An essay on the rising health care costs associated with moral hazard and why, despite some skepticism, consumer driven healthplans (CDHP) can provide a solution.
Abstract The paper discusses Consumer Driven HealthPlans (CDHP) and how these plans can reduce medical spending. The paper examines the rising cost of health care and how health insurers have developed new and innovative ways of dealing with the ever pressing issue moral hazard has had on overall medical spending. The paper further analyzes how through consumer driven healthplans, health insurers hope to encourage more conservative and responsible consumerism as patients are forced to pay higher out of pocket costs for medical services.
From the Paper "Year after year, as the cost of health care continues to rise and the American public's frustration continues to grow, those with influence over the market have begun to offer new and innovative solutions in the hopes of curbing the ever rising prices a broken system has helped to create. In a flawed design where everyone but the consumer is picking up the tab - the employers, health insurers, and government, it's of no surprise that Americans have been more than indulgent in their consumption of medical services. Unfortunately, this careless consumption, driven by moral hazard, is what continues to drive the overall cost of health care up at a rate of inflation higher than that of other goods and services. Now, in an effort to reduce the most costly of effects attributing to the rising cost of medical services, health insurers have focused on reducing moral hazard through the introduction of consumer driven health plans (CDHP)."
Abstract The purpose of this paper is to analyze how and why a national healthplan should be introduced in the United States. Health care in the United States is a big business. As such, a national healthplan threatens the bottom lines of gigantic health maintenance organizations who have fought national health care consistently. They fight a plan that could cause their demise, but ensure the increased health and well being of millions of Americans. The paper argues that it is time we stopped letting big business set the agenda for the health of the American people.
From the Paper "However, there were many proponents to the plan. Some experts felt the plan was not comprehensive enough, and did not cover enough basic, preventative health care. For example, the plan did not cover some areas of mental health treatment, such as alcoholism. Others felt it should not be affiliated at all with health insurance plans. Then there were the social implications of including such treatments as abortion, physician assisted suicide, and euthanasia in the areas of treatment. All of these concerns were eventually answered, but they raised questions in the minds of the public that were never quite eliminated."
Abstract This paper involves the content analysis of the website for the Community HealthPlan of Washington (CPHW) and a seminal article in its newsletter, which aims to determine how dedicated the CPHW is to providing healthcare for the underprivileged. It examines in detail what necessary policies and general messages are mentioned by the healthplan with regards to uninsured and underinsured populations. The paper comes to the conclusion that CHPW is not a typical profit-maximizing firm in that it was willing to compromise profits to some extent in order to embrace the needs of this population.
Table of Contents:
Introduction
The Website and Newsletter: Measurement and Coding
The Uninsured and Underinsured for CHPW: Demographics, Needs and Health Practices
Who are the Uninsured/Underinsured?
Trends in Utilization Patterns: Predictions from the Content Analysis
Financial Impact of the Insured/Underinsured Population for CHPW
Why Does CHPW Embrace this Organizational Culture?
Conclusion
From the Paper "Since the uninsured and underinsured population is less likely to receive preventative care, the forecasted trends include higher mortality rates and increased hospitalization for avoidable health problems. This may further increase the cost of healthcare, which creates the 'vicious cycle of increasing healthcare costs' for CHPW divisions.
"There is also the general expectation that the at-risk population will increase their enrollment in the government aided programs that provide healthcare coverage at little or no cost-sharing. Currently, these programs like Medicaid are not at their maximum potential and are expected to have increase enrollment, when the uninsured and underinsured population for CHPW realize that they can qualify and access healthcare."
Tags: content, analysis, community, health, plan, Washington
Abstract Stakeholders in the U.S. health care system include private and public purchasers of healthplans, physicians, hospitals, clinics, healthplans, consumers, and public health programs. Each stakeholder wants quick access to information for a variety of reasons. The paper shows that, in light of these important issues, information systems in the health care environment is no longer a luxury; it is a necessity. The paper examines the benefits as well as the disadvantages of the health care industry's move towards dependence on IS. It also presents information on proposed legislation to protect medical records and patient confidentiality.
From the Paper "The intertwined issues of security, privacy, and confidentiality have drawn increased attention to and public unease with the growing use of technology in health care. In 1996, HIPAA mandates included the enactment of federal laws and regulations against unauthorized access to electronically stored or transmitted patient records and misuse of personal health information. These new security standards were designed to protect all electronic health information from improper access, alteration, or loss. The proposed regulations include technical guidance and administrative requirements for those who use, maintain, or transmit electronic health information."
