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
Computer Science

Hypervisors

Although hypervisors are useful because they allow different operating systems to share a single hardware host, there are several technical advantages and disadvantages of using a hypervisor in an enterprise. According to vconsulting.us, hypervisors are what is responsible for making the Cloud possible. In addition, the advantages and disadvantages of hypervisors are dependent upon the types being used (Bredehoeft, 2012).

            Type 1 hypervisors are installed directly onto “bare-metal hardware” and they don’t require an additional operating system. There are several types of type 1 hypervisors and they include several names that are familiar even to people who don’t regularly deal with computers. These brands include VMware ESX and ESXi, Citrix Xen Server, Linux KVM, Microsoft Hyper-V, MokaFive, and XenClient. The advantages of using a type 1 hypervisor include installing on Bare-Metal Hardware so that the hypervisor is able to directly access the hardware, the system is thin so it is optimized to have a minimal footprint and enables us to give resources to the host, it is more difficult to compromise the system and therefore provides increased security, it is useful for testing and lab settings, it is capable of supporting more than one virtual machine on hardware, and hardware failures will not affect the operating system.

            There are also several disadvantages associated with using a type 1 hypervisor. Very large virtual machines are not supported (ex. 1000+ GB), it requires particular hardware components, there is a cost associated with the license or support, there is a bad console interface, and not every operating system can be run.

            Type 2 hypervisors are more of an application that can be installed on an operating system rather than directly on the bare-metal. Examples of type 2 hypervisors include parallels, VMware fusion and player, VMware workstation, VMware server, Microsoft Virtual PC, Virtual Box, Linux KVM, and Citrix Receiver. The advantages of using a type 2 hypervisor include their ability to run on a greater variety of hardware because the host operating system is controlling the hardware access, it has an easy to use interface, it can be run in a Windows operating system, it is good for lab testing and development, it allows the use of several operating systems within a single operating system, it creates an easier management paradigm for desktops which is useful for enterprises, it doesn’t have to provide hardware to every user so a company would be able to run their own, and data can be secured on the desktop.

            The disadvantages of type 2 hypervisors include decreased security because of interaction with the VM container and its ability to copy this for additional use, large overall footprint, the type 2 hypervisor must be installed in the host operating system which is straightforward but can sometimes become complex, there is a loss of centralized management, and lastly, type 2 cannot support as many VM’s as type 1 can.

            Microsoft (Hyper-V), VMware (ESXi), and Hitachi’s (Virtage) are commonly used hypervisors in enterprise. Hyper-V was formerly known as Windows Server Virtualization and allows for platform virtualization on x86-64 systems. The architecture of Hyper-V allows the isolation of virtual machines using a partition. At least one parent partition needs to be running Windows Server in order for the hypervisor to be able to access the hardware. Supported guest operating systems include Windows 7, Windows Server, Windows Vista, and Windows XP. This hypervisor has several disadvantages including the fact that it doesn’t support virtualized USB or COM ports, audio hardware is not virtualized by Hyper-V, optical drives virtualized in the guest VM are read only so it’s impossible to burn media to CDs and DVDs, there are reported issues with graphics performance on the host because the translation lookaside buffer is flushed frequently, Windows Server 2008 doesn’t support the maintenance of network connections and uninterrupted service during VM migration, there is a degraded performance for Windows XP users, link aggregation is only supported by drivers that support NIC teaming, and there is no support for home editions of Windows (Conger, 2012).

            VMware ESXi is a type 1 (bare metal embedded) hypervisor that is used for guest virtual servers that run directly on host server hardware. This hypervisor is unique because its placed on a compact storage device, which makes it different from VMware ESX. As previously stated, the VMware ESXi hypervisor’s architecture is built to run on bare metal. In addition, it uses its own kernel rather than a third party operating system. The VMware kernel connects to the internet using hardware, guest systems, and a service console. For VMware ESXi to be able to virtualize Windows 8 or Windows Server 2012, the hypervisor should be 5x or greater (VMware, 2004). There are several limitations of this system including infrastructure, performance, and network. The infrastructure requirements include RAM guest system maximum of 255 GB, a RAM guest system maximum of 1 TB, 32 hosts in a high availability cluster, 5 primary nodes in ESX Cluster high availability, 32 hosts in a distributed resourced scheduler cluster, 8 maximum processors per virtual machine, 160 maximum processors per host, 12 cores per processor, 320 virtual machines per host, and ESXi prior to version 5 will not suppor the latest Microsoft operating system Windows 8 and Windows 2012. The network limitations primarily involve the use of the Cisco Nexus 1000 distributed virtual switch and cause the following limitations: 64 ESX/ESXi hosts per VSM (Virtual Supervisor Module), 2048 virtual ethernet interfaces per VMWare vDS (virtual distributed switch), a maximum of 216 virtual interfaces per ESX/ESXi host, 2048 active VLAN’s (one to be used for communication between VEM’s and VSM), 2048 port-profiles, 32 physical NIC’s per ESX/ESXi (physical) host, 256 port-channels per VMWare vDS (virtual distributed switch), and a maximum of 8 port-channels per ESX/ESXi host (CISCO, n.d.). The performance limitations include an increase in the amount of work that the CPU has to perform in order to virtualize the hardware. According to VMware, the Virtual Machine Interface was developed to correct this issue using paravirtualization, although only a few operating systems support this program.

