Categories
History

Őtzi: Uncovering the Iceman

In September of 1991 two hikers in the Őtzal Alps near South Tyrol, Italy came across the frozen body of a man. Although the hikers first suspected that it was the body of someone who had recently died, it turned out to be the corpse of a man who had been frozen in that spot for thousands of years. The frozen was given the nickname Őtzi because of the region where it was discovered, although he also became known as the Iceman. Researchers believe that Őtzi is over 5000 years old, and that he lived during the Neolithic period known as the Copper Age. Because his body was so well-preserved in the ice and snow, scientists have been able to learn many things about how he lived, and even about how he died.

            Although the elements eventually stripped away all of Őtzi’s hair, some of his hairs were found stuck in his clothing, and researchers have been able to determine that he had short, dark, curly hair that had been recently trimmed prior to his death (Conklin, 2005, p.137). Some of Őtzi’s clothes were damaged or destroyed during the process of removing him from the ice, but the remnants of what was destroyed as well as the articles of clothing that were preserved offered many clues about his life. Őtzi appeared to be well-prepared for traveling, as he was wearing soft leather shoes and a jacket made of leather or animal hide (Conklin, p.137). He had been carrying some sort of large backpack, though it had been damaged over the centuries, so it is not clear what was inside it, although it does offer evidence that Őtzi was traveling for some purpose (Conklin, p.137).

            Őtzi was wearing a small leather pouch that contained several items, such as pieces of flint, some unfinished arrowheads, grass string, and a hole punch or awl that may have been used for sewing leather (iceman.it, n.d.). In addition to the items in the pouch, Őtzi was carrying a large bow that had not been strung yet, a flint knife in a grass sheath, and a copper axe. Although the people who have studied Őtzi have used a number of different techniques to determine how old he is and to learn about his health and his way of life, the copper axe offers some clues. Őtzi was alive in the period known as the Copper Age, but in the typical settlement that people from that period often lived, it would not have been common for everyone to have copper axes or other tools (Conklin, p.135). Some researchers believe that this axe is evidence that Őtzi was an important person, and may have been a shaman, a medicine man, or some other significant figure among his people (Hales, 2000, p.86). Along with the items of clothing and tools that were found with Őtzi, researchers also found several different types of food, such as pieces of animal meat and pieces of plum or some other form of fruit. The presence of the fruit may indicate that Őtzi died in autumn, when the growing season had ended but fresh fruit was still available (Hales, p.86).

            There were a number of areas that had been settled in the region between what is now Switzerland and Italy, and the people of this period usually lived by farming and hunting. Agriculture would not have been particularly advanced, but archaeologists have found evidence that people raised sheep and goats, planted grains and other crops, and had carts with wheels and other basic farming tools. These people had the capacity to cook and to bake bread, and there was evidence that Őtzi ate a significant amount of grains in his life, as the grains had worn down his teeth (iceman.it, n.d.).

            Researchers used a number of scientific techniques to study Őtzi. Although the existence of his axe made it clear right away that he was at least several thousand years old, it was not until Carbon-14 dating techniques were used that it was possible to make a fairly accurate assessment of his age. The results of the test showed that Őtzi had lived sometime between 3350 and 3100 B.C., and had been trapped in that spot for over 5,000 years (iceman.it, n.d.). Other studies of his internal organs showed that he still had food in his system when he died, meaning that he had eaten recently, and that he showed signs of parasitic infections (Conklin, p.138). Some of the plants and food items Őtzi had with him may have been intended for use as medicine to fight symptoms of parasites.

            X-rays of Őtzi’s body showed a number of interesting things, including the fact that he had signs of arthritis in his hips, knees, and ankles. The most significant find uncovered by the X-rays, however, was the presence of a small flint spearhead or arrowhead embedded below his left shoulder (Gay and Whittington, 2002, p.20). The discovery of this spearhead has led researchers to believe that Őtzi may have been attacked while traveling, and that his death was a result of blood loss (Gay and Whittington, p.20). It is unlikely that it will ever be known for certain how Őtzi died, but this theory seems as plausible as any other possibility. Other tests and studies have determined that Őtzi was approximately 45 years old at the time of his death, which would have been a relatively old age for a man of his era.

            It is not known exactly which culture Őtzi lived in, though there were several different cultures scattered throughout the region that had developed the use of stone and metal tools and the ability to make ceramics. The museum exhibit featuring Őtzi’s body also makes information available about how he and people from his time lived. The cultures from this time and place are described as “cults of the dead,” and funeral ceremonies, burial rituals, and graves were all central parts of the culture (iceman.it, n.d.). Őtzi’s people buried important items with the dead, such as weapons and tools, so that the spirits of the dead would be prepared for the afterlife. Some people of this time buried bodies in mass graves, and others built stone crypts. The graves of the dead would be visited for prayers and rituals on a regular basis. Őtzi had a number of tattoos on his back and legs, which may have been put there as part of some sort of religious ceremony, or in the belief that they would help with the pain of the arthritis he had in those areas (Gay and Whittington, p.21).

            The settlements and communities of the Copper Age had other ceremonial sites besides graves, and religion was a central part of life for people from Őtzi’s time period. The people of this time would have worshipped the spirits of deceased ancestors and engaged in rituals to commune with the spirit world and to ask for acceptance in the afterlife (iceman.it, n.d.). Natural forces, such as the wind and rain, would be believed to be controlled by the gods. Because Őtzi was carrying the copper axe, it is possible that he was a religious figure among his people, and he may have been traveling on some important mission or quest. It is impossible to know everything about his life, but the remarkable condition of his preserved body has mean that Őtzi has been able to tell us many things about how people lived thousands of years ago.

