TRICARE is the healthcare program for Uniformed Service Members and their families around the world. This program provides extensive to all beneficiaries, including: Healthcare plans Special programs Prescriptions Dental plans TRICARE Standard, is an option where that provides the most flexibility to eligible beneficiaries. It is the fee-for-service preference that gives beneficiaries the opportunities to see any TRICARE provider. Although, TRICARE Standard, is not available to active-duty members. Beneficiaries who are satisfied with the treatment they receive from a particular provider that may not be in the TRICARE provider network often choose to use TRICARE Standard. Retirees under 65 and their families, may live in ranges where the
According to Statistics Canada Report 2013, “life expectancy in Canada is one of the highest in the world” and it is expected to grow, making the aging population a key driver to our health-systems reform. By 2036, seniors in Canada will comprise of twenty five per cent of the population (CIHI, 2011). Seniors, those aged 65 years and older are the fastest growing population in Canada. Currently there are approximately 4.8 million Canadians aged 65 or greater. It is projected that this number will increase to 9 to 10 million by 2036 (Priest, 2011). As the population get aged the demand for health care and related services are expected to increase. Currently, the hospitals in Ontario are frequent faced with overcrowding emergency departments, full of admitted patients and beds for those patients to be transferred to. It has been reported that 20% of the acute care beds in the hospital setting are occupied by patients that do not require acute hospital care. These patients are termed Alternate Level of Care (ALC). ALC is “When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (Acute, Complex, Continuing Care, Mental Health or Rehabilitation), the patient must be designated Alternate level of Care at that time by the physician or her/his delegate.” (Ontario Home Care Association, 2009, p.1).
The Joint Commission is a nonprofit organization that focuses on improving the Healthcare system. They do this by regulating and evaluating health care organizations, helping them improve and give a more effective and safe care (The Joint Commission, 2012). The National Patient safety goals are ways in which the joint commission strives to improve the way health care is provided (The Joint Commission, 2012). Effective on January 1, 2012, the Joint commission came up with new ways to improve the Care of Medicare Based Long term Care facilities and provided Safety regulations to be followed. In order to better understand the impact that this regulations have in the healthcare, it is necessary to identify and describe the purpose of each regulation, and emphasize on the impact that falls in particular, can have among the geriatric patients.
This segment provides coverage for employees (and sometimes their families) who are on assignments for their companies in another country as well as individual policies for people visiting other countries. These policies include medical coverage and access to clinicians who can help with pre-trip planning based on the country of destination and can help locate providers in those countries. The customer service centers are open 24 hours a day, 7 days a week and can answer calls in eight languages. Aetna has also been able to build a network of providers and has direct settlement agreements with providers around the globe. (Aetna International, 2016).
In December 2011, Texas Health and Human Services Commission (HHSC) received federal approval of a Medicaid Section 1115(a) Demonstration Waiver, entitled “Texas Healthcare Transformation and Quality Improvement Program,” for the period starting with December 12, 2011 through September 20, 2016. The main objective of the 1115 Waiver is to improve access to and quality of health care by expanding Medicaid managed care programs and promoting health care delivery system reforms while containing cost growth. Specifically, the Waiver created two new pools of funding—Uncompensated Care (UC) and Delivery System Redesign and Innovation Payment (DSRIP) pools—by redirecting funds that were available under the old Upper Payment Limit (UPL) payment methodology.
Tricare is a health care program of the United States Department of Defense Military health system. Tricare is formerly known as the Civilian Health and Medical Program. Three plans from Tricare are Tricare Standard, Tricare Extra and Tricare prime.
Three examples of policies that do this are: Medicare, No Child Left Behind, and TANF, or the Temporary Assistance for Needy Families. Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and people of any age with End-Stage Renal Disease. There are four subcategories of Medicare. Part A is for hospital stays or, with certain restrictions, at-home care for a limited number of days. Part B is more like regular medical insurance.
Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPO), and Point of Service Plans (POS). `The information management system in a managed care organization is determined by the structure of the organization' (Peden,1998, p.90). The goal of a managed care system is to provide subscribers and dependants with needed health care services at the lowest possible cost. Certain managed care plans also focus on prevention by trying to keep members healthy.