            According to storageservers, Hitachi offers the “world’s first server virtualization software capable of running on multiple instances” (storageservers, 2012). It has functions that will allow logical petitioning and is useful for multi-tenant style cloud computing. To initiate virtualization, the system integrates Kernel based Virtual Machine technology which runs on top of Hitachi Virtage and is a base for the Hitachi BladeSymphony Server Line. Since this product is relatively new, there aren’t many known disadvantages of the system so users will be selecting to use this hypervisor at their own risk. While the older hypervisors have many known limitations, there are some known ways to enhance these systems; when considering Hitachi Virtage, buyers should be aware that this is not the case. Despite this, the article argues that this hypervisor is useful for reducing the total cost of ownership because it uses server virtualization technology. The article also states that this hypervisor will have a high level or hardware stability and it is compatible with high level Linux systems. It is expected that as this system is used, it will continue to be upgraded and made to be more user friendly and meet the needs of the consumer.

            Certain use of hypervisors could lead to a decrease in total cost of ownership for enterprise. According to the TechTarget article “Time to consider multiple hypervisors?”, many companies are finding that using a single hypervisor isn’t enough for their data centers. Despite this, adding an additional hypervisor can add several risks, so it’s important to consider the advantages and disadvantages of using one hypervisor versus many (Bigelow, n.d.). One of the major reasons that the article argues for using a second hypervisor involves a decrease in the total cost of ownership (TCO) of an enterprise.  In 2010, TechTarget surveyed a series of information technology professionals about their hypervisor choices. They found that cost efficiency was a big issue for a majority of experts, and this drove their decisions; this was mainly a factor when participants wanted to consider an alternative to VMware virtualization. The reasoning behind this involved their need for more features and functionality, want improved interoperability, and desire to avoid a vendor lock-in; although VMware is a good hypervisor, it is expensive and the lock-in would lead to consistent purchasing of only VMware brand products which is a disadvantage if budgets are tight.

            Information technology professionals argue that the cost involved in hypervisor selection isn’t due to the actual hypervisor that is chosen and rather is involved with the virtualization management strategy. While companies that run uniform x86-based servers will be able to get by using a single hypervisor for a good price, they must keep in mind that it will not run as well or offer all of the features on the mainframe, RISC, or SPARC-based servers. Therefore, there is a need to develop a better hypervisor for these systems. To solve this issue, it is useful to use a single hypervisor for server visualization and a separate one for desktop virtualization. The article also notes that organizations may want yet another hypervisor to support their private clouds. In addition, utilizing several hypervisors can be cost effective depending on the company’s technological evolution and acquisition of these systems. For example, a company may start out with a basic hypervisor to suit their needs. As the company evolves and needs a hypervisor that can support different capabilities, they should switch the old hypervisor to a new function instead of replacing it altogether. Now the company will be running two hypervisors and be able to virtualize information more efficiently without wasting any money.

            Considering the direct cost of hypervisors is an additional issue in an enterprise. Most hypervisors are free to try and some even come with the Windows Server operating system. However, it is important to understand that acquiring a hypervisor costs more than just obtaining the software license. The cost comes into play mainly when considering the features that come along with the hypervisors in addition to the management tools needed to keep track of the virtual data center. In addition, running several hypervisors increases cost because more IT resources will be needed to support and maintain these platforms. As a consequence, enterprises that considers a second hypervisor need to carefully think about the features and capabilities of their second hypervisor. If the second hypervisor leads to more efficient or better performance in terms of computing, this will save the company money overall because they will be able to perform their basic job functions more accurately.

            Unfortunately, using a single hypervisor or multiple ones is not a one size fits all cost-saver across the board. Companies that use more data and have many systems will likely benefit from using multiple hypervisors while smaller companies that don’t require a lot of data will benefit from using only a single hypervisor. When considering total cost of ownership for hypervisors, it is essential that an enterprise takes all of its computing needs into consideration before making the decision. Additional costs that companies will have to consider before budgeting for one of many hypervisors is the cost of replacement for when they will need to purchase a new hypervisor to completely replace an existing one. They should calculate the costs that business disruptions will cause in addition to considering that data may be lost or that overall performance may decrease depending upon their hypervisor selection and the physical installation process.

            The implementation of hypervisors has a clear impact on system administration. If a company needs to maintain their current hypervisors, replace, or add a new one, the information technology department of their company will need to remain highly involved for several reasons. First of all, the system administration should review the choices they have for hypervisors and pick the ones most suitable for their company’s needs. It is unlikely that any other department would fully understand the technical implications of the hypervisor; depending on which one is selected, there may need to be changes in the operating systems that the company’s network is using in addition to installation of software that would be compatible with the hypervisor. In addition, even if the IT department isn’t responsible for physically installing the hypervisor, they need to be made fully aware of how it was installed and what to do to troubleshoot and optimize the system should the need arise. Lastly, the IT department would be responsible for deciding whether the company would be better off using a single hypervisor, multiple hypervisors, and which kinds.