Tags: JCAHO, Health, Insurance, Portability, Accountability, Act, AIDS
Abstract This paper first addresses the problem of teen pregnancy and then proposes establishing a community that provides support and education to pregnant teens and teens already with children. Next, the paper discusses the four basic elements of social marketing. The paper also examines the measurable outcomes of the program and describes evaluation strategies for determining the success of the program in achieving its goals.
Table of Contents:
Community Health Social Marketing Program
Overview of Community of HealthPlan Formative and Summative Evaluation Strategies
Reasoning for Evaluation Methodologies
Impact of Project Success on Public Health Policy
Conclusion
References
From the Paper "Social marketing in the community refers that for adequate contraceptive behavior to occur, teenagers must first recognize that they risk becoming pregnant if they have intercourse and do not use contraceptive properly. Also important is the teenager's knowledge or perception concerning pregnancy risk. The teenage perception is a result why some teenagers do not use contraception. Teenagers must have the ability to generate ways in which they can reduce their risk of pregnancy such as contraceptive methods. Social marketers is expected to determine and maximize the most effective ways in which to heighten teenagers' personal perception of pregnancy risk, their understanding of the potential consequences of an unplanned pregnancy, and their awareness of available contraceptive methods. A social marketing objective is to promote discussions on contraceptive issues and a sense of shared responsibility among partners."
Tags: nursing, community health, teen pregnancy, sex
Abstract This paper explains that the U.S. health insurance industry is a faltering system as witnessed by poor performance, difficulty accessing physicians and rising premiums that cut into after-tax income. The author compares two healthplans in Texas: Aetna Life Insurance Company's PPO 500 plan, which is judged better for a younger workforce that is predominantly unmarried and without children, and Blue Cross and Blue Shield of Texas' PPO Select Saver Plan IV Blue Cross plan, which is deemed a better arrangement for an older, "graying" workforce. The paper evaluates the Health Insurance Portability and Accountability Act (HIPAA), which is generally seen as a watershed event for health insurance reform.
Table of Contents:
Introduction
The U.S. Health Care Industry over the Last 10 Years
The U.S. v. Canadian Approach to Health Care
Development of Managed Medicare Insurance Products in Texas
A Comparison of Two HealthPlans in Texas
A Plan for Managed Care Organization Seeking Accreditation from JCAHO or NCQA
The Health Insurance Portability and Accountability Act (HIPAA)
A Plan for Comprehensive Improvement of a Managed Care Organization's Processes
Conclusions
From the Paper "In fairness, the U.S. model has its advantages. For one thing, wealthier individuals/employees who wish to "cut through" the bureaucratic red-tape of socialized medicine in Canada can go to the United States and have their needs promptly addressed in a way not possible in Canada. Moreover, from a strictly business perspective, the fact that American HMOs are prepared to exclude various clientele in order to serve the "bottom line" and are likewise prepared to similarly slash services can be just the excuse private American corporations need in order to exclude various members of their workforce."
Abstract The paper defines what smog is and explains that it is often found in large urban areas. The writer breaks down and explains the chemical components of smog and its effects on health and the environment. The paper summarizes the Ontario Smog Plan and discusses whether it will work to reduce smog significantly. The writer suggests some tips that citizens can follow in order to contribute to the goals of the Ontario Plan. In conclusion, the writer states that, although not perfect, the plan is a step in the right direction and that hopefully, with community participation and clever fine-tuning, the Canadian city's plan will become a model for future environmental efforts around the world.
Table of Contents:
Emission Sources
- NOx emissions
- VOCs
- Ambient Air Levels (ground-level ozone)
- Human Health Effects
- Environmental Effects
Particulate Matter (PM)
- Ambient Air Levels of PM
- Human Health Effects
Environmental and Other Impacts
Ontario's Plan - Goal
Transportation
1. Drive Clean (MOE)
2. Gasoline Formulas (MOE)
3. Green Fleets (Toronto)
4. Anti-Idling Bylaw (Toronto)
Particulate Matter
5. PM10 Standard (MOE)
Industry
6. Stewardship Initiatives
State of the Environment Reporting
7. Air Quality Monitoring (MOE)
The Targets
- Transit
- Coal Fired Electric Plants
- Transboundary Air Pollution (Canada/U.S.)