Works Cited

Conklin, Wendy. Mysteries in History. Westminster, CA: Teacher Created Resources, 2005. Print.

Gay, Kathlyn, and Christine Whittington. Body Marks: Tattooing, Piercing, and Scarification. Brookfield, CT: Millbrook Press, 2002. Print.

Hales, Sheila. Developing Literacy Skills: Pack Unit 1. Oxford, UK: Heinemann, 2000. Print. “Ötzi – the Iceman | Ötzi – South Tyrol Museum of Archaeology.” Home | Ötzi – South Tyrol Museum of Archaeology. N.p., 2013. Web. 15 June 2013.

Categories
Healthcare

Advantages and disadvantages of the hospital payment systems

Outline

Advantages and disadvantages of the following hospital payment systems on cost containment and provider behavior:

  • Fee-for-service
  • Per diem
  • The DRG-based payment system (i.e., Medicare’s Inpatient Prospective Payment System)
  • Capitation

Fee-for-service:-

         A major advantage of the Fee-for-service (FFS) payment model is that services are paid for separately and not together as other plans. Importantly, it is beneficial to both hospital and the provider since through this payment system earnings can be increased because it patients are charged for each intervention. For example, if a patient had a surgery, the surgeon is paid for the operation whereas the hospital stay is recorded separately benefiting from the procedure. Hence, opportunities to provide more care since these are billed individually. In countries such as Japan fee –for-Service Payment methods are connected to national pricing to contain cost within health care organization

      A notable disadvantage of this method, however, is that patients tend to be offered treatment, which unnecessary, but are added because the physician can derive a fee for the service. In this case the emphasis flows away from quality care towards quantity care critics argue that it is not cost effective because the focus in on quality and not quality. As such, whether patients are heard regarding their complaints is unimportant to both hospital and physician. Subsequently, efficiently is greatly compromised since the goal is more towards improving the censuses and not quality of care (Fuchs, 2009).           

            Per diem:-

         Per diem is a limited model of the prospective payment technique whereby patients pay a daily price or rate for their health care services when hospitalized. Reimbursement is through a third party payer. An example of this system and its advantages for healthcare organizations, especially, hospitals is one practiced by the Indian Health Service whereby they found it useful to combine these payment strategies with supplemental health insurance plans. It has been executed with such dexterity that the payment system has been a tradition in that society regarding fairness of reimbursing physicians for services rendered to patients who are being hospitalized for extended periods of time (Casto & Layman, 2006).

        Critics argue that the method can be exploitive to patients because providers do take advantage of the opportunity to increase the days patients remain hospitalized or hospitalize patients unnecessarily. While all of this may be true the system is cost effective because calculations of daily rates are far less complicated than coding charges per service. Therefore, cost is contained and the health care facility makes a greater profit than in many other payment methods (Casto & Layman, 2006).

Capitation:-

     A great advantage of capitation payment method in health care relates to the third party payer reimbursement strategy. This is calculated based on providers being afixed a certain amount per given period, per capita amount for a period’ (Casto & Layman, 2006, p 4). The terminology per capita pertains to per head or on per person per month (PMPM). Usually, this is the amount of money paid to the provider or hospital on a monthly basis one the client/patient is enrolled in the health insurance plan. It means that providers receive payment for services of all group members regardless of whether the patient is seen or not. Therefore, this is a tremendous advantage for maintenance organizations (Hughes et.al, 2004).

      Consequently, the amount of services has no effect on payment as it relates to increase because there is a set amount of money allotted to the organization or provider for that period. As such, if the entered into an agreement to offer a certain amount of services within a given period of a set of employees this is the payment that will be received. This a notable disadvantage, but it can still contain cost to patients in long term care facilities (Casto & Layman, 2006).

The DRG-based payment system (i.e., Medicare’s Inpatient Prospective Payment System)

         An advantage of DRG-based payment system is the assignment of a specific DRG weight by Centers of Medicare Services to each patient’s accessibility of care profile. This weight gives an estimate regarding the services that are available to that Medicare recipient in the DRG program. It also helps the medical record department to align these resources to those received by other recipients. The purpose of all these weights is mainly for accurately giving account of cost differences among various treatments administered by care providers during hospitalization. Conditions that cost more are ascribed a higher DRG weight for accountability. Examples of weight ranges are ‘the fiscal year 2001 the DRG weights ranges were .5422 for a concussion (DRG 32) to 1.4966 for viral meningitis (DRG 21) to 19.0098 for a heart transplant (DRG 103).29’ (Blount & Waters 2001, p 12).

          However, while the weight assignment is a great advantage of cost containment to hospitals and providers non – physician services provided by hospitals cannot be reimbursed though this system. The organization or provider has to access another resource for submitting such costs directly for reimbursement through PPS (Blount & Waters 2001).

References

 Blount, L. L., & Waters, J.( 2001). Managing the Reimbursement Process. 3rd ed. Chicago:

                  AMA Press

Casto, B., & Layman, E. (2006). Principles of Healthcare Reimbursement. American Health

                  Information Management Association

Fuchs, V. (2009). Eliminating waste’ in health care. Journal of the American Medical

              Association, 302 (22), 2481–2482

 Hughes, J. Averill, F.  Eisenhandler, J. Goldfield, N.Muldoon, J.  Neff, M., & Gay. J. (2004).