            Since the system administration is generally responsible for computer and network safety, they should be especially concerned with using hypervisors. Although they can increase efficiency, they could potentially provide a security threat; therefore, additional system administration is essential in order to ensure that all employees know how to protect their company’s computers against these threats. Malware and rootkits can take advantage of hypervisor technology by installing themselves below the operating system which makes them more difficult to detect. In this situation, the malware is able to intercept any of the operations of the operating system without anti-malware software being able to detect it. While some information technology professionals claim that there are ways to detect the malware using a hypervisor-based rootkit, this issue is still up for debate (Wang et al., 2009). This technology is relatively new and we cannot truly be certain that these security issues can be removed.

            A second reason why the systems administration would require additional training would be due to the use of x86 architecture that is typically used in PC systems. Virtualization is generally difficult on this type of system and requires a complex hypervisor; to solve this issue, CPU vendors have added virtualization assistance to their hypervisors such as Intel products and AMD’s. These provide support to the hypervisor which allow it to work more efficiently. Other solutions to this issue include modification of the guest operating system to make system calls to the hypervisor using paravirtualization and the use of Hyper-V to boost performance. It is essential for the information technology staff to be aware of the price hypervisor their company is using in addition to any potential modifications that can be associated with it. Therefore, additional training and troubleshooting to resolve matters related to their hypervisors would be useful.

References

Bigelow, SJ. (n.d.). Time to consider multiple hypervisors?. SearchDataCenters. Retrieved from             http://searchdatacenter.techtarget.com/tip/Time-to-consider-multiple-hypervisors

Bredehoft, J. (2012). Hypervisors – Type 1/Type 2. Retrieved from http://vconsulting.us/node/24

CISCO. (n.d.). Cisco Nexus 1000V Series Switches Data Sheet. Retrieved from             http://www.cisco.com/en/US/prod/collateral/switches/ps9441/ps9902/data_sheet_c78-     492971.html

Conger, J. (2012). Video: Microsoft Hyper-V Shared Nothing Live Migration. Jason Conger     Blog. Retrieved from           http://blogs.technet.com/b/uspartner_ts2team/archive/2012/07/23/shared-nothing-live-            migration-on-windows-server-2012.aspx

Storageservers. (2012). Hitachi offers world’s first Server Virtualization software capable of     running on multiple instances. Retrieved from     http://storageservers.wordpress.com/2012/09/13/hitachi-offers-worlds-first-server-     virtualization-software-capable-of-running-on-multiple-instances/

VMware. (2004). Support for 64-bit Computing. Retrieved from Vmware.com

Zhi W, Xuxian J, Weidong C, Peng N. (2009). Countering Kernel Rootkits with Lightweight     Hook Protection. Microsoft/North Carolina State University. Retrieved from             http://discovery.csc.ncsu.edu/pubs/ccs09-HookSafe.pdf

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

 

Categories
Healthcare

Medicare Payment Mechanism

What is Medicare?

 

The Medicare payment mechanism is a national tool used to reimburse hospitals and physicians for Medicare services. According to the official U.S. Government website for Medicare, people 65 and over, or people with certain disabilities are eligible to receive Medicare, which is a federal health insurance program (Medicare). It is estimated that there are over 39 million people in the United States insured by one or both options provided by Medicare. If a person is eligible for the first option, he or she is automatically enrolled in the second option; however, the person has a right to cancel this. The first option is Medicare Part A, which is hospital insurance for people aged 65-years-old or older who are eligible to receive Social Security benefits. The second is Medicare Part B which is medical insurance. Medicare is funded by the payroll taxes of working people and employers, monthly premiums, general federal funds, and deductibles (Scarrow, 2002).

Categories
Business

HR problems/issues that you have personally been exposed

Human resource management is an intricate part of any organizational environment. Human resource managers do not have an easy task. A successful human resource management program requires continuous planning and organization. A human resource manager is responsible for recruitment and selection, training and development, compensation and benefits, ensuring fair treatment and legal compliance, using job analysis and performance management, employee fit and retention, and promoting workplace safety and health. With so many job duties, at times some aspects of the job description may fall through the cracks. There are many businesses that suffer from a poor human resource management department.

Categories
IT Management

A Key Concept in Information Systems

Introduction

Information is believed to be a key asset of any business today. No matter how exactly the business operates, disclosure of information to people that are not authorized to make changes to it or utilize it will be costly. The disclosure of information is a serious blow to any company, which may result in loyal customers’ loss, downgrade of the business’s reputation and image in the market, and considerable loss of business opportunities.

Categories
Psychology

Child Development in Negative Socio-Economic Situations

It is often said, and with great merit, that the most important years in a persons’ lifespan with regards to overall development occurs during the malleable years of childhood. A child is not only extremely impressionable and likely to replicate behaviors they see as normal or acceptable, but can be taught be nature to perpetuate these antisocial behaviors way past an age where a normal range of fluctuation is expected. When a child who has had a significant amount of trauma in their childhood, especially with reference to social (including racial status), economic, or emotional factors, negative results often ensue, and can carry these behaviors into later life situations–proving without a doubt that nurture is extremely important when considering child development and antisocial behavior during and after development.