- Sulphur in Fuels
Tips for contributing to the goals of the Ontario HealthPlan - Getting Around
- Around the Home
- Shopping
- Community
Bibliography
From the Paper "Human Health Effects. Research in the US and Canada has repeatedly documented a strong correlation between high ozone levels and rates of hospitalization and worker absenteeism. Ontario studies have shown that in the months May to August, approximately five per cent of daily respiratory hospital admissions are associated with ozone. Other findings have shown hospital admissions linked to ozone occurring at levels well below the current national air quality objective of 82 ppb, with the probability and severity of health effects increasing with increasing exposure. Furthermore, it appears that there is no human health threshold for ozone, that is, there is no level that can be deemed safe. Populations more sensitive to ozone exposure include young children, the elderly, people with respiratory problems, and people active outdoors, particularly in the summer.
Impacts on human health related to high ozone levels are summarized below:
? respiratory system:
? lung functioning (coughing, shortness of breath, pain on inspiration, throat irritation, wheezing, chest tightness);
? chronic and acute bronchitis, asthma; and
? pulmonary emphysema;
? possible interference with the immune system; and
? headaches, burning eyes, irritated sinuses."
Abstract This paper presents a letter to Senator Hillary Clinton as a candidate for president regarding a proposal for a single-payer plan for American health care. The letter discusses the problems with the plan. The paper then continues to provide the facts about health care in the United States and discusses the possible implications of a single-payer plan in the United States.
Table of Contents:
Letter to Senator Clinton
The Facts about Healthcare
From the Paper "While it is true there are frustrating delays in terms of accessing care in the United Kingdom, Canada, and other nations with single-payer nations, it is also worthy of reflection that both anecdotally and statistically, Americans must wait for a long time, for approval for payment from their insurance companies for procedures, and in the waiting rooms of many Emergency Rooms that are filled to the brim of individuals who use the facility as a site of primary care, because they cannot afford a regular physician. Americans may even find their coverage denied after the fact, if their condition is deemed a 'preexisting' condition not covered by the insurance policy they possess."
Abstract The paper discusses a plan to create a national health insurance system. This system would have a reasonable but sufficiently high co-payment to instill responsibility and would be means-tested so as to protect the truly poor and assure that they get the health care they need. The paper examines the issues of developing a national health insurance system and compares the health care that is provided in the United States with other countries that already offer some form of national health insurance. The proposed plan would avoid some of the problems people fear might develop while offering the benefits people need.
From the Paper "In the effort to make the individual exhibit greater responsibility for his or her own health and so to promote more preventive care, the only system that has a good chance of working on a national basis is a form of national health insurance. HMOs work to minimize costs and to reduce overuse of the health care system, but the emphasis is on denying service and denying expensive procedures, many of which are badly needed and which can create higher future costs when denied in a timely manner. A national health insurance system with a reasonable but sufficiently high co-payment to instill responsibility, means-tested so as to protect the truly poor and assure that they get the health care they need is the best approach. Other countries already provide some form of national health insurance and manage to do so at a lower cost than the U.S. ...."
Abstract This paper will take a detailed look at the 1993 healthplan and concentrate on the effects it had on the insurance industry. The prevailing sentiment among insurance companies was that the 1993 was unequivocally 'bad' for their business. After six years of lobbying and the application of economic pressure, insurance companies feel that the 1999 reforms are a step in the right direction after the botch-job launched in 1993. In brief, the paper will show what happened in 1993, how health care changed as a result of the 1993 plan, how insurance companies reacted to the plan, whether or not insurance companies acted rationally (i.e., is there economic support for their negative reaction?), and how the present situation meshes with the insurance companies' recommendations for change. .
Abstract This paper discusses how the company, "Pro-Fit", offers an employee wellness program for companies wishing to provide their staff with the option of health and fitness centers. It states that the health of the employee involves all aspects of employee life, including their physical, mental, and spiritual health. A healthy employee is an asset to the company because he or she provides many positive aspects to the work environment. This paper discusses the importance of an Employee Wellness Program and how "Pro-Fit" fulfills this niche in the business world. Includes a total business plan of this company.