           Clinical risk groups (CRGs): A classification system for risk-adjusted

            capitation-based payment and health care management.

            Medical Care 42 (1): 81

Categories
Healthcare

Nursing

Introduction

             The case study for this lesson encompasses hospitalization costs of a 70 year old woman who underwent kidney transplant at a general hospital. She accumulated a total of $150,000 in Medicare-approved charges associated with the procedure. This report outlines individual cost pertaining to the DRG Description Case Weight; 115; Permanent Cardiac Pacemaker; 3.5513; 302 Kidney Transplant 4.1370 and 441 Hand Procedure/Surgery 0.8785. Related to the surgery itself cost will be calculated for operating; capital payment for the hospital. Considerations regarding whether the hospital will be eligible for Medicare outlier payments and the total payment the hospital can receive form the entire procedure.

Case study Application

          The DRG Description Case weight refers to the diagnostic related group (DRG), which classifies hospital inpatient cases for Medicare services. Specifically, DRGs classify all human diseases based on the ‘affected organ system, surgical, procedures performed on patients, morbidity, and sex of the patient’ (Gottlober, 2001, p 2). This classification taken in to consideration an additional eight primary diagnoses along with six procedures performed during Mr. Smith’s hospitalizations. Consequently when a weight is assigned to Mrs. Smith’s procedures it shows the Medicare resources available to her when compared to other recipients with the same condition/ disease. The more intense the disease condition the greater is the weight (Gottlober, 2001).  

         Precisely, 115; Permanent Cardiac Pacemaker; 3.5513; 302 Kidney Transplant 4.1370 and 441 Hand Procedure/Surgery 0.8785 has a less weight than Kidney Transplant and they both have a stronger weight than Hand Procedure/ Surgery.115,302 and 441 are codes provided to each procedure, which indicate the cost ascription of each service. Calculations for each DRG are modified from time to time. However, in the standard methods charge for individual DRG is calculated by adding up all charges for cases within that particular DRG (Gapenski, 2009).

       After arriving at this figure that amount is divided by the number of classified cases contained in the DRG. Prior to this process, though, patient charges are standardized and the effects of regional area wage differences along with indirect medical education costs if the institution is a training hospital are removed. In this case The San Francisco General Hospital is not a teaching facility, but is located in a large urban geographic location. Also, additional payments to hospitals that treat a large percentage of low income patients are removed. (Gapenski, 2008).

      In applying the wage criteria to hospital costs, this accounts for the greatest care expenditure. Center for Medicare Service usually adjusts this cost according to the patient’s income level. Teaching institutions carry a higher cost which could escalate prices for patients even when bring more profit to the institution. There are three other conditions which can affect Mrs. Smith’s the overall cost. They include whether San Francisco General Hospital is located more than 35 miles in proximity to another hospital. Secondly, whether San Francisco General Hospital the only so inpatient hospital servicing that geographic location or if San Francisco General Hospital was designated “critical access hospital’’ by the Secretary (Blount & Waters, 2001).

           In relation to the Kidney Transplant the operating payment to be paid to the hospital requires a six step calculation. Step 1 is calculating the Standard rate; Step 2 Adjusting for the Wage Index Factor; Step 3. Adjusting for the DRG Weight; Step 4 Disproportionate Share Payment ; Step 5 Indirect Medical Education Payment and Step 6 Outlier Payments

Step 1 Calculating the Standard rate

A large Urban area is used because San Francisco General Hospital is located there

Labor related $22,809.18 Non-labor related $10,141.85

Step 2 Adjusting for the Wage Index Factor

$22,809.18 x 1.4193 = $3987.07 (adjusted labor rate for San Francisco) $34,987.07 + $21,141.85= $55,128.92 — Generic Hospital’s Adjusted Base Rate

Step 3 Adjusting for the DRG Weight

Based on the codes

($33,987.07 + $21,141.85) x (1.8128) = $91,297.71

Step 4 Disproportionate Share Payment

This rate is 0.1413. Generic’s base payment rate is multiplied by this rate. ($91,297.71) x (1+ 0.1413) = $100,611.47

Step 5 Indirect Medical Education Payment

The adjustment factor for Indirect Medical Education is 0.0744. This rate is added to the DSH factor plus 1 to give the Hospital an adjustment rate of: 1 + 0.1413 + 0.0744 = 1.2157. The payment the hospital can expect to receive for this case is: $9,297.71 x 1.2157 = $11,303.23

Step 6 Outlier Payments

$150,000 If  Mrs. Smith/’s cost of care exceeded the payment rate by $14,050, the hospital can apply for Outlier Payments

(Blount & Waters, 2001).

Conclusion

What is the operating payment to be paid to the hospital?

This is calculated applying the following formula

DRG Relative Weight x ((Labor Related Large Urban Standardized Amount x Core-Based Statistical Area [CBSA] wage index) + (Nonlabor Related National Large Urban Standardized Amount x Cost of Living Adjustment)) x (1+ Indirect Medical Education + Disproportionate Share Hospital).

What is the capital payment to be paid to the hospital?

This is calculated using the following formula:-

(DRG Relative Rate x Federal Capital Rate x Large Urban Add-On x Geographic Cost Adjustment Factor x Cost of Living Adjustment) x (1+ Indirect Medical Education + Disproportionate Share Hospital)

Will the hospital be eligible for the Medicare outlier payment?  

