MHA 516 Consumer and Provider Costs Paper

MHA 516 Consumer and Provider Costs Paper

Order ID	53563633773
Type	Essay
Writer Level	Masters
Style	APA
Sources/References	4
Perfect Number of Pages to Order	5-10 Pages

Description/Paper Instructions

MHA 516 Consumer and Provider Costs Paper

STUDENT RESPONSE 1

BEATRICE O.

The way America determines who is “poor” is a continuous debated issue that affects many. Healthcare disparities with health insurance coverage, related to poverty, have been a long-standing issue in the United States and is also a big concern among policymakers and health care professionals. The Proposed rule I would like to review is the 2022 Federal Poverty Level Standard. The Department of Health and Human Services (HHS) updates the poverty guidelines at least annually and by law these updates are applied to eligibility criteria for programs such as Medicaid and the Children’s Health Insurance Program (CHIP). These annual updates increase the Census Bureau’s current official poverty thresholds by the relevant percentage change in the Consumer Price Index for All Urban Consumers (CMS, 2022)

According to Lin, (2021) Most people who care about measuring poverty—academics, policymakers, nonprofit leaders, and the like—agree that the way the federal government currently determines who is at the poverty level and who is not doesn’t work. The so-called “poverty line” was determined in the mid-1960s by calculating the amount of money it costs to buy a basic basket of food and then multiplying that amount by three. Each year the line is updated to account for inflation.

Cultural sensitivities regarding Poverty Level Guidelines are far and wide. When you take a look at culture with respect to ethnicity, religion, geographical location, and social groups they all have a different way of life that may affect the household expenditure. Therefore, having a poverty guideline can not possibly meet the standards with all cultural appropriations and affiliations. However, trying to adjust the guidelines to meet the needs for all cultures may become challenging but not an all out fail. All aspects of culture should be considered with making decisions in the health care industry.

 

 

STUDENT RESPONSE 2

CALANDRA P.

The proposed rule I will discuss is the “Coverage of Stand-alone Vaccine Counselling for Beneficiaries Eligible for EPSDT.” Some of the cultural sensitivities that need to be considered because of the rule are religious sensitivities. Certain religious groups decline treatment, and such groups cannot engage in vaccine counseling because they are likely to decline the vaccine. Social sensitivity is also essential, whereby it is important to consider that people from certain social groups and sexual orientations may take a different approach to vaccine counseling.

It is essential to consider all cultures in health care policies. The lack of culturally competent health care policies reduces patient participation. When the patients are unable to receive certain services because of their culture, this can lead to decreased patient safety. Some religions decline treatment; it is, therefore, essential to develop policies that work around traditional treatment plans (Brooks,2019). Policies should also consider people from all social groups and be provided with the same treatment options regardless of gender identity.

Some aspects of culture should be considered in the health care industry. Nurses should consider language barriers whereby some patients have specific preferred methods of communication, and it is, therefore, essential to arrange for an interpreter. It is also important to consider gender roles in certain cultures whereby women request less invasive treatments that make them comfortable (Henderson,2018). Different cultures also have different beliefs regarding their health care. For example, Caucasians have low pain tolerance and higher expectations of receiving the prescription, while people from a Hispanic background are less willing to take western medicines.

 

STUDENT RESPONSE 1

JENNIFER M

Hi Class,

As future healthcare leaders and administrators, we need to understand the topics of payer mix and population mix within the state and community we are working in and those of the organization we are employed at. The video titled How do public health care programs affect the way health care leaders manage organizations? shared great insight on the payer and population mixes. For example, in the United States, the payer mix can range from private insurance, private pay, and government programs such as Medicare (elderly) and Medicaid (low income). About population mix, it can vary from one organization to the other. The types of populations that receive care at an entity will affect payments for the services rendered. This in turn will allow healthcare leaders/administrators to provide pricing accordingly. (University of Phoenix, 2022).

As I have continued reading through the class novel I have learned more about the Hmong culture, Hmong refugees, the level of care they were receiving at MCMC, and government programs/publicly funded programs available to them. As Fadiman (1997) described in chapter 3, pages 24-25, MCMC accepted all patients, whether or not they could pay for services.

MCMC’s payer mix included the following:

-“Only twenty percent are privately insured, with most of the rest receiving aid from California’s Medi-Cal, Medicare, or Medically Indigent Adult programs, and a small (but to the hospital, costly) percentage neither insured nor covered by any federal or state program.”