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
The VA (Veterans Affair) Health Care System is one of the largest, most advanced health care networks in the U.S. The VA Health Care System is the provider for veterans, retirees and their dependents and manages all their health care needs. VA Health Care is actually part of the Department of Veterans Affairs. There is also the VA Benefits Administration which has to do with compensation and pensions. Then the other part of the VA is the National Cemetery Administration, which is in charge of the cemeteries and providing burial and memorial benefits.
Insurance is a matter of financial safety that all deserve, but taking on too much at once is a sure way for the economy to plummet. An affordable plan is for insurance companies to create the option of one more group’s coverage: senior citizens. Medications would become affordable, and the employer would pay less than the premium for a spouse’s coverage. Finally, companies will not have the risk of losing business. Comfort in old age can be a reality.
Patient safety one of the driving forces of healthcare. Patient safety is defined as, “ the absence of preventable harm to a patient during the process of healthcare or as the prevention of errors and adverse events caused by the provision of healthcare rather than the patient’s underlying disease process. (Kangasniemi, Vaismoradi, Jasper, &Turunen, 2013)”. It was just as important in the past as it is day. Our healthcare field continues to strive to make improvement toward safer care for patients across the country.
The public agencies such as CMS have periodically made drastic changes to their reimbursement policies. In 2003, the CMS began the hospital quality initiative and Home Health quality Initiatives ( Denisco & Barker, 2013). The hospital quality initiative mainly focused on Acute Myocardial Infarction (AMI), heart failure ( HF), and pneumonia( PNE). The home health quality initiatives also focused on quality measures for individuals receiving home care services ( DeNisco & Barker, 2013). In 2001 about 3.5 million disabled and elderly Americans received care from 7,000 Medicare certified home health agencies and about 3 Million elderly and disabled Americans received care from 17,000 Medicare and Medicaid certified Nursing Homes ( DeNisco & Barker, 2013). In 2004, CMS Nursing home Quality Initiative started 14 quality measures in the areas of delirium, pain( acute and chronic), incontinence, decline in activities of daily living, physical restraints, worsening of anxiety and depression, pressure sores, indwelling catheters, mobility decline, bedfast, weight loss and urinary tract infections( DeNisco & Barker, 2013). The National...
Universal Healthcare is implemented among three different types of systems: Single Payer, Two-Tier and Insurance Mandate. Through the single-payer plan, the government provides insurance for all residents (or citizens) and pays all health care expenses except for copays and secondary insurance. Providers can be public, private or a combination of both. The two-tier system involves the government providing or mandating insurance coverage for all residents (or citizens), while allowing those who can afford a secondary insurance receive better quality and/or faster access. Insurance Mandate involves the government mandate that all citizens acquire health insurance, whether from private, public, or non-profit insurers (Ghanta). In the United States, starting in April 2014, all citizens have to obtain health insurance (insurance mandate) through the Affordable Care Act. The Affordable Care Act was enacted to provide affordable and quality health care for all Americans. The law was signed by President Obama on Mach 23, 2010 and was upheld in the Supreme Court on June 28, 2012. There are fifty-eight countrie...
Medicare is the federal program that provides health coverage for people who are 65 and older (Green, 2003). Although many assume that Medicare provides long-term care, these benefits are very limited and are not efficient enough to accommodate the much needed care services for older adults. For example, Medicare programs do not help to pay for personal care services such as eating, dressing or using the bathroom even though these “activities of daily life” are the most needed services for most seniors (Green, 2003). These care services can be provided to seniors by the long term care insurance program. According to the national survey that was conducted among people who are 55 and older, just 36% believed that they would need long term insurance (Carter, 2008). However, it's estimated that at least 60% of people over age of 65 will require some long-term care services at...
Health care policies are plans that intended to determine or influence decisions or actions that will help to achieve specific health care goals. Most of these policies are actions taken by the government to improve the American health care system. The purpose of this essay is to describe the process of how a topic eventually becomes a policy and tie to how the Affordable Health Care Act (ACA) policy process. This essay will include the formulation stage, legislative stage, and implementation stage of a complete policy process.