No because Mrs. Smith’s care does not exceed the pay rate by $14,050,

What is the total payment to the hospital?

$100,611.47

References

Blount, L. L., & Waters, J. ( 2001). Managing the Reimbursement Process. 3rd ed. Chicago:

                  AMA Press

Gapenski, L. (2009). Cases in Healthcare Finance (4th edition). Boston: McGraw Hill-Irwin

                               McGraw-Hill Irwin

Gapenski, L.C. (2008). Healthcare finance: an introduction to accounting and financial

                  management (4th ed.). Chicago, IL: Health Administration Press.

 Gottlober, P. (2001) Medicare Hospital Prospective Payment System: How DRG Rates Are

                       Calculated and Updated. Office of Inspector General Office of Evaluation and                         Inspections Region IX

Categories
Psychology

Human Memory

When the brain, an overall fragile organ, is subjected to a certain amount of trauma, many long-term effects can be seen with regards to cognition, and specifically long-term memory. Though all humans have very individual brains, and thus brain chemistries, it is the nature of the processes the brain follows that is effected, and can subsequently be significantly damaged.

Categories
Business

Level of Organization Change

Chapter 6 explains the three different levels of organizational change: individual, group and larger systems based on the processes, responses and methods for introducing gradual and dramatic changes.

            Individual Level Change

The authors explain that the major changes in the organization result in training, change of position, development programs and coaching. The main focus when introducing change on the individual level should be on gaining commitment, developing the individual’s skills according to the new requirements and effective communication patterns that highlight the benefits of the change for the individual. Likewise, selection and recruitment models also have to be adjusted to the changes in the organization’s needs and priorities. Individuals usually respond to changes going through five different stages; all to be addressed by managers: shock and denial, anger, bargaining, depression and acceptance.

Categories
Finance

Analysis and Discussion of Financial and Accounting Processes

Abstract

This discussion and presentation is based on the analysis of the different conditions by which a business is able to smoothly operate based on the accounting and financial management operations it embraces to adapt to. Presented in a form of memo, this documentation is supposed to be presented to the board of members of the XYZ Construction Inc in the absence of the Chief Financial Officer to give them an idea on how the financial assets of the organization is being managed through accounting principles.

Categories
Other

Continued Fish Bowl Experimental Design. Testing for Impact of Sunlight

Performing an experiment to test for a relationship between sunlight and the presence of purple goop would require a design that is similar to that which examined the influence of fish on the water. Two identical bowls of water with no fish would be needed with one placed in the sunlight for 24 hours and the other placed in the dark for the same amount of time to act as a control. The hypothesis for such a test is that the water in the sunlight will develop the purple slime over this period. Possible outcomes of this experiment include the prediction that only the water in the sunlight develops slime, that both bowls develop slime, that neither bowl will have slime, and even the possibility that only the bowl in the darkness ends up with slime.

Categories
Creative Writing

Travel

Introduction

Virtually everybody travels at various times in their life, and for an enormously wide range of reasons.  The word itself usually brings to mind recreation, or the desire and plan to go somewhere new for enjoyment purposes.  Even in this type of travel, however, it can be seen that the experience itself provides limitless opportunities because a change of environment creates changes in perspective.  New places, different people, and elements of unknown culture trigger responses in the individual which, even when relaxation is the goal, must have a strong effect on the individual’s ways of seeing and thinking.  Then, the mechanics of travel often challenge people, just as assessing the experience afterward adds other dimensions.  No matter the form or reasons, one factor is inevitably in place when people travel: in leaving their known environment, they are entering into others which will have many and diverse influences on them, but still have the effect of emphasizing the identity of the traveler.

Categories
Other

Clinical Data of the Effects of Marijuana

Marijuana is a dry and odorous, green or brown plant derived from the hemp plant that goes by the scientific name Cannabis sativa. In a more concentrated form marijuana is called hashish, and as a sticky black liquid it is known as hash oil. The main psychoactive chemical in marijuana is delta-9-tetrahydrocannabinol, or THC (National Institute on Drug Abuse). The use of marijuana and the effects of THC on humans has been a heated debate for decades.

Categories
Criminal Justice

Research Project Hypothetical

When conducting a research project of any kind, but especially in the field of Criminal Justice, there are many factors that must be considered from an economic, social, and political standpoint. Generally, the research topic is selected based on a whole host of very important factors.

First, when presented with the task of selecting a topic, one must consider the relevance of the topic they plan to choose. Picking a research topic that is not a controversial issue, a frequently covered news topic, or something new and innovative that can be correlated to one of the previous two criteria. If the topic is not viewed as relevant enough, not only is it likely that the university will pull a research grant, but it just overall will not have a lasting impact. The purpose of a research study is to obtain new information–a topic that is not relevant is a waste of new information. Some examples of good research topics in Criminal Justice are cyber-crime, legalization of marijuana, bullying and violence in schools, as well as reform of the penal system (Criminal Justice, 2013).

However, there are factors that also must be taken into account when even choosing a topic that is relevant. The demographic population of the city chosen would also have to be taken into account when choosing a specific topic. For example, for the aforementioned topic of penal reform, there is a host of statistics that also must be taken into consideration. If, say an urban city with a high minority population was chosen, the statistics of minorities in prisons compared to whites would have to be considered.

