Health care coverage is important because it enables different people to be able to access medical care. It is important for different individuals to have health insurance because it helps one have timely access to medical care and can improve the health and lives of different individuals. There are several health care options for different people and the large population can get access to health care based on the age and socioeconomic background. However, health care insurance is not provided for everyone in the population. There are individuals that are uninsured who face an increasingly huge amount of difficulties when trying to access health care. Poor health care access can lead to late diagnosis, development of chronic conditions, and poor quality of care among the uninsured population. An analysis of various benefits and limiting factors to Medicare and Medicaid, the benefits of Diagnosis Related Groups (DRG) and the role of Charity Care is important to analyze the status of health insurance in the United States.
Healthcare Coverage and Vulnerable Populations
The vulnerable population includes different groups across the age spectrum. The elderly can be described as a vulnerable population because they become too old or too sick to take care of themselves. The fact that they are too old to work means that their income will decline. Children also fall in the vulnerable population because they must depend on other individuals that care and fend for them (De Chesnay, 2019). Vulnerable populations do not have the ability or resources to access healthcare and the provision of health insurance will ensure that they have the required resources. Health coverage for the vulnerable populations will thus enable them to overcome their vulnerability. The increasing costs of health care in the United States means that the vulnerable population does not have adequate resources. Health coverage ensures that the group can have the required resources and overcome their vulnerability.
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Providing healthcare coverage for the vulnerable population will also be beneficial in improving the quality of care and healthcare outcomes. Most of the uninsured vulnerable individuals get less preventive care and less screening services. The associated costs of healthcare mean that these individuals do not get healthcare in a timely manner and this can affect their healthcare outcomes. Vulnerable populations thus need additional assistance from the government or other organizations to help improve the overall quality of care.
Medicare
Medicare is a health care insurance option that is usually available to individuals that 65 years of age and above. The coverage can sometimes include individuals that are below the age of 65 and may have specific diseases or medical disabilities. One of the factors that facilitate access to Medicare is that it is specific to a target population. The health care has been suited to combat the challenges that individuals that are above the age of 65 years face. A large percentage of the elderly that are above the age of 65 are increasingly being supported and realizing the benefits of Medicare (Jensen et al., 2015).
Medicare also facilitates healthcare coverage through the division into separate parts. Different individuals can thus subscribe to the different types of Medicare based on their ability to pay the coverage options. Medicare Part A usually covers hospital services and is usually free. Individuals that did not work for long enough may have to pay for Medicare Part A. Medicare Part B usually covers medical services and may come with associated costs. Medicare plans A and B do not include additional services such as dental care. Medicare Part C involves coverage of Part A and Part B and could include additional prescription costs. Medicare part D covers up to prescription drugs.
The two main factors which hinder access to Medicare are age-related issues and socioeconomic background. Medicare is age-specific and patients that are not above the age of 65 may not be eligible for Medicare. However, individuals that could be disabled may have access to Medicare. While Medicare Part A is free, there are other parts and plans for Medicare which can lead to increased costs of healthcare for individuals that do not have sufficient capital. Individuals that may want access to dental services may not receive treatment through the healthcare plan.
Medicaid
Medicaid is a health insurance program which is run by the federal government and the state. The eligibility of Medicaid is based on the income of the individual instead of age and disability. Medicaid facilitates healthcare coverage by ensuring that individuals that could be having limited financial resources can have adequate access to health care. Medicaid comes at a free to low-cost health coverage option for low-income individuals.
Medicaid can also facilitate care to the vulnerable population. The vulnerable population addressed by Medicaid include individuals limited by low-income, pregnant women, and other individuals with a disability. Individuals that are below the age of 65 and disable in some ways can qualify for Medicaid. Another section of the vulnerable population addressed are minors. Individuals that have a child under the age of 18 can apply for Medicaid. There are several benefits of Medicaid which vary based on the state and the different types of care options. Medicaid can provide coverage for inpatient and outpatient hospital services, laboratory and x-ray services, home and nursing home care, and transportation to a medical facility.
The limiting factors to the access to Medicaid include the socioeconomic status of an individual and their racial backgrounds. Medicaid access comes with associated costs and not everyone in the vulnerable population can access its coverage options. There are several low-income individuals who cannot be covered by Medicaid. Health care insurance coverage by Medicaid also varies based on the racial backgrounds of different individuals. The minority population such as African Americans and the Latino population have been found to have the highest population of the uninsured and cannot easily access Medicaid (Yue et al., 2018).
Diagnosis Related Groups
A diagnosis-related group (DRG) is a patient classification scheme which is used to standardize the prospective payment to hospital institutions and to encourage cost containment programs. A DRG payment generally covers all the charges that can be associated with the inpatient stay right from the time they were admitted to the time they were discharged. The purpose of the DRG is to set rates and price for specific healthcare services. The amount paid is a fixed amount no matter the total costs and the time spent. This has enabled hospital institutions to increase their efficiency, shorten the stay of patients, and to minimize unnecessary tests.
DRG has also impacted the quality of care provided to patients. One of the impacts of the quality of care is that the DRG can be used to judge the quality of care delivered by a physician. Each admission and procedure is attributed to an individual physician who receives a score based on the severity of the documented illness. In case the documentation is not specific, the general assumption is that the patient did not have severity in the illness and the care came at low costs. Physicians have to thus try to improve their documentation and the quality of care they provide to patients in order to maintain a high score.
Charity Care
Charity Care is state-mandated care that is usually provided for free for individuals that may not be able to pay or afford care. Charity care is a state-funded program and will allow for the uninsured and the underinsured population to receive outpatient and inpatient care services at a reduced cost. The vulnerable population thus highly benefits from charity care. Vulnerable populations and individuals that are uninsured do not have other means to pay for the health care costs. Charity Care will be helpful for these individuals because it can simply be compared to a tax write off. However, people that have a certain income and a certain amount of asset criterion quality for charity care.
The adoption of Charity Care adoption requires that hospitals provide certain types of care for free and at lower costs if an individual cannot pay for medical treatment. Hospital institutions are thus mandated to provide the medically necessary treatment for treatment options such as emergency treatment services and inpatient services. Charity Care can come with huge costs on the part of the health care facility. This has largely led to its decline and use among several health care practitioners.
Conclusion
Health care coverage is important to ensure that different individuals can have access to health care at reduced costs and that they can realize the quality of care. The vulnerable population may not have adequate resources to access health care and the provision of health care can be used to overcome their vulnerabilities and improve the quality of care. Medicare is tailored for the elderly population above 65 but could have limiting factors such as age and socioeconomic background. Medicaid was created for low-income individuals but could still have limiting factors such as socioeconomic and racial factors. Charity Care was created to provide care for the vulnerable population. The use of Diagnosis Related Groups can be used to improve health care by ensuring hospital institutions become more efficient and physicians try to provide the best care possible.
References
De Chesnay, M., & Anderson, B. A. (2019). Caring for the vulnerable: Perspectives in nursing theory, practice, and research . Jones & Bartlett Publishers.
Jensen, G. A., Salloum, R. G., Hu, J., Ferdows, N. B., & Tarraf, W. (2015). A slow start: Use of preventive services among seniors following the Affordable Care Act's enhancement of Medicare benefits in the US. Preventive medicine , 76 , 37-42.
Yue, D., Rasmussen, P. W., & Ponce, N. A. (2018). Racial/ethnic differential effects of Medicaid expansion on health care access. Health services research , 53 (5), 3640-3656.
