Policy Priority Issue
Those who utilize the Medicaid system range from low income families to the over 65 age group. Within this population is also those who are disabled due to physical or mental problems. This is among the sickliest of our American population. A paper based on a study in Oregon stated that “Medicaid significantly increased the probability of being diagnosed with diabetes, and being on diabetes medication as well as high blood pressure and high cholesterol.”(Baicker et al., 2013, p. 1715).
Much of this is due to the struggle that the Medicaid beneficiary has to accessing all of the benefits of the program. This mostly consists of medical appointments, especially those related to a specialist physician. This paper will identify the importance to make available proper healthcare to those who receive Medicaid. Not only with specialty doctors but also with their own primary physicians. The need to transfer the ownership from the government to the patient is necessary for better healthcare outcomes. This is directly correlated to the care received and expected by the patient. This will result in a better outcome both medically for the patient and fiscally for the government.
The specific problem
Medicaid is a government sponsored and run program, it provides care to over 53 million low income Americans yearly and has an average operating budget of $349 billion dollars (O’Shea, 2007). This increasingly high expenditure has caused much strained to the budgets of not only the federal government but also the state budgets as well. With the changes to the way we view healthcare and the use of evidence based practice in the care delivered it is evident that the quality of care given to those with Medicaid is missing. Evidence has shown that patient’s with Medicaid receive inferior care than those with private insurance based solely on the access they have to the Medical providers, especially those who provide specialty care (O’Shea, 2007).
In a survey conducted in 2003, it highlighted that the recurrent problem is the reimbursement rate from Medicaid to the physician (O’Shea, 2007). The Center for Studying Health System Change (HSC) show that 21% of physicians that state they accept Medicaid have reported they will not accept a new Medicaid patient in 2004-2005(O’Shea, 2007). This number would only logically be assumed to have risen in 2013 A survey conducted by the U.S. National Health reported that researchers have found two standout trends among Medicaid beneficiaries: they have more difficulty getting primary care and specialty care and they visit hospital emergency departments more often than those with private insurance (Seaberg, 2012). The lack of primary and specialty care access is mostly contributed to the following barriers; unable to reach the MD by phone, not having a timely appointment with the MD and lastly unable to find a specialty MD that will accept Medicaid.
In a recent report released by the Partnership to Fight Chronic Disease, it stated that about 30% of Medicaid patients experience “extreme uncoordinated care”, there is a strong correlation between this situation and higher Medicaid spending and less quality of care given (Bush, 2012). After January 1st 2013, healthcare providers have experienced a 2% reduction in payments for Medicaid beneficiary, this will only create more of a problem for these patients to seek the care thy desperately need. The question must be asked, how can we give the care necessary to those with Medicaid and also make this as cost effective for the providers seeing the patient as well.
Steps to Change
There is much conversation in government today that would expand the Medicaid program, but there is no discussion on payment to physicians, hospitals and other providers, which is the main problem at hand. A system that would most be beneficial is one that is centered on the patient-doctor relationship (Felland, Lechner, & Sommers, 2013). This would not only improve the standard of care given to the patient but help with the fiscal decline related to a very broken system that is presently in place. Our aim should be to stop the decision making from the government, and transfer this power to the individual as well as promote individual responsibility for healthcare choices. A policy that would restructure the financing of healthcare to assist low-income families and medically needy Americans to purchase coverage that would best meet their needs and their medical situations.
This approach would need to be Nationwide and would be a great undertaking to accomplish. The rational approach model would be the model of choice for this type of change. It would take many years to accomplish based on financial barrier as it pertains to the various budgets at the state and federal levels. However, the end result would be that a personal ownership of health insurance, and control over the flow of dollars in the health care system, this will enhance personal responsibility. Another aspect it would accomplish would be that patients would demand and receive better value for health their care dollars.
This ownership of their own care would raise much awareness in the patients and facilitate many quality conversations with their healthcare provider. This is an opportunity currently unavailable to patients enrolled in the Medicaid program and has resulted in a system that does not give quality care and the costly price to the government is evident.
Until we can have all 50 states participating in this policy change Nationwide, there are some steps that can be taken with the present system in place. These would involve the use of technology in interesting situations. If you cannot get the patient to the physician, regardless of primary or specialty, bring the physician to the patient. Using telehealth programs would help identify problem before they are in need of emergency attention (Felland et al., 2013). Kentucky used this system to help with the overpopulated Medicaid system and this state was able to save money and provide quality care to those who are in need of it (Ungar, 2013).
Another solution would be to expand the primary role of the primary provider. Utilizing the Advanced Registered Nurse Practitioner (ARNP) to take on the care of patients in the role of the Primary Provider would help ease the burden for the dwindling Medical Community (Felland et al., 2013). With only 7% of the graduating physicians choosing primary care a large strain is evident on the medical community to provide care to patients (Sellers, 2013). Both the above policy changes would best be suited under the stage-sequential model. Putting both of these changes in to place at the same time in multiple areas then re-evaluating the need for changes in order to define a process that could be utilized Nationwide would be important for success. Both of these policy changes would give way to better care for the Medicaid beneficiary, better outcomes and a use of funds that would be cost effective as well.
In conclusion this paper has reviewed the importance of change needed to the present Medicaid system. The present system has shown to take away the ownership of healthcare from the patient and given it to the government. In doing so several areas for needed improvement have been identifies; cost, lack of resources among physicians and most important below quality care. All resulting in a system that is not able to deliver quality care to those who are in desperate need of it the most. By implementing the changes outlined in this paper, it will be able to change and improve these barriers for the better, resulting in better patient care outcomes, better financial outcomes and a healthier America. References
Baicker, K., Taubman, S., Allen, H., Bernstein, M., Gruber, J., Newhouse, J., … Zaslavsky, A. (2013, May 2, 2013). The Oregon Experiment — Effects of Medicaid on clinical outcomes. The New England Journal of Medicine, 368, 1713-1722. Bush, H. (2012, November 2012). Caring for the costliest. Hospital and Health Networks, 156-162. Felland, L., Lechner, A., & Sommers, A. (2013, June 6, 2013). Improving access to specialty care for Medicaid patients: policy issues and options. The Common Wealth Fund. Retrieved from http://www.commonwealthfund.org/Publications/Fund-Reports/2013/Jun/Improving-Access-to-Speciality-Care.aspx O’Shea, J. (2007). More Medicaid means less quality health care. Retrieved from http://www.heritage.org/research/reports/2007/03/more-medicaid-means-less-quality-health-care Seaberg, D. (2012). Medicaid patients go to emergency room more often. Retrieved from http://www.ncpa.org/sub/dpd/index.php?Article_ID=21732 Sellers, A. (2013, July 23, 2013). Nurse practitioners aim to fill care gap.