One of the most important parts of a study is the purpose statement. It must be specific enough to maintain its overall relevance, while remaining broad enough that it can be made applicable in the most ways possible. Keeping in mind the function of a purpose statement is to explain why the study is necessary, the statement should be clear and concise. The four parts of a purpose statement should include the method, both dependent and independent variables, the target audience, as well as the setting the study is to be conducted in (Writing the Purpose Statement, 2011).

If the proper steps have been followed to this point, a hypothesis or two should have evolved around the research topic. Taking into consideration the variables such as demographics, political affiliation, and population and applying it to a research topic should raise plenty of questions that can be addressed. At this point, the most important part is to discern which of these should be addressed–in other words, prioritizing the questions. These will be become research questions.

When a null or alternative hypothesis is introduced along with the one being presented, many things come to light as a whole, and in parts. First and foremost, considering and even presenting counter-arguments to their own can be a very effective tool in judging the strength of one’s own argument. If, when considering alternative thesis’, one sees that their research is futile, than much unnecessary work can be avoided.

Another strong reason to present counter-arguments is to actually strengthen ones own. If the alternative thesis can be deconstructed and thus proved false by ones own research study, then doing so in the findings can be nothing besides beneficial in the long-run. Thesis’ that deconstruct other thesis’ is how information progresses.

The overall research effort is measured an analyzed in many different ways. First, the outliers must be taken into consideration–why did a certain population deviate so much from the rest of the study? After that, the raw data must be compared to studies that correlate to it, and compared and contrasted for the sake of accuracy. After demographics are considered, the report can be drafted to some extent.

Quantitative research is research that depends on the collection of quantitative data. This data is characterized by deductive reasoning on the part of the researcher, and depends on the regularity of human behavior under controlled conditions. The researcher is generally supposed to be objective from the beginning. It normally ends with a statistical report (Quantitative, Qualitative, and Mixed Research, 2012).

Qualitative research is directly dependant on new hypothesis’ that arise while collecting new data. It is a more adaptive research approach, and tends to not control the environment, but rather using a natural environment. In addition it is a subjective research method that searches for patterns. The final report is more narrative in nature. Mixed research is exactly what it sounds like–it combines necessary elements of both qualitative and quantitative methods for the study at hand (Quantitative, Qualitative, and Mixed Research, 2012).

The literature review of the findings would probably be of the mixed nature, encompassing both quantitative and qualitative research methodologies. In this way it covers all the bases. In addition, this is the best way to end up with the highest standard of results as a whole, while encompassing the most possible amount of data into consideration.

The integrity of the report is an ethical and moral issue as well, and can be tainted if certain data is omitted, or even under-researched. This burden does indeed fall on the researcher, so the utmost time should be put into any research study, with all of the dependent and independent variables, as well as the atmosphere and climate. There are also the legal implications of the study, which can be direct or indirect, and far-reaching indeed.

First and foremost, if the researcher is able to adequately prove their thesis than their study could be cited in either future studies, or even used in testimony in court cases. If the research is in any way compromised, it must be taken into consideration as well as adequately noted. In addition, another major thing to consider is the omission of information to further prove a thesis.

Unfortunately this is something sociologists and criminologists deal with on a daily basis. To think a person would taint research with far reaching implications simply to further their own career is disgusting–however, it is a reality. Specific care must be taken to ensure all information, no matter how small, is in some way in the literature published. There is no imperative way to know how far reaching the implications of any individual research project can, and will be.

 

Resources

“Choosing & Defining a Topic   Tags: Controversial Topics, Issues in the News,           Social_issues, Thesis Statements  .” Start Here. N.p., n.d. Web. 02 June 2013.      <http://libguides.monroecc.edu/content.php?pid=124732>.

“Quantitative, Qualitative, and Mixed Research.” Southalabama.edu, n.d. Web.   <http://www.southalabama.edu/coe/bset/johnson/lectures/lec2.pdf>.

“Writing the Purpose Statement.” Writing the Purpose Statement. N.p., n.d. Web. 02 June         2013. <http://bold-ed.com/purpose.htm>.

 

 

Categories
World Affairs

Election 2012 research

One of the major issues during the 2012 presidential elections was the economy. The economic issues that particularly got coverage during the election season included personal income tax rates and government’s role in the economy. President Obama and the Democratic Party advocated raising taxes on the high-income groups to reduce deficit as well as support programs for the middle class (Nazworth). As far as government’s role in the economy is concerned, President Obama called for greater intervention in economy such as investments in infrastructure, healthcare, and education to reduce unemployment rate and grow the middle class. He also called for greater regulations to reform the financial sector and supporter government bailout programs such as that of the auto industry (Nazworth, Obama vs. Romney: Jobs and the Economy).

Mitt Romney and the Republican Party were of the view that tax cuts should not be raised on any income group even though Romney claimed he may cut some deductions (Nazworth, Obama, Romney Debate Jobs, Economy, Deficits). Romney also called for lower government intervention in the economy and hinted at repealing President Obama’s healthcare plan if he is elected. Romney also called for lower financial regulations (Nazworth, Obama vs. Romney: Jobs and the Economy).

The positions taken by President Obama were relatively liberal while Romney were conservative since Romney advocated minimum government intervention in economy. In my opinion, President Obama’s positions were more sensible because the bailout of auto industry has been a success and government has historically played an important role in the economy. In fact, U.S. came out of Great Depression due to President Roosevelt’s beliefs that government has a role to play in economy to reduce unemployment and improve infrastructure to support economic growth.

