The U. S government sponsors a national health insurance program managed by the social security administration. This national health program is referred to as Medicare. The Medicare is generally available to all U. S citizens aged sixty five years and above and the young disabled persons. Since Mrs. Zwick has Medicare part A she will therefore get service benefits on the cost of her stay in the inpatient hospital, the skilled care nursing home and the rehabilitative services she received from the skilled nursing home. She will also get benefits on the cost of pain relief and symptom management during her stay in the hospital. Further more she will benefit from the hospice services and part-time in home skilled nursing care considering she will still need to spend more time in Hospital.
Medicare part B covers certain medical and outpatient services. Due to this fact, Medicare part B will meet 80 percent of Mrs. Zwick incurred costs on outpatient hospital procedures followed, the lab tests carried out on her and the diagnostic tests undertaken to determine her condition and health status. Since Mrs. Zwick was given a lot of drug prescription on drugs for relieving pain and her symptoms kept under management upon her discharge from the skilled home care, she will have to pay for twenty percent only of the cost of these. The other eighty percent is covered by Medicare part B. Lastly, the walker given to her since she was still weak during the time of her discharge falls under Medicare part B and therefore she will to pay 20 percent of the total cost.
Medicare part D particularly offers drug coverage to each and everyone with the Medicare. As such, Medicare part D will meet the cost of prescribing and buying drugs to Mrs. Zwick. Also Medicare part D will provide a protection to Mrs. Zwick against higher costs of drugs in the future and so she is protected against any future expenses on drugs.
There is Medicare policy in US that are meant to help those people who have reached part D. There is a policy called the Patient Protection & Affordable Act that is meant to help those who have reached part D to meet their medical bills. The policy offers a $ 250 rebate for people like Mrs. Zwick with prolonged stay in the Hospital due to a hospital-acquired infection. Additionally an additional provision of the health legislation that was enacted in 2011 offers individuals like Mrs. Zwick a 50% discount on brand name prescription drugs.
It is apparent that a number of events do occur throughout a career life ranging from job changes to a complete lose of job. There is need therefore to have a law that helps and protect guarantee individuals health coverage especially in event of job lose, considerable diminution in the number of hours worked and during times of job transition. US has developed a number of intervention measures by coming up with agencies that would take care of the above mentioned requirement. One of the agencies is the concentrated omnibus budget reconciliation (COBRA). It has the authority of taking care of health needs of gives all the workers who lose their health benefits.
There are a number of factors that can cause members of the family to lose the group health coverage that calls for the right to concentrated omnibus budget reconciliation coverage. The COBRA intervene in cases where the covered employee terminate his or her job or when covered employee is terminated on grounds of Medicare. Since Davis was working in a factory with 100 employees and was terminated on grounds of Medicare and no evidence whatsoever of cross-misconduct, he is fully allowed by COBRA to continue his insurance coverage while he is out of work. This is because it is a mandate of COBRA to handle issues related to Davis case.
In general, health care benefits provide better coverage for acute disease cases compared to the ongoing care. Medicare covers only some services while leaving out some medical services such as those needed by the beneficiaries suffering from Chronic illnesses like Davis and most prominently on the provision of drugs. Furthermore, the some medical insurers use certain medical definitions in determining whether the patients are legible to reimbursement. In most cases, insurers restrict their reimbursement to cases where the patient is showing improvements.
Therefore, services designed for patients like Davis may not have services that slow the progression of the chronic illness should be covered. Persons with chronic illnesses spent more out of their pocket in cost sharing and coinsurance. Such patients are eventually left in a state of poverty and bankruptcy. Since chronic diseases takes a very heavy toll on health and cost vast amounts of money, many persons with chronic illness die when they are unable to support themselves any more. In the events where such patients do not have sufficient funds to contain or improve their condition, the state is forced to come in to improve the quality of life. The state faces a lot of challenges in trying to make budgets in order to meet the demand of such patients and design the best cover for them. The state faces a lot of economic challenges and strains in meeting the costs of treating of chronic illnesses. This takes the form of medical resources needed for the patients with chronic illnesses, negative effect on the labor supply to the state which translate to low GDP and hence a drag on the long-term economic growth.
