Financing and reimbursement approaches in the US healthcare compared to single payer system.

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Discuss financing and reimbursement approaches in the US healthcare compared to single payer system.

In broad terms, in the US healthcare system financing includes the concepts of financing, insurance, and payment. Financing enables people to obtain health insurance, and the payment function determines reimbursement and undertakes the actual payment for services received by the insured.

For this discussion, use the information in the textbook and in your learning resources to assess the effect of different financing and reimbursement methods and reflect on the following questions:

How do different types of insurance plan (public, private, HMO, etc.) determine access to healthcare?
Consider how different reimbursement methods (fee-for-service, bundled payments, capitation, etc.) may influence provisions of care offered by healthcare providers and the goal of patient-centered care.
Consider how these different methods (different insurance plans/lack of insurance) affects the consumer?

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.

God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

US Healthcare Financing and Reimbursement:

The US healthcare system is a multi-payer system, meaning it relies on a combination of public and private insurance, as well as out-of-pocket payments.

  • Public Insurance:

    • Medicare: For individuals 65 and older, as well as those with certain disabilities.
    • Medicaid: For low-income individuals and families.
    • Children’s Health Insurance Program (CHIP): For children 1 in families who earn too much to qualify for Medicaid but cannot afford private insurance.

US Healthcare Financing and Reimbursement:

The US healthcare system is a multi-payer system, meaning it relies on a combination of public and private insurance, as well as out-of-pocket payments.

  • Public Insurance:

    • Medicare: For individuals 65 and older, as well as those with certain disabilities.
    • Medicaid: For low-income individuals and families.
    • Children’s Health Insurance Program (CHIP): For children 1 in families who earn too much to qualify for Medicaid but cannot afford private insurance.

  • Private Insurance:

    • Employer-sponsored plans.
    • Individual plans purchased through health insurance marketplaces.
    • Health Maintenance Organizations (HMOs): Emphasize preventive care and require referrals for specialists.
    • Preferred Provider Organizations (PPOs): Offer greater flexibility in choosing providers but may have higher costs.

  • Reimbursement Methods:

    • Fee-for-service: Providers are paid for each service they provide.
    • Bundled payments: Providers receive a single payment for a group of related services.
    • Capitation: Providers receive a fixed payment per patient per period, regardless of the number of services provided.

Single-Payer System:

A single-payer system is a healthcare system in which a single public agency finances healthcare for all citizens.

  • Financing: Typically through taxes.
  • Reimbursement: May use various methods, but the payer is always the government.

Effects of Different Financing and Reimbursement Methods:

  • Access to Healthcare:
    • Private Insurance: Access is often tied to employment, which can leave many uninsured. HMOs and PPOs offer different levels of access, with HMOs generally having more restrictions.
    • Public Insurance: Medicare provides relatively comprehensive coverage for seniors, but Medicaid and CHIP access varies by state.
    • Lack of Insurance: Significantly limits access to care, often leading to delayed treatment and increased health risks.
    • Single-Payer: Aims to provide universal access to healthcare, regardless of income or employment status.
  • Provisions of Care and Patient-Centered Care:
    • Fee-for-service: Can incentivize providers to perform more services, which may not always be necessary, and may not incentivize preventative care.
    • Bundled payments: Encourage providers to coordinate care and reduce costs.
    • Capitation: May incentivize providers to focus on preventive care and cost-efficiency, but there are worries that it could create a decrease in the amount of care administered. To get greater patient centered care within capitation models, it is very important that careful monitoring and quality measurement metrics are used.
    • Single-Payer: Can incentivize a focus on preventative care and primary care, because of the global budgets that are put into place. Also with greater governmental oversite, patient centered care can be prioritized.
  • Effects on the Consumer:
    • Private Insurance: Consumers face varying premiums, deductibles, and co-pays. Those without robust plans or who are uninsured, face potentially ruinous financial implications when needing healthcare.
    • Public Insurance: Can provide financial protection, but access may be limited.
    • Lack of Insurance: Consumers may delay or forgo necessary care, leading to poorer health outcomes and higher costs in the long run.
    • Single-Payer: Aims to reduce out-of-pocket costs and provide financial security.

Key Differences and Considerations:

  • Cost: Single-payer systems often have lower administrative costs, but the overall cost of healthcare depends on various factors, including utilization rates and provider payments.
  • Choice: The US system offers greater choice of providers for those with robust private insurance, but single-payer systems typically restrict this choice to a greater degree.
  • Equity: Single-payer systems aim to provide more equitable access to care, while the US system can lead to significant disparities.

In summary, the US healthcare financing and reimbursement system is complex and fragmented, which can lead to disparities in access and cost. Single-payer systems offer a different approach with a focus on universal access and cost control, but come with trade-offs.

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