References

Nazworth, Napp. Obama vs. Romney: Jobs and the Economy. 11 October 2012. 2 June 2013 <http://www.christianpost.com/news/obama-vs-romney-jobs-and-the-economy-83115/>.

—. Obama, Romney Debate Jobs, Economy, Deficits. 4 October 2012. 2 June 2013 <http://www.christianpost.com/news/obama-romney-debate-jobs-economy-deficits-82684/>.

 

Categories
Healthcare

Medicaid Eligibility Comparison

According to USA.gov, eligible Medicaid recipients include individuals and families from qualified low-income groups that do not have health insurance coverage. Medicaid is a federal program with strict rules and regulations that each state must follow, although these rules and regulations vary by state and by group. Though varied, each state is monitored and required to cover base mandatory benefits and each state has the option of including optional benefits to offer Medicaid recipients. Applicants must apply at their state Medicaid office to qualify (Eligibility Requirements). In addition, the Affordable Care Act of 2010 includes a Medicaid eligibility expansion slated for 2014; however, states can elect to choose to implement this initiative before 2014. This acts will expand eligibility to Amerians under the age of 65 who fall below 133% of the FPL (federal poverty level). This changes Medicaid eligibility criteria on a federal and state level (Medicaid).

As mentioned, each state has its own set of eligibility criteria, based on compliane with federally regulated guidelines. Following is a Medicaid eligibility comparison between two states: Virginia and Kentucky. This comparison highlights the similiarities and differences between two states regarding Medicaid eligibility.

Virginia Medicaid Eligibility and Covered Services

Virigina’s state Medicaid healthcare services fall under the authority of the Department of Medical Assistance Services. This department aims at offering cost-effective, high-quality services to those in Virginia who qualify for Medicaid.

According to the state’s website, income and resource eligibility requirements for Virginia vary by category. Eligible recipients in the state fiscal year of 2012 included 604,442 children; 216,734 disabled individuals; 195,681 pregnant women, children’s caregivers, or parents; and 79,613 elderly persons (DMAS, 2013).         The Medicaid program in Virginia Medicaid covers services with some minor cost sharing for some beneficiaries.

Federally mandated coverages in Virginia include: hospital, physician, and midwife services; health centers and rural health clinic services; Lab and x-ray services; transportation services, family planning services; nursing facility services; home health services; health screenings, diagnoses, and treatment programs for children; and routine dental care for persons under age 21. Optional services include: certified nurse practitioner services; prescription drugs; rehabilitation services; occupational therapy and speech language pathology services; hospice services; select mental health services; select substance abuse services; and intermediate care facilities services (DMAS, 2013).

Kentucky Medicaid Eligibility and Covered Services

According to the state of Kentucky’s website, the state healthcare program is under the Cabinet for Health and Family services. Currently, the state’s Medicaid eligibility includes individuals and families with dependent children such as pregnant women, dependent children under at 19, parents of dependent children if unemployed or underemployed or if one parent is deceased. Income and resource requirments vary by family size and income, and this is even more varied for pregnant women and children (Programs and Services, 2012).

Covered Medicaid programs in Kentucky include the Early Periodic Screening, Diagnosis and Treatment Services (EPSDT) program; Kentucky Children’s Health Insurance Plan (KCHIP); Kentucky Transitions (for those transitioning from long-term care to the community); Kentucky Women’s Cancer Screening Program; Medicaid Works (work program for the disabled); Medicare Savings Plan Program (financial assistance with Medicare premiums); Presumptive Eligibility (program for pregnant women who do not yet have Medicaid); and Title V (serving children in state custody). Covered services in Kentucky include: nurse practicioner, child advocacy, chiropractor, dental, medical equipment, family planning, hearing, vision, hospice, laboratory, medical transportation, organ transplant, pharmacy, podiatry, preventive, and dialysis services (Programs and Services, 2012).

Virignia vs. Kentucky

In comparison, it appears that both states have similarities in the required federally funded mandated coverages; though, they do have some variations in how they are administrered. For example, Kentucky offers some creative options for Medicaid recipients that do not appear in Viriginia’s offersings, in some areas, such as special programs offered such as Medicaid Works and Kentucky Transitions. However, Virignia’s website shows they are putting in effort to keep abreast of how their Medicaid dollars are allocated with posting their statistics. There is adequate information on Medicaid expenditures and delivery of services options shown in a report from their website.

Conclusion

Recently, Medicaid eligibilty requirements have expanded to include more Americans under the age of 65, thanks to the implementation of the Patient Protection and Affordable Care Act, also known as Obamacare, which was signed into law by President Barack Obama in 2010. This enactment will go into effect in 2014 and help save the lives of many Americans who would otherwise die, due to not having any health insurance. This initiative will also save the United States money from preventing healthcare emergencies and diseases of the indigent and manyh people with low incomes, living below the poverty line. Many who are not eligible under the current Medicaid plan will be eligible under the new plan. Also, as mentioned, each state has the option of putting Medicaid expansion initiatives in place prior to 2014.

 

References

Programs and Services. (2012). Retrieved from Kentucky Cabinet for Health and Family Services: http://chfs.ky.gov/dms/services.htm

DMAS. (2013). The Virginia Medicaid Program at a Glace. Department of Medical Assistance Services. Virginia.gov.

