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Final HPM5001

Final HPM5001

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Published by aholmes172
Final essay for Health Care in the United States, HPM5001 @ NYMC.
Final essay for Health Care in the United States, HPM5001 @ NYMC.

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Published by: aholmes172 on May 18, 2010
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10/24/2012

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Austin HolmesHPM5001 Spring 2010Professor Markenson
Final ExamDescribe the three major factors driving the change in our healthcare system to a more primary care based system. 
Due to its reliance on specialty care under an illness model, the U.S.health caresystem has become fragmented, quality has been compromised, and costshave risen beyond any other country (AAFP, 2010) . This has caused a
need or demand 
within our country to shift focus to a more primary care system.Studies have shown that systems reliant upon primary care have bettercoordinated care, increases in utilization efficiency, and decrease in over-allcosts (AAFP, 2010). In-fact, states within the U.S. who rely more heavily onprimary care consistently show lower Medicare spending, lower resource andinput utilization and higher quality of care and health outcomes, than theircounterparts.Studies have also shown that systems relying more heavily on primarycare cause an increase in
access to care
(AAFP, 2010). Certaindeterminants detrimentally influence a person’s ability to access care, andprimary care clinics, including retail clinics and community health clinics,have given people who would otherwise be unable to access care, the abilityto access care (RAND, 2009). Also, access to care can be as simple asconvenience of location and accommodation of patients needs, which retailclinics offer. With over a 1,000 locations in department stores (target, wal-mart, etc), grocery stores, or other locations, retail clinics offer the ability towalk-in whenever care is needed, and they offer deep discounted prices forthose who do not have insurance or have an insurance they do not accept(RAND, 2009). Accessing primary care through these clinics has literallybecome as easy as shopping.According to Shi and Singh (2008),
Managed Care Organizations
are the single most influential force of change within the U.S. health caresystem since the 90’s. As of 2006, over 90% of covered employees (thosewho receive their insurance through an employer) were enrolled in amanaged care plan. MCO’s single largest contribution to the shift towardsprimary care is the idea of gate keeping. All HMO’s require and some PPO’sincentivize the use of gate keeping, which is where a PCP must first be seenand authorization obtained prior to seeing a specialist. In HMO’s especially,the PCP is the main physician in charge of coordinating the patients care.Another contribution MCO’s have made to the shift towards primary careoccurred during the 80’s when MCO’s implemented a novel idea; coverage of preventative check-ups and annual physicals.
Summarize the 4 “A” concepts that are significant to a discussion of access to care.
 
 The four significant concepts determining access to care areaccessibility, affordability, accommodation, and acceptability.
 Accessibility 
is the ease of being able to receive care from a healthprofessional for a disorder or disease (Shi & Sing, 2008). Both geographiclocation and types of services influence accessibility (Markenson, 2010). Forinstance, a person in a rural community would likely have lower accessibilityto many services taken for granted by those in urban areas; however, ruralindividuals may have higher accessibility to some types of services due toshorter wait times and greater availability in a doctors schedule.Austin HolmesHPM5001 Spring 2010Professor Markenson
 Affordability 
refers to the ability of individuals to pay for neededmedical service (Markenson, 2010). If deductibles, co-insurances and/or co-payments are too high, access to care will diminish and utilization of care willdecrease in accordance with market theories and supply/demand curves (Shi& Singh, 2008).
 Accommodation
 
is a measure of how well a business adapts itspolicies and procedures to the needs of the population and/or its patientbase (Shi & Singh, 2008). For instance, if many of the patients work duringthe weekday, a Saturday clinic could be opened to meet the needs of thesepatients. An Inflexible schedule reduces accommodation, thus reducingaccess to care and inversely, a flexible schedule increases accommodation,thus increasing access to care.
 Acceptability 
 
refers to the openness of patients to receive care fromhealth care professionals. For instance, some patients only like to receivecare by either a male or female provider, or by a provider of a specific race(Shi & Singh, 2008). Also, wait times, and the doctors ability/desire to explainthe condition are both very influential factors in the patients acceptability of care being offered (Shi & Singh, 2008).
Identify which government agencies regulate the U.S. emergencymedical system and describe their responsibility.
 The emergency medical system can be broken down into two maincategories; normal emergency response and disaster response. There areagencies at the federal, state and local level to handle these responses, andin many an agency may be responsible for both type of responses.At the federal level, there are five (5) main agencies (NHTSA, 2009).First, the
Department of Transportation; National Highway Transportation Safety Administration Department of Emergency Medical Service
is responsible for creating standards and guidelines foreveryday EMS practice. Most importantly, this department is responsible forthe educational standards for emergency services personnel from firstresponders to paramedics and everything in between. Second, the
General 
 
Services Administration
.
deals with federal vehicle standards and isresponsible for all public emergency service vehicles, including ambulances. Third, the
Federal Communications Commission; Public Safety and Homeland security 
,
 
is responsible for regulating the communicationequipment used in emergency services vehicle and communication duringdisasters. Fourth
,
the
 
Department of Health and Human Services:Centers for Disease Control and Prevention
 
plays an advisory rule byissuing studies related to EMS and published a widely used and accepted asthe gold standard “field triage decision scheme.” They are also responsiblefor identifying biological and environmental threats and are responsible forresponse to these threats. Lastly, the
Department of Health and HumanServices: Office of Public Health Emergency Preparedness (OPHEP)
has the largest role in the regulation and implementation of the day to daypractice of Emergency Medical systems directly through its Emergency CareCoordination Center (ECCC). It also plays a coordination role during disasters.Each of the 50 states and the District of Columbia has its own,independent Health Department (NHTSA, 2009). In fact, within the U.S., thestate health department is the main regulatory body for both normalemergency response and disaster response. In the event of an emergency,federal organizations will only assist if asked to by the state. Statedepartments areAustin HolmesHPM5001 Spring 2010Professor Markensonalso involved in the creation of curriculums and training programs for EMSpersonnel within their state and EMS personnel must be licensed to practicein that particular state. In most cases, licenses are not transferable to otherstates, and recertification is necessary if an individual moves to a differentstate.Within the U.S., there are over 150 local EMS agencies and theseagencies are responsible for their communities (NHTSA, 2009). As needed,they add tailor EMS personnel’s scope of practice to the individual needs of the community, and in-order to practice within that community, EMSpersonnel must also register with the local agency.
The Medicare program (all parts) pays for a significant portion of health care that is delivered in the USA. Describe who is covered bythis program, its major components how it is financed andspecifically what coverage each part of the program provides.
 There are four parts to Medicare; parts A,B,C, and D. In-order for aperson to qualifyfor any part of Medicare, they must meet one of the following requirementsas described in the Social Security Act of 1965 (Shi & Singh, 2008); 1). Beover the age of 65. 2). Be a disabled individual who is entitled to Social

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