-“The hospital receives reimbursements from the public programs, but many of those reimbursements have been lowered or restricted in recent years.”

MCMC’s population mix included the following:

-“Southeast Asian refugees began to move to Merced in large numbers.”

-“The city of Merced, which has a population of about 61,000, now has just over 12,000 Hmong.”

-“Hmong patients in almost every unit.”

-“The Hmong fail resoundingly to improve the payer mix-more than eighty percent are on Medi-Cal-but they have proved even more costly than other indigent patients because they require more time and attention.”

According to Dreger & Trembeck (2002), “More than 90 million Americans have limited literacy skills. Almost two million US residents cannot speak English, and millions more speak it poorly.” The Lee family was not able to communicate effectively with their care providers and vice versa. Based on the notes and/or documentation shared by the physicians, residents, nurses, and visiting nurses in chapter 5 one could see how the documentation lacked substance and emotional intelligence. The care team was very frustrated and took some of the encounters with the Lee family personally. “Patients who do not understand their plan of care do not comply with instructions and, therefore, suffer unnecessary complications. Health care providers who can communicate with their patients through multilingual, low literacy patient education materials and with the use of qualified interpreters markedly improve the quality of care for their patients and the resulting outcomes.” (Dreger & Trembeck, 2002).

While going through the chapters of the novel, I learned that the Lee family was welfare-dependent. They struggled to present their Medi-Cal card as they couldn’t even locate it at times. At one point, I had to stop to process everything that the Lee family was going through and the cultural and communication gaps that existed among the MCMC providers, care team, and the Lee family. In a sense, there was so much information overload for the family, let alone even understanding the intricacies of health insurance, coverage, and payment. In my humble opinion, I believe publicly funded health care programs do overrule cultural differences for the sake of providing a standard level of care. Once again, there is not a one size fits all approach. Within these healthcare programs, cultural differences and language barriers such as the ones experienced by the Lee family do have an impact on healthcare compliance. “The effect of health literacy on patient compliance is a recurrent theme in health literature. Patients who cannot read their prescriptions, medication labels, or written instructions for home care do not clearly understand their treatment regime; therefore, they do not follow it.” (Dreger & Trembeck, 2002). When the aforementioned occurs, serious consequences follow such as life-threatening complications.

 

Only one response was posted. Here is the other one

ARIES A.

Do public funded health care programs overrule cultural differences for the sake of providing a standard level of care? My answer to this question is no, I do not believe that health care programs choose on how they decide to give care to patients based on their cultural differences. Culture is a big part of healthcare how and all cultures should receive equality care, race, gender, and ethnicity should not play a part on how to treat a patient in need. In some families, cultural differences can play a part in how they choose to proceed with the type of health care service. “All cultures have developed systems of beliefs to explain the cause of illness, how illness can be cured or treated, and who should be involved in the health care process. In other words, every culture has beliefs about health, disease, treatment, and health care providers”. (Lake Park, 2017)

After reading about the Lee family, their cultural differences and language barrier did have an impact on how they were receiving care from the doctors. The providers also felt like Lia’s family was neglecting her when they stopped giving her medications that was supposed to help with her epilepsy. Based on the family’s culture and beliefs, they didn’t feel like the meds were helping but hurting their daughter, which is why they stopped it. Cultural differences can have an impact on healthcare compliance if the healthcare facility has not established culture compliance within the organization. ” A culture of compliance promotes prevention, detection, and resolution of instances of conduct that do not conform to government laws, public and private payor healthcare program requirements, and ethical and business policies”. (Strategic management services LLC, 2018)

MHA 516 Consumer and Provider Costs Paper

RUBRIC QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points:  Student failed to submit the final paper. 20 points out of 50:  The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50:  The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately.  Elements of the required response may also be lacking. 40 points out of 50:  The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples.  The answer is complete. 50 points:  The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples.  No aspects of the required answer are missing. 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And/or there is a significant use of highly questionable sources. 15 out 20 points:  Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented.  APA 6th Edition is used with only a few minor errors.  There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points:  Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented.  APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points:  Student failed to submit the final paper. 5 points out of 20:  The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors  10 points out 20:  The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20:  The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points:  The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points:  Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements.  The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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