There is need by the state to closely monitor chronic diseases and issue preventive and control programs in order to gap this nightmare. The state should regularly and in a systematic way be able to collect, asses, analyze and come up with viable results of the health status of her citizens. From this epidemiologists on chronic diseases will provide the expertise and skills needed to carry out recommendations through a chronic disease program. This way the chronic diseases epidemiology capacity is kept at low levels. There is need centre for disease control and prevention, council of state and territorial epidemiologist and association of state and territorial chronic disease program directors to work in unity to address the concerns about chronic diseases . This will help the state health departments in defining the highest main concern functions and the duties of chronic disease epidemiologist in their agencies. This will give the state ability to fully utilize epidemiology and therefore reduce its burden of chronic diseases.
Just as Mr. Davis claims that he was better to be in another state, it is clear that his argument were true particularly when one compares the way United States and nations such as Great Britain, Japan, Germany or Switzerland conduct their operations. Available sources show that there is a significant difference in the manner in which the healthcare system in Great Britain differs with that of United States. It is clear that the way medical charges in U. K are made differ in greater extend with the way one could have done in United States. U. K has a single-payer system that has enhanced the access to the healthcare to many. The system enables the children, unemployed and retired individuals to access healthcare services anytime without major procedural and bureaucratic measures.
Available sources indicate that U. K has single-payer system that greatly simplifies billing and collections. In other words, the financial management issues and healthcare and environment differs to a greater extend in the two states. U. K healthcare management system is constantly looking for ways of reducing costs while still trying to provide high-quality health care. Consequently, the accessibility of health care services by citizen in U. K is better as compared with United States. This means that if MR. Davis was in Great Britain, his problem could have been resolved easily. He should not have gone through financial stress as described in the case.
One of the striking differences that distinguish the health care system in U. K and in U. S. is the fact that the healthcare providers in United Kingdom does not issue bills to individuals for services offered. This means that the medical bills are not an individual matter. United Kingdom has local strategic health authority that works on behave of the individuals in ensuring that their medical care bills are catered for. The local strategic health authority receives funds from primary care trusts. The local strategic health authority and primary care trust offers funds to healthcare facilities that correlate to the demographic and population data. The amount that the healthcare facilities receive depends on the demographic and population data. Consequently, one can access health care services in Great Britain easily.
Coverage for medication in US
The medication coverage in U. S is also relatively low as compared to states such as Japan. Available sources reveal that Japan has a well-established medication coverage that is precipitated by the fact that Japan has come up with several programs that are meant to promote the extent of medication coverage. They have Birth control guidance, mass examination and regular check-ups for early detection of chronic conditions such as hypertension, cardiac disease, diabetes and other forms of chronic conditions. The major difference between the medical care in Japan and United State can be inferred from the average life expectancy of the two nations. Sources state that the life expectancy in Japan is about 77. 16 years for men.
On the other hand, the life expectancy in United States is 73. 8 years for Caucasian man. Research shows that Japanese do not experience medical problems as compared to the citizens in U. S. A. this is because Japanese medical care cost are relatively much less than in the USA. In fact it is shown that the surgical operation rates in Japan are about one-quarter of those in the USA. One of the reasons why the medical care cost is relatively less in Japan is that the ministry of health and welfare control has an obligation of ensuring that majority of people especially those who have less influence in their health such as children, elderly, and retired are able to access health care with ease.
The ministry and welfare control has devised a way of ensuring that the elderly can access the medical care with relatively lower charges. Additionally, Japan has a well established universal health insurance system. The system is controlled by Japanese government. This system allows anyone to get medical services in the outpatient department of most hospitals. Such insurance system has helped the elderly so much because virtually all their medical cost is taken care of.
Requirements to get referrals to see specialist in US
Available sources indicate that the specialist services in US are limited and that they operate under the Federal rules. This means that any person intending to see a specialist must follow a given set of procedures set by the federal laws. In US, there is what is called Federal ant kickback statute. This is a body that ensures that people follows the right procedures in their attempt to see the specialist. It squarely implicates a call center or organs that offer referral services without their consent. Any organ that violates the Federal antikickback statute would be fined heavily in an amount of about $ 25, 000 per violation. At extreme, the party involved in violation may get excluded from Medicare, Medicaid and any other federally funded healthcare programs. This implies that any person wishing to see the specialist must follow a certain procedures called federal safe harbor. Safe harbor enables the participants and a referral service