Mission Statement
Objectives
Goals
Customer Needs and Rationale
Proposal Plan of Action
Action List
Key Personnel
Marketing Plan Proposed Operating Budget
From the Paper "The benefits of an Employee Wellness Program are numerous and many companies and government agencies are now beginning to provide these programs as a part of their benefit package. There is an ever-growing demand for these services. It is the mission of Pro-fit to fill the needs of companies in offering guidance and consultation in the provision of employee wellness programs. The Pro-fit Company will offer companies a number of options tailored to their business needs that will help them to optimize employee health and ultimately increase their profitability."
Abstract This paper explains that there is an urgent need for quality home care that exceeds the minimum expectations of patients and their families. The author points out that there is a dearth of data relating to the specific training, planning, and placing advanced practice nursing talent in home health care situations. The paper suggests that the medical staff train the advanced practice nurses in home care, and they, in turn, will teach families how to give good care to their loved ones.
Table of Contents
Introduction
Identification of the Phenomenon.
Review of Literature
Relevant Literature Appropriate for The Qualitative Study Planned Integrating Advanced Practices Nurses into Home Care Environments
Effects of a Relationship-Enhancing Program of Care on Outcomes
Validity and Community-Health Nursing Sensitivity of Six Outcomes for Community Health Nursing with Older Clients
Review: Prenatal Home Visitation by Nurses through Infancy
Effect of Prenatal and Infancy Home Visitation
Home Health Care: Improving Quality, Tightening Standards
A Case Study in Care: APRN Home Nursing Service
A Practical Guide to Caring for Caregivers
From the Paper "After all, NPs have a ?proven efficacy in health promotion, early identification and prevention of complications,? as well as patient compliance and education ? so, it is a logical argument to bring advanced practice nurses into the home care environment, and in order to plan for the future, more specifically targeted nursing teaching programs are proposed as a solid strategy for integrating primary care by NPs into the home care genre. The growth of home care services was tremendous between 1988 and 1995, as the number of Medicare home health visits jumped from 37 million to 252 million. Money spend through Medicare home health care visits also leaped during that period ? from $2.1 billion to about $16 billion, which is the fastest-growing budget item in Medicare."
Abstract This twelve-page graduate-level research paper discusses, compares, and contrasts Governor George W. Bush's and Vice-President Al Gore's proposed health care plans. The discussion covers various current issues in health care including Medicare, prescription drugs, and universal health care coverage for all Americans.
This paper discusses the impact Health Information Portability Accounting Act (HIPPA) has had on employers and on the confidentiality of health information.
Abstract This paper explains that the Health Information Portability Accounting Act (HIPAA) creates federally mandated requirements regarding protected health information (PHI) that can impact any employer, regardless of its size, location or industry. The author points out that employers who sponsor group healthplans are affected depending on whether the employer (1) is fully insured or self-insured and (2) creates or receives Protected Health Information, defined to include all individually identifiable health information held or transmitted by a covered entity or business associate electronically or in other forms with the exceptions (a) that the Privacy Rules do not apply to employment records, including medical information employers use to comply with various disability laws, such as American Disabilities Act (ADA), and workers' compensation, or to administer workplace disability policies or substance abuse rules and (b) health information useful to the employer in administering their healthplan. The paper relates that the act allows adolescents access to confidential care for contraception and sexually transmitted diseases and other services.
Table of Contents
Introduction
HIPPA Privacy Rules
HIPPA Compliance and Employers
HIPPA and Consumers
From the Paper "In connection with implementing a compliance program, group health plans are exempt from these requirements if they provide health benefits solely through an insurance contract with a health insurance issuer or an HMO and they do not create or receive PHI except for summary health information, or information regarding the status of an individual's enrollment, or disenrollment from the HMO or health insurance issuer. It is important to note that employers must consider their activities not only in the context of use and disclosure of PHI between the group health plan and the plan sponsor, but also in the context of any disclosures of PHI to a third party. A disclosure from the group health plan to a third party administrator would require adequate assurances of confidentiality, and would require a business associate agreement under the Privacy Rule before PHI could be disclosed."
Abstract This paper presents an aging plan for an adult approaching retirement age, focusing on the advance planning needed to be financially secure and legally protected while aging. The paper covers the following pertinent topics: financial planning for adequate income, legal documentation for estate protection, legal documentation for healthcare and end-of-life decision making, health related expenses, housing, assistance and care. The paper includes a conclusion about what a baby boomer nearing retirement needs to plan for.
Tags: Older adilt, retirement, pensions, 401k, social security, SSI, health care, medicare, medicaid, estate planning, trusts, executor, end of life decisions
