Assignment 4: Funding Health Care Services
You are a senior advisor of XYZ Health Care Organization and have been tasked with making a recommendation regarding how health care expenses associated with the following services should be funded within your state. The recommendations made will then be a part of a proposal that will be shared with state legislators. Consider all the approaches to health care funding covered in this course when completing this assignment.
Write a three to four (3-4) page paper in which you:
Recommend how ambulatory services should be funded.
Recommend how continuum of long-term care services should be funded.
Recommend how mental and behavioral health services should be funded.
Your assignment must follow these formatting requirements:
Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; references must follow APA or school-specific format. Check with your professor for any additional instructions.
Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required page length.
The specific course learning outcomes associated with this assignment are:
Analyze the different ways of financing the health care system and the impact on individuals.
Use technology and information resources to research issues in health services organization.
Write clearly and concisely about health services organization using proper writing mechanics
Approaches to Health Care Funding
Introduction
A majority of the countries possess virtually universal or universal arrangements through which the citizens’ health care is funded. The universal cover is usually provided via a wide array of mechanisms including explicit insurance arrangements (combination of private and public moneys), taxation-funded implicit insurance, and self-provision. Private health insurance also has a great role in funding for healthcare services. Although this form of insurance is given a central role in some countries, others consider public healthcare funding system to be the cardinal provider (Gröne & Garcia-Barbero, 2011). On the same note, the role and extent of out-of-pocket forms of funding varies considerably. Therefore, there are various methods through which healthcare services can be funded. This paper aims at discussing funding of ambulatory; continuum of long-term care; and behavioral and mental health services.
Ambulatory Services
Presently, in the United States, ambulatory care is becoming a cardinal component of healthcare. As a result of technological progress, a majority of the treatments that were previously provided in hospitals can now be accessed from ambulatory settings. The shift to ambulatory care, although a positive move towards more appropriate and less expensive health setting, has had providers struggling to adjust to the rapid technological developments as well as complex, novel reimbursement systems. This issue is particularly more pressing to safety net providers who serve uninsured, low-income patients and experience constraints from their funding sources (Diehr & Evashwick, 2004).
Since a majority of these services are offered outside the hospital setting, out-of-pocket payments can cater for the larger percent of the costs. There can also be Medicare reimbursements for ambulatory care facilities and this should be inspected and regulated by federal governments so as to ensure that standardized payments are made. State Medicaid programs can caters for some of the ambulatory services.
Continuum of Long-Term Care Services
Medicaid and Medicare are the principal funding sources that can be used for long-term care services. Public programs form a crucial part of the long-term care system. Although Medicare is important in funding for these services, Medicare should be used more since it is the biggest public funding source for such services. Therefore, it is and should remain a principal lifeline for the many vulnerable citizens (Litva et al., 2002). Medicaid should fund for approximately fifty percent of the entire amount spent on the services. Medicaid funding should originate from both state and federal sources and should constitute of nearly 150.5 billion dollars (Essock et al., 2003). It is worth noting that as the baby boomers generation continues to age, which necessitates for more long-term care, public programs that are funded by the state and federal government will not be sufficient to cater for the entire costs of their care.
Citizens can also be encouraged to fund and plan for their personal long-term care through the use of long-term care insurance. As a result, there will be more dollars for use in the long-term care system. In addition, this will ensure that Medicaid still remains the safety net program to whose whore require it (Litva et al., 2002). In addition to Medicare, Medicaid, and long-term care insurance, there can be Long-term Care Partnership Program. This allows states to offer people full-asset or dollar-for-dollar protection against the Medicaid spend-down eligibility essentials. This should be after a person purchases a qualifying partnership policy.
Mental and Behavioral Health Services
Behavioral health challenges encompass a number of illnesses including substance disorder, impulse-control disorder, mood disorder, and anxiety disorder. Mental challenges involve the people’s psychological states (Diehr & Evashwick, 2004). Many people suffer from the outlined conditions, either on chronic or short-term basis. Interventions include pharmacological services, psychosocial counseling, or a combination of the two for behavioral conditions. On the other hand, people with critical mental illness need extra non-medical services including vocational training, housing assistance, and income support. This outlines the immense costs that these services require so as to promote comprehensive and extensive care.
Some of the funding methods that can be used are as follows; public funding sources should comprise the larger percent for the services. State-federal Medicaid program can be very useful in funding for the services where it should fund for almost a quarter of the entire expenditures. It is useful in that its eligibility rules can reach many people with significant need, there are wide array of benefits that are covered, and the financing structure can permit states to use the federal financing assistance to expand services. Medicaid coverage can allow adoption and deinstitutionalization of novel treatment modalities (Essock et al., 2003).
Medicare can finance about seven percent of the costs. It can be used for both behavioral and mental health care services. It can be perfect for support and psychosocial services, some providers, and inpatient psychiatric care in hospitals. The services can also be funded from local, state, and federal public programs. Regardless of the fact that the programs may not be for people with behavioral and mental needs, they can provide vital ancillary support services including vocational training, income support, and housing. There financing can cater for a quarter of the costs (Anderson & Knickman, 2011).
Although private insurance coverage might be the coverage for many people, it can cater for approximately a quarter of behavioral and mental services’ cost. Although people with employer-sponsored coverage many possess some mental health benefits in the health plan, there are limits as far as the services are concerned. Philanthropic and charitable sources of funding have a long funding history but can form a small share of about four percent of the entire costs. These funds can be used for offering system change incentives or piloting innovative programs.
Finally, out-of-pocket sources can cater for nearly twelve percent of the costs of these services. These include co-payments for services that the insurance covers, payment for services that are excluded from the insurance plans, and direct payment for services by people who do not have insurance coverage (Goddard & Smith, 2011). These payments vary depending on insurance coverage where people with private coverage and the uninsured will pay more compared to people with Medicaid coverage.
Conclusion
From the foregoing discussion, it has been established that as the baby boomer generation is aging, the need for ambulatory, long-term care, and behavioral and mental services continues to increase. There are several ways through which these services can be funded. Considering that one source of funding many not be enough for cater for all the costs, it is important to consider a number of funding sources. This ensures that comprehensive care is offered to all who require it and for the period they need it. Medicare, out-of-pocket payments, Medicaid, and public programs are some of the funding sources used.
References
Anderson, G., & Knickman, J. R. (2011). Changing the chronic care system to meet people’s needs. Health Affairs, 20(6), 146-160.
Diehr, P., & Evashwick, C. (2004). Factors explaining the use of health care services by the elderly. Health Serv Res, 19(3), 357-382.
Essock, S. M., Goldman, H. H., Van Tosh, L., Anthony, W. A., Appell, C. R., Bond, G. R., & Drake, R. E. (2003). Evidence-based practices: Setting the context and responding to concerns. Psychiatric Clinics of North America, 26(4), 919-938.
Goddard, M., & Smith, P. (2011). Equity of access to health care services:: Theory and evidence from the UK. Social science & medicine, 53(9), 1149-1162.
Gröne, O., & Garcia-Barbero, M. (2011). Integrated care: a position paper of the WHO European office for integrated health care services. International journal of integrated care, 1.
Litva, A., Coast, J., Donovan, J., Eyles, J., Shepherd, M., Tacchi, J., & Morgan, K. (2002). ‘The public is too subjective’: public involvement at different levels of health-care decision making. Social Science & Medicine, 54(12), 1825-1837.