.org March