Using Erik Erikson’s model of child development, between year one and year three a child develops their ability to want to try new things as a whole. Either emerging confident or withdrawn, this stage in development directly depends on the next stage, known as “initiative versus guilt”, and occurring between ages three and six. These two stages in particular are very important for interpersonal development as a whole (Oswalt, 2013).

The key is that how the child develops, whether receptive to trying to new things, or withdrawn overall, is extremely indicative of the direction the child receives. The “initiative versus guilt” stage is truly nothing more than an extension of the stage before it. With proper direction, at the ages of three to six a child should develop what is commonly known as a “child’s curiosity”, as well as the extent to which a child can interact with his or her peers. If this stage in development becomes misguided from the perspective of the parents of the teachers, a child can grow no sense of self-esteem at all, and thus harming their overall chances at any interpersonal relationships as they continue to grow older, and into more complex stages of development overall (Oswalt, 2013).

The ages between one and six are the most important from a developmental standpoint for a few key reasons. Because these are the ages that lay the foundation for a child’s development both socially and intellectually, children exposed to negative environments at these ages can have long-term consequences, including antisocial behaviors, an inability to interact with others, as well as a clear stunting of the specific intellectual areas of creativity, abstraction, as well as symbolism. Again, this directly correlates to the next developmental stage set forth by Erikson, called “industry versus inferiority” (Oswalt, 2013).

Industry versus inferiority, which occurs between ages six and eleven, has to do with self-esteem directly. Where the child is becoming more developmentally complex, as are the possible problems that can incur. These years are very important with regards to the amount of confidence a child will have–with their peers, and with authority figures. In addition, development in this period is truly the first time a child can separate social situations–whether it be with peers, at a home environment, or in school as at whole (Oswalt, 2013). There are many consequences of being developmentally deficient by this stage in Erikson’s model. The aforementioned continuations of antisocial behaviors are truly illustrated in this developmental phase.

The ability to separate social situations from one another creates an entire new dimension as far as development goes. Very often parents end up “surprised” at the bad actions of their seemingly perfect children. This directly correlates with the ability to differentiate social situations, because it is here that manipulation can be developed. A child can develop skills to adapt to different social situations, and respond accordingly. This is meant in both a positive and negative connotation–a child with a disturbed development simply may not possess the skills to understand the differences in social situations. On the other hand, a child can also become hyper-aware of this ability, and begin to use it for their benefit. A certain amount of this is expected, although to an extreme is not healthy either.

Although the model of Erik Erikson is old, it does apply today. In the article “Child Psychiatric Disorders”, the major factors of how a child can develop a psychiatric disorder correlate in many ways. The article names environmental factors as just as important as constitutional ones, or genetic and hereditary. In fact, the article goes one step further, and names the family life, school life, as well as the overall “community” as the direct environmental factors that have the largest impact of child development (Child Psychiatric Disorders, 2011).

Although Freud’s psychosexual model no longer holds much merit, it is still relevant to call on his concepts of id, ego, and superego with regards to development and especially development in lower socio-economic classes. Freud stated that all humans, from the time they are born, are instilled with selfish and carnal unconscious wants, which he called the id. A child eventually comes to terms with what is actually realistic, versus their selfish wants. This is called the sense of ego. Further along the developmental path, a child begins to take on the values of their own parents, which he called the superego.

Returning to “Child Psychiatric Disorders” now considering Freud’s model, even more regarding a child’s socio-economic situation with regards to development comes to light. The article lists some very relevant factors that contribute to the development of a psychiatric disorder in a child. The article cites marital problems, children with divorced parents, as well as children placed in a daycare as generally more susceptible to developing a psychiatric disorder. This is a direct play on the id a child develops–their sense of egotism can be released, or become imbalanced, as Freud would say, thus laying the foundation for an unhealthy psychological development. The child in these situations can feel neglected, and therefore become selfish as a natural reaction (Child Psychiatric Disorders, 2011).

The same article cites “parental deviance” as a major factor in the development of psychiatric disorders in children. This, again, can be applied to Freud’s model of id, ego, and superego to very effective results. Though the article narrows down “parental deviance” to just previous mental health problems in the mother, as well as the criminal record of the father, this can certainly be expounded upon. While a child is developing his sense of superego, or taking on the values of their own parents, this concept of “parental deviance” is very important indeed. If a child was brought up in an environment where antisocial behavior is either empirically shown, or, by and large encouraged, which is sometimes the case, the development of the superego can be tainted–and thus parents that present with antisocial behavior create children that turn out to be just as antisocial (Child Psychiatric Disorders, 2011).

Other major contributors to mental illnesses among developing children that can be tied to Freud are social and economic factors. “Child Psychiatric Disorders” names large family sizes, as well as children with fathers in unskilled occupations, as important factors in the development of mental illnesses (Child Psychiatric Disorders, 2011). Larger families, as well as unskilled labor, are two things generally attributed to a lower class, or economically strained, family. This can be damaging with regards to both Freud’s ego and superego. On one hand, the ego, which is supposed to be the healthy and realistic balance that one attains, can be damaged by self-attributed traits that go along with their socioeconomic status, such as the lack of a belief in social mobility. This lack of a true belief in social mobility can greatly affect the balance of how a child grows up viewing their own perceived realistic goals. This directly correlates with an imbalance in the superego. When children unconsciously take the traits of their parents, they may be unconsciously setting themselves back by not realizing their full potential, directly linked to development by Erikson’s model as well.