Eligibility Requirements for Medicaid Benefits. (n.d.). Retrieved from USA.gov: http://answers.usa.gov/system/selfservice.controller?CONFIGURATION=1000&PARTITION_ID=1&CMD=VIEW_ARTICLE&ARTICLE_ID=10265&USERTYPE=1&LANGUAGE=en&COUNTRY=US

Medicaid. (n.d.). Affordable Care Act: Eligiblity. Retrieved from Medicaid.gov: http://www.medicaid.gov/AffordableCareAct/Provisions/El

Categories
Healthcare

The Medicaid Program

What is Medicaid?

According to Medical News Today, Medicaid is a government medical and health program that provides health and dental services to eligible low-income groups in the United States, and it is managed by the U.S. Department of Health and Human Services. Medicaid is a federal program; however, it is managed at state levels regarding eligibility standards, scope of services, and payment rates for services (MNT). Medicaid is made available to help low income families, children, the elderly, and the disabled.

How Medicaid is Financed

Each state receives federal funding for there Medicaid programs; however, all states must adhere to mandatory requirements that include required services that must be offered to eligible individuals. These required services under Medicaid include hospital and physician services, prenatal are, vaccinations, home health services, lab and radiological services, diagnostic services, preventive health services, and ambulatory services (MNT). This list is not all inclusive, but it represents a significant part of what Medicaid covers for those who qualify.

Medicaid Eligibility

The federal government oversees state Medicaid programs to ensure compliance with federal requirements and guidelines; however, each state is responsible for its own adherence. States must screen Medicaid applicants to be sure they are in a group that meets eligibility requirements such as low income, having dependent children under 6 in a low income household, pregnant women with low family incomes, and recipients of Supplemental Security Income. This list is not all inclusive but it shows the basic requirements for qualifying for Medicaid, based on need (MNT).

 

The Patient Protection and Affordable Care Act

This act is also known as Obamacare and was signed into law by President Barack Obama. It is an amendment to the United States healthcare system and is designed to insure all low-income Americans up to age 65 by decreasing healthcare costs and access problems. This act expands Medicaid coverage to more people. The expansion includes a minimum income eligibility level of 133% of FPL (federal poverty level). One significant change about this is adults without children, who fall below the FPL, will qualify for Medicaid insurance. This act also makes provisions for enrollment, an earlly option prior to 2014, maintenance, former foster care children, and family planning (Medicaid).

In addition, those people whose incomes are over the eligiility level may still quality for Medicaid on a medically needy basis. This is an option that allows for the extension of Medicaid eligibility to people in this group. There eligibility is calculated by a spend down option. This spend down amount is incurred by people in this group with medical expenses that exceed their income, as determined by their state’s medically needed income level.

Design of Medicaid Programs

According to the National Conference of State Legislature (NCSL), Medicaid is both a federal and state partnership program. Both entities share authority of the program, as well as financing of the program. On the federal level, the state Medicaid programs are monitored, based on how individual states manage their Medicaid programs. This includes service quality measurements, as well as measurements of delivery methods and eligibility criteria. In addition, with the onset of the Patient Protection and Affordable Care Act, the Medicaid program design has expanded that changes policies at the state level with specific provisions. State policymakers are charged with innovating the Medicaid programs in their states to improve quality and delivery of service (NCSL).

Conclusion

There are millions of uninsured or underinsured people in the United States because they cannot afford health insurance and previously did not qualify for Medicaid. The Patient Protection and Affordable Care Act has changed this dynamic and will allow more people to get the care that they need. Many would argue that healthcare is not just a privilege for those with a certain amount of money or a certain level of income, but it is a right that all Americans should have. Medicaid covers most physician, hospital, and dental services for those who qualify and gives various options for community-based care.

Some people may not understand the difference between Medicaid and Medicare. The difference is Medicare is associated with Social Security and is currently offered to people 65 years of age and over. Medicaid is not tied to Social Security and is for people up to age 65. This is significant because there are many people who are too young for Medicare, but may not qualify for Medicaid, except under the new Affordable Care Act. This will save many lives and help many sick people who suffer needlessly because they have nowhere to turn for healthcare services. Medicaid is there to help even more people with the expansion provided by the Affordable Care Act, and this will help decrease medical care costs throughout the United States, because many health problems can be averted because of prevention options available to those who previously had not option.

References

Medicaid. (n.d.). Affordable Care Act: Eligiblity. Retrieved from Medicaid.gov: http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html

MNT. (n.d.). What is Medicare / Medicaid? Retrieved from Medical News Today: http://www.medicalnewstoday.com/info/medicare-medicaid/

NCSL. (n.d.). Medicaid. Retrieved from National Conference of State Legislature: http://www.ncsl.org/issues-research/health/medicaid-home-page.aspx

 

Categories
Healthcare

Medicaid managed care plans

Medicaid is better known as Medi-Cal in the State of California and there are approximately six million people enrolled in various managed care plans, including but not limited to Anthem Blue Cross, Health Net, and LA Care (California Department of Health Care Services, 2013). As of 2011, the national enrollment statistics for Medicaid and managed care include approximately 23.1 million Americans, with a total Medicaid enrollment of 40.1 million people (Medicaid.gov, 2012). Therefore, almost 58 percent of all Medicaid users are enrolled through managed care plans (Medicaid.gov, 2012).

