Healthcare Utilization and Finance Essays - Health, Personal Life

Healthcare Utilization and Finance Amara Smallcombe In healthcare today, it is very important that healthcare providers, especially nurses, have an understanding of the matters pertaining to healthcare financi ng . Knowing and understanding each of these policies and all involved which affect essential delivery of healthcare puts the nurse in a better position to advocate for the patient and their family so that each of their healthcare needs may be met . It was once said that America was the greatest country in the world, but in comparison in healthcare, does this still reign true? Because we live and work here in the U.S., we know and understand our healthcare system a little bit more, but does that mean it's better than other countries? Let's compare, for example, Great Britain. A2. Access In America, healthcare is looked upon as a privilege and not a basic human right. Everyone in the U.S. is responsible for their own healthcare coverage. For those who have jobs, usually the employer pays a portion of the coverage and the rest is left to the individual. For those whom do not fall into this category: children, unemployed, and retired, differe nt programs are available through funding from taxes . For children, if their parents are within a certain wage bracket, they are eligible to receive assistance through Medicaid, CHIPS, and even other programs aimed at preventative measures, such as WIC. Unemployed adults may also receive Medicaid without the assistance of the other programs, but, may also receive assistance to purchase healthy foods to maintain heath. For retired persons, programs such as Social Security and Medicare provide healthcare options. Through these programs, most medications are paid for, however, it is at the discretion of these progra ms what will be paid for, i.e. brand name vs. generic. Access of care through the ER is surprisingly speedy with an average wait time of 58mins. But, if an emergency situation is not what is being experienced, the average time it takes to get in to see a primary care physician (PCP) is 19.5 days. (AIMS, 2015) This information is important because if further assessment is necessary and a specialist must get involved, a special referral from the PCP is required. After obtaining the referral, another waiting period on average of 16.8 to 28.8 days may be implemented. (AIMS, 2015) In reality, just to get in to see a specialist may take as long as 48.3 days. Prior to January 1, 2014, anyone with a pre-existing health con dition could be denied coverage for that condition or any thing relating to such . After the implementation of Obamacare, this statute was reversed. It is now the law that " health insurance companies can't refuse to cover you or charge you more j ust because you have a "pre-existing condition" that is, a health problem you had before the date that new health coverage starts. They also can't charge women more than men. " ( HHS, 2016) It is no secret that healthcare reform needs consideration. In comparison with America, Great Britain does not see healthcare in the same light. " The British National Healthcare System is a social insurance system that operates on the belief that healthcare is a right, not a privilege. " (AIMS, 2015) Their system is similar to our Social Security and Medicaid here in the U.S. whereas everyone pays into it and everyone receives treatment, no one is turned away. Services are "free" for all at the time it is rendered and is paid for through taxation. (AIMS, 2015) This system is publicly funded and each of the healthcare workers are considered public servants. The coverage is the same whether you are a child/ adult, employed/ unemployed, or retired. Because of this, the citizens of Great Britain pay about 9% of their gross income, which is 4% greater than the average cost of American health coverage. The only way to be able to see a specialist is also by referral. To do this the general practitioner (GP) must be seen. However, unlike the U.S., a specialist may only be seen if the GP agrees that you need to see one. Going to see a specialist without the "consent", if