In 1975 sociologist Hollingshead revised his previous model to an updated “Four Factor Index of Social Position” used to do exactly what the title indicates. These individual socioeconomic factors are very important when taking the larger picture of development into consideration. In Hollingshead’s revised model of his own work, he named occupation, education, marital status, and gender as the four main factors that determine socioeconomic status (Gottfried, 1987).

Hollingshead’s model can be directly applicable to a child’s development. If nurture is indeed the thesis of this paper, it is important to consider the four-pronged model Hollingshead put forth with regards to the parents of the child. It has been proven thus far that the parents and other authority figures have a direct result on child development with two different models. All four of the main factors Hollingshead put forth–occupation, education, marital status, as well as gender–can define the socioeconomic status of the parents, and by applying Freud’s superego, can affect the development of their children (Gottfried, 1987).

Returning again to “Child Psychiatric Disorders”, this article even further proves the correlations made. Again, the article names large family sizes, children with fathers in unskilled occupations, previous mental health problems in the mother, as well as the criminal record of the father as important precursors to psychiatric problems in children (Child Psychiatric Disorders, 2011). Every single one of those precursors fall right into Hollingshead’s model of discerning socioeconomic status–occupation, education, marital status, and gender (Gottfried, 1987). This connection is truly vital to understanding socioeconomic situations and child development as a whole. Now, direct examples and applications can be given to further prove this idea.

On one hand, there is Child X–male, white, and from a wealthy family. He is enrolled in private schools where education is valued, his parents are happily married, and both successful professionals. His social skills are enhanced by his safe, and well-funded, neighborhood park and recreation system. He progresses on to another private high school eventually, again, well-funded and with high standards. His social skills proliferate through school-based functions.

Now consider Child Z. She is white, and lives in a poor neighborhood, in an urban setting. Her father left her and her mother when she was very young, and she attended an underfunded public school system. Her social skills are learned by a chaotic home and school environment–she has none of the normal recreational activities that Child X can take advantage of, because even allowing her to play outside is hazardous. This is how she grows up, and watches others around her grow up on a daily basis, most never escaping their impoverished situations.

The last child will be Child Y. First, imagine Child X and all his advantages in life. Now picture his life if he was black.

The fields of psychology and sociology in particular are in the minority where making generalizations is necessary to support research. Of course, there are plenty of instances where Child X ends up with a cocaine habit, living off his wealthy parents to support his habit. However, when considering Hollingshead’s model, as well as the works of both Erikson and Freud, it is a relatively safe assumption to make that Child X will be successful–some of course to his own merit, but much to do with the social and economic benefits he was born into.

Child Z is also very important in the general scope of this hypothetical. Again, there are plenty of people like fashion designer Damon John who have risen up out of destitute situations and controlled their own destiny. Again, for the psychological and sociological aspects, a safe generalization can be made that he is not the norm. Most born into these situations unfortunately never escape them, living a life of poverty. Again, applying Freud and Erikson, this vicious cycle is perpetuated during development during childhood.

Child Y is clearly the most interesting hypothetical for a child–purposefully placed to foil both of the other children. Had an African American been used as Child Z, the social and economic implications could not be explored. That is the inherent problem with regards to Child Z–her economic status, as well as her home life. She was crafted as the exact opposite of Child X. Child Y, given the exact same advantages as X, generally will make less money than white contemporaries, incur some kind of blatantly racist event over the course of his childhood, as well as his further isolation as a minority in the upper class. Our current President is an example of what happens when Child Y sees the injustices, and works that much harder to overcome them.

However, this is clearly not always the case. It is very likely, and it can be seen to this day, that Child Y would have seen the injustices in front of his face, and became bitter. He may feel isolated for being an African American in the upper-class, and struggle to find a sense of identity. This is a very real hypothetical–applying any model of development, it is clear that there will be some stunting of social growth, which can end up in a very different place than Child X, though afforded the same exact economic benefits.

This isolation that can be so frequently experienced in negative socio-economic situations, referred to so frequently during the course of this paper, has a direct correlation to the development of psychiatric disorders. According to a 1979 article published in the International Journal of Psychiatric Medicine, an acute feeling of isolation can take away from a child’s ability to individually define themselves without fear of being chastised. This development of one’s own identity, occurring in the latter years of development, would also be the same time in one’s life that they would be becoming acutely aware of their negative socioeconomic condition, furthering isolation (Adler, 1979).

As a whole, and for many reasons both internal and external, children who are forced to grow up in negative socioeconomic situations not only generally have a harder time moving through the stages of development, but are more likely to present with their own psychiatric symptoms later in life due to the interruption and detriment to a full development.