There are a number of different types of Medi-Cal managed care plans in the state, including the County Organized Health System, the Two-Plan Model, and the Geographic Managed Care plan (Medi-cal.ca.gov). The County Organized Health System is located in such counties as Monterey, Napa, Santa Barbara, and Ventura; the Two-Plan Model is located in Los Angeles, San Bernardino, Riverside, San Francisco, and other counties; and the Geographic Managed Care Model is located in Sacramento and San Diego (California Department of Health Care Services, 2013). The County Organized Health System is comprised of approximately one million enrollees, the Two-Plan Model has 3.6 million enrollees, and the Geographic Managed Care Plan has 600,000 enrollees (California Department of Health Care Services, 2013).

The manner in which Medi-Cal providers receive payments is important because it supports their revenue streams and continued growth, in spite of an increasingly competitive and regulated industry profile. The managed care organization must pay a capitation payment in order to participate and to accept Medi-Cal patients (Santa Clara County, 2013). In general, “in exchange for a comprehensive array of health care services at a fixed monthly premium, enrollees in managed health care plans typically face the choice of using participating health care professionals and facilities or incurring higher out-of-pocket costs for treatment” (National Council on Disability, 2013). This strategy is important because it demonstrates the need to remain as cost effective as possible when providing care to Medi-Cal patients throughout the State, regardless of the managed plan care plan that is used (National Council on Disability, 2013). In addition, it should be noted that “because Medicaid payment rates are generally lower than commercial rates, provider networks and access to out-of-plan services typically are more tightly controlled under Medicaid managed care plans than they are under employer-sponsored and Medicare Advantage plans” (National Council on Disability, 2013). In this manner, it is likely that there is a continuous push to obtain adequate reimbursements and timely payments for Medi-Cal benefits because they are provided at lower rates than other services (National Council on Disability, 2013).

The Medi-Cal system in the State of California is complex and challenging in many ways and requires expert knowledge and understanding to effectively navigate the system and its mandates. Due to the nature of the Medi-Cal system and its provision of services for lower income individuals and families, it is important to recognize that the necessity of the insured to provide a significant portion of the cost does not generally exist (National Council on Disability, 2013). In this context, it is observed that managed care organizations are required by state and federal laws to require their participants to contribute a very small amount of the costs associated with the provision of care and treatment for specific healthcare services (National Council on Disability, 2013). From this perspective, it is likely that the cost sharing component will remain low and consistent with current figures, there is a greater likelihood that the type of service providers will also be consistent and the willingness to seek out providers that are more expensive will be minimal (National Council on Disability, 2013). These efforts are important because they demonstrate the importance of keeping costs affordable for low income individuals and families who require Medi-Cal to begin with so that they do not face the burden of excessive costs and out-of-pocket spending (National Council on Disability, 2013).

It is believed that the managed care system and its primary subsets under the Medi-Cal system in the State of California are important providers of care and treatment to millions of residents throughout the state. The efforts made with the provision of healthcare access and services for low income individuals and families requires an effective understanding of the elements and opportunities that are available these residents when they require different types of healthcare services to meet their needs. At the same time, the provision of these services varies from one geographic region to the next, with three primary models in place to accommodate California residents who are categorized as low income.

It is expected that the provision of healthcare services will encourage the growth and development of new ideas and strategies to keep costs as low as possible, particularly since the passage of the Affordable Care Act, which places new mandates on insurance providers and managed care organizations of all types to provide affordable options for all individuals and families. These efforts must demonstrate that there are significant factors associated with obtaining adequate and consistent access to healthcare services that will emphasize improved quality of care and treatment for all persons in the State of California. Although Medi-Cal is designed for low income individuals and families, it provides many important benefits that must remain cost effective without compromising the integrity or the quality of care that is provided to patients. In this manner, managed care organizations within the Medi-Cal system must continue to explore their options to remain efficient and cost effective without damaging their reputations and running the risk of providing lower quality care and treatment to patients who require care in different forms.

References

California Department of Health Care Services (2013). Medi-Cal managed care enrollment

reports. Retrieved from

http://www.dhcs.ca.gov/dataandstats/reports/Documents/MMCD_Enrollment_Reports/MMCDEnrollRptMay2013.pdf

California Department of Health Care Services (2013). Medi-Cal managed care program fact             sheet. Retrieved from    http://www.dhcs.ca.gov/provgovpart/Documents/MMCDModelFactSheet.pdf

Medicaid.gov (2012). Medicaid managed care enrollment report. Retrieved from            http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/2011-Medicaid-MC-Enrollment-Report.pdf

Medi-cal.ca.gov. MCP: An overview of managed care plans. Retrieved from  http://www.google.com/url?sa=t&rct=j&q=medi-cal%20types%20of%20managed%20care%20plan&source=web&cd=3&ved=0CD0QFjAC&url=http%3A%2F%2Ffiles.medi-cal.ca.gov%2Fpubsdoco%2Fpublications%2Fmasters-mtp%2Fpart1%2Fmcpanover_z01.doc&ei=Jui4UcKMMcK6igLa8YBA&usg=AFQjCNEZrUg6lKxM8YqxKfztECMgviHXwA&cad=rja

National Council on Disability (2013). Chapter 1. An overview of Medicaid managed care.             Retrieved from http://www.ncd.gov/publications/2013/20130315/20130315_Ch1

Santa Clara County (2013). Health care options/managed care. Retrieved from http://www.sccgov.org/ssa/medical/mcchap15.pdf