 

Resources

“Aloneness and Borderline Psychopathology: The Possible Relevance of Child   Development Issues.” National Center for Biotechnology Information. U.S.             National Library of Medicine, n.d. Web. 01 June 2013.      <http://www.ncbi.nlm.nih.gov/pubmed/457345>.

“Child Psychiatric Disorders.” Child Psychiatric Disorders. N.p., n.d. Web. 01 June      2013. <http://nursingplanet.com/pn/child_psychiatry.html>.

Gottfried, Allen W. “Measures of Socioeconomic Status in Child Development Research:         Data and Recommendations.” Jstor.org. Merrill-Palmer Quarterly, n.d. Web. <http://www.jstor.org/discover/10.2307/23086136?uid=3739256&uid=2134&uid            =4581319437&uid=2&uid=70&uid=3&uid=4581319427&uid=60&sid=2110235          2024317>.

“Gulf Bend MHMR Center.” Gulf Bend MHMR Center. N.p., n.d. Web. 01 June 2013. <http://www.gulfbend.org/poc/view_doc.php?type=doc>.

Papalia, D.E. & Feldman, R.D. (2010). A Child’s World: Infancy through Adolescence (12th ed.). New Jersey: McGraw Hill.

 

 

 

Categories
Psychology

Family and Substance Abuse Paper

One of the most serious problems pertaining to substance abuse in the family is drug abuse by adolescents. The literature has identified a number of documented risk factors that are predictive of a young person’s likelihood of abusing illegal drugs. These factors range from individual factors, such as tendencies towards aggression and stimulus-seeking, to family factors, such as abusive, inept, or simply uncaring parents, to school and social influences, such as poor academic performance and associations with other antisocial and maladjusted young people. Fortunately, there are a number of treatments that have been studied and found to be efficacious in the treatment of drug abuse in adolescents.

To a considerable extent, drug use in adolescents can be predicted by a number of risk factors. The first group of risk factors are individual risk factors, pertaining to aspects of the individual’s personality and disposition (National Institute on Drug Abuse [NIDA], 2003, p. 6). A very important individual risk factor is out-of-control aggressive behavior, which may manifest even in very young children, and is often at least partially controlled by genetics (p. 6). If this behavior is not corrected properly, it may lead to further dysfunction in school and with peers, which in turn may contribute to such individuals turning to drugs in adolescence (p. 6). Another important risk factor is sensation-seeking: young people who display high thrill-seeking behavior and low inhibitions may be innately predisposed to seek out new experiences and new stimuli (Milkman & Wanberg, 2012, p. 40). If unchecked, these tendencies may lead them to experiment with drugs (p. 40). Adolescents with depression may also be at risk of abusing drugs, turning to them as an attempt at self-medication (p. 40). Conversely, young people who learn control and a health discipline, and who have a positive self-image, have been shown to be less at risk of abusing drugs (p. 40).

Of course, this touches on other categories of risk factors, such as familial influences: children who grow up with parents who are uncaring, inattentive and ineffective are certainly at greater risk of turning to drugs (NIDA, 2003, p. 8). Other parental influences that contribute to adolescent drug abuse include parental substance abuse, mental illness, criminal behavior, and a chaotic and even abusive home environment (p. 8). Parents who are physically or sexually abusive often produce adolescents who abuse drugs (Milkman & Wanberg, 2012, p. 66). Conversely, parents who are attentive, caring, and exercise their authority by setting boundaries and maintaining a certain amount of discipline tend to raise young people who are at much less risk for drug abuse (NIDA, 2003, p. 8). In sum, the type of environment that an adolescent experiences in their family and home life plays a major role in determining whether or not they are likely to abuse drugs (p. 8).

Other possible risk factors are found in adolescents’ social environments outside the home (NIDA, 2003, p. 9). Teenagers who engage in aggressive and/or impulsive behavior in the classroom are at higher risk, and related factors, which often cluster together, include poor academic performance, poor social coping skills, and associating with other young people with behavioral problems such as drug abuse (Milkman & Wanberg, 2012, p. 43; NIDA, 2003, p. 9). Young people who associate with antisocial peers are at elevated risk of drug abuse: in fact, this is the single strongest predictor that an adolescent will use drugs. By contrast, young people who are well-adjusted and well-behaved, work hard in school, and spend time with other young people who are similarly well-adjusted are at much lower risk of abusing drugs (Milkman & Wanberg, 2012, pp. 43, 65-66; NIDA, 2003, p. 9).

There is a rich literature on interventions for adolescent drug abuse. Individual, interpersonal therapies are commonly used, notably cognitive-behavior therapy (CBT) and motivational interviewing (MI) (Feldstein & Miller, 2006, p. 638). Both CBT and MI have been correlated with successful reductions of adolescent substance abuse (p. 638). Other therapies target parental behaviors, based on the observation that parental influences play a considerable role in predicting an adolescent’s risk of substance abuse (p. 638). Family interventions are also used, based on the recommendations of some researchers for multi-level interventions in cases of adolescent drug use (p. 638).

Parental involvement is a very important factor to consider in the evaluation of efforts to treat adolescent substance abuse, and as Bertrand et al. (2013) explained, has long been a predictor of successful interventions: when parents participate actively and are attentive to the needs of their adolescent children, the outcomes of the intervention are correspondingly more efficacious (pp. 28-29). However, surprisingly few studies have examined how improvements in parenting style could in turn facilitate positive outcomes for adolescents who are abusing drugs (p. 29).

Bertrand et al. (2013) found evidence for precisely such a correlation. In a study of treatment outcomes for adolescents who were abusing drugs, as well as the parenting styles and practices of their mothers, Bertrand et al. found that the adolescents significantly reduced consumption of drugs from the time that they were admitted to a drug treatment clinic to the three-month follow-up (pp. 31- 32). The pattern largely held to the six-month follow-up, although there was a slight regression (pp. 32-33). At the same time, the psychological distress levels of the mothers declined as well (p. 33). Moreover, the adolescents’ perceptions of self-disclosure improved, although adolescents’ reported scores of parental warmth did not change (p. 33). What this study established was that increases in the mental health of parents, coupled with greater use of relevant services, are correlated with decreased substance abuse on the part of young people (p. 33). This effectively demonstrated that there is a link between improved parental practices and improved treatment outcomes for adolescents (pp. 33-34).

Although adolescent drug abuse is a widespread problem in American society, it is especially of concern in low-income inner-city neighborhoods, which often have predominantly minority populations (Collins, Ready, Griffin, Walker, & Mascaro, 2007, p. 430). The reason for this is that youth from these populations are over-represented in the criminal justice system (p. 430). There are also important concerns about the state of current knowledge regarding substance abuse by African American youth: while surveys and studies indicate that they are not particularly more likely to abuse substances than their white peers, the argument has been advanced that perhaps substance abuse is being underreported by African American youth (p. 432).

In light of these concerns and evidence that minority populations are less likely to use mental health and substance abuse treatments, Collins et al. (2007) examined the outcomes of a specific intervention plan, Drug Abuse Treatment and Education (DATE), implemented in a setting wherein most clients were adolescent African American males from low-income communities (p. 434). Typically, clients are referred by the juvenile court system, and often have Disruptive Behavior Disorders as well as substance abuse issues (p. 434). Other problems include poor educational performance, any number of psychosocial stressors, family violence, and parental substance abuse (pp. 434-435).

In order to address these many sources of dysfunction, DATE involves the family through a special intervention called Family Power (Collins et al., 2007, pp. 435-436). Family Power encourages family involvement through the lens of multidimensional family therapy (MDFT), an ecological approach that seeks to address dysfunction in relationships between family members, and correct it (p. 436). Problem-solving is a key aspect of this approach: both the young people being treated and their families are encouraged to engage with their problems and find positive, constructive ways of resolving them (pp. 436-437). Although some of the results have been promising, high rates of incompletion (63%) raise concerns that the program is not entirely sensitive to the needs of these families, and that the court orders may have created an unfortunate power differential between therapist and client (pp. 437-438).

A very important finding in the literature on adolescent substance abuse is that adolescents who acquire generic life skills tend to evince at least short-term reductions in the use of drugs (Stoil, Hill, Jansen, Sambrano, & Winn, 2000, p. 379). These ‘life skills’ include things like “problem-solving skills, decision-making skills, resistance skills against adverse peer influences, and social and communication skills” (p. 379). The importance of these skills lies with their facility in teaching young people to confront what are often difficult situations, and to make the decision to reject drug use, making this a proven strategy for prevention (p. 379).

However, contrary to some of the older research from the 1960s and 1970s, there is no consistent pattern characterizing the relationship between self-esteem and substance abuse, with both measures being self-reported (Stoil et al., 2000, p. 379). In some studies, improved self-esteem is correlated with reduced drug usage, while others show no change in drug usage whatsoever, and a few have even shown a correlation between lower self-esteem and reduced drug use (pp. 379-380). This suggests that self-esteem and tendencies to use drugs are two very different things, and any relationship between them is highly variable, differing considerably between individuals.

An encouraging finding, however, regards the efficacy of strategies that involve strong interactions between therapist and patient (Stoil et al., 2000, p. 381). Strategies such as “interpersonal counseling, mentoring, and other forms of intensive interaction” are among the best, and most well-supported (p. 381). The reason is not difficult to parse: the literature indicates that these strategies work, because they focus on the underlying factors and help young people to improve their performance in school, decrease their associations with antisocial peers, and generally improve their attitudes and outlooks on life (p. 381).

Therapies for adolescent substance abuse are growing in sophistication and efficacy. As Winters, Leitten, Wagner, and Tevyaw (2007) explained, over the course of the past two decades a great change has taken place in the field of treating adolescent substance abuse: no longer are young people treated with interventions designed for adults; instead, they are enrolled in programs that are better informed by the developmental literature (p. 197). And the literature supports this paradigm change: the evidence clearly indicates that young people do better in programs that are specifically designed for their needs and capacities (p. 197). However, treating young people for substance abuse disorders still causes a great deal of strain on community health resources, highlighting the importance of community-based interventions, notably school-based interventions (p. 197).

For school interventions to be successful, Winters et al. (2007) argued, seven factors must be observed. The first factor concerns the importance of “timing, duration, frequency, and intensity of exposure”, all of which will determine how effective the intervention can be (p. 198). The school setting is a good venue for such interventions, because it can often catch drug abuse early, and this good timing can increase the efficacy of the therapy considerably (p. 198). However, the interventions still need to be designed with the appropriate duration and intensity: if the student does not experience the intervention for long enough, and it is not intense enough methodologically, the efficacy of the intervention will be compromised accordingly (p. 198).

The second factor concerns the fidelity with which the intervention is implemented: interventions that are not carried out correctly will typically lose therapeutic power (Winters et al., 2007, p. 198). Standardization is key if an intervention approach is to succeed in a school setting. The third factor, which is closely related, concerns the relationship between the school and the staff who are implementing the program, whether the staff are from outside the school or not (p. 198). The key here is proper training and orientation for all members of the staff involved with the intervention program (p. 198). Any role conflicts, and the possibility of role overload, must also be taken into account (p. 198).

The fourth factor concerns recognition and awareness. If the program is to succeed, it is an imperative that everyone involved with it understands fully why the program is important in the first place: in other words, they must be aware of the problem and committed to changing it (Winters et al., 2007, p. 198). Proactivity is the key if the program is to succeed: the staff who carry out the program must be extremely proactive about getting absolutely everyone to ‘buy into’ the program (p. 198). What this means is that they must be prepared to do everything in their power to reach out to the students, communicate with them, and ensure that the program comes across as relevant to their needs and their perspectives (p. 198). For school administrators, the program must appear to be effective and efficient (p. 198).

The fifth factor for a successful intervention is a clearly written policy (Winters et al., 2007, p. 198). While it may be a truism to observe that drawing up a policy on paper is not the same thing as observing it in practice, the importance of a clearly written policy is considerable: it provides a guiding document for all subsequent efforts, a blueprint of what the school is hoping to achieve through the program (p. 198). This helps to ensure consistency as well as clarity of purpose and focus.

The sixth factor concerns the importance of social ecology: if an intervention is to truly succeed, it must be connected with other aspects of students’ lives (Winters et al., 2007, p. 198). This is absolutely crucial: the best interventions draw on the social ecology of a student’s many interconnected relationships with friends, family members, and neighbors (p. 198). Involving such relationships goes a very long way towards ensuring that the changes produced by the intervention will be real and meaningful, enabling them to endure long-term rather than for just a season (p. 198).

And seventh, building off of point six, the effectiveness of any intervention is always maximized when the person is able to carry out their changed condition in their natural social environment (p. 198). Engaging programs will help young people to learn important ways to do this, including finding and cultivating positive friendships with peers who will help them to reinforce behaviors that will keep them away from drugs (p. 199). By so doing, the adolescents will derive the maximum benefit from the interventions, helping them to stay clean and away from drug abuse (p. 199).

Adolescent substance abuse can be predicted by a number of factors pertaining to individual disposition, behavior, and the familial and other social environments. However, just as importantly, those same influences can be used to help young people overcome drug abuse, or even to prevent them from experimenting with drugs in the first place. Indeed, family support in particular is of fundamental importance for preventing drug abuse and helping young people to overcome it. What successful interventions all seem to have in common is their ability to engage young people, and/or their parents and other people around them: in other words, the interventions are seen as relevant, and teach important skills. By this means, young people can learn the kinds of positive, pro-social skills that they need to avoid drug abuse.

References

Bertrand, K., et al. (2013). Substance abuse treatment for adolescents: How are family factors related to substance use change? Journal of Psychoactive Drugs, 45(1), pp. 28-38. Retrieved from http://search.ebscohost.com/

Collins, M., Ready, J., Griffin, J., Walker, K., & Mascaro, N. (2007). The challenge of transporting family-based interventions for adolescent substance abuse from research to urban community settings. The American Journal of Family Therapy, 35(5), pp. 429-445. DOI: 10.1080/01926180601057515

Feldstein, S., & Miller, W. (2006). Substance use and risk-taking among adolescents. Journal of Mental Health, 15(6), pp. 633-643. DOI: 10.1080/09638230600998896

Milkman, H.B., & Wanberg, K.W. (2012). Criminal conduct & substance abuse treatment for adolescents: Pathways to self-discovery and change (2nd ed.). Thousand Oaks, CA: SAGE Publications, Inc.

National Institute on Drug Abuse. (2003). Preventing drug use among children and adolescents: A research-based guide for parents, educators, and community leaders (2nd ed.). Bethesda, MD: U.S. Department of Health and Human Services.

Stoil, M.J., Hill, G.A., Jansen, M.A., Sambrano, S., & Winn, F.J. (2000). Benefits of community-based demonstration efforts: Knowledge gained in substance abuse prevention. Journal of Community Psychology, 28(4), pp. 375-389. Retrieved from http://search.ebscohost.com/

Winters, K.C., Leitten, W., Wagner, E., & Tevyaw, T.O. (2007). Use of brief interventions for drug abusing teenagers within a middle and high school setting. Journal of School Health, 77(4), pp. 196-206. DOI: 10.1111/j.1746-1561.2007.00191.x

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