JCHS IPE 300

The patient-doctor relationship should not be greatly affected by the regulations. Communication, respect and fairness are just a few aspects of what determines a quality patient-doctor relationship. It was stated, “Due to the changes with obamacare doctors have government rules and regulations what will tear apart the doctor-patient relationship. Doctors will have to focus more on government rules and regulations, rather than the specific needs of their patients.” Doctors can focus on the specific needs of their patients, and determine what method of treatment is best for the patient, while staying within the rules and regulations.

Because of the affordable care act, everyone will be covered by some form of health insurance. Rules and regulations have been put into place, however they should not interfere with the doctors knowledge and education. The act is assuring these knowledgeable doctors are doing what’s best for ALL patients, and not just the patients with money and insurance.

Studies show that a reduction in mortality of 5-15% could be expected if the uninsured were to gain continuous health coverage (1). Research has also shown that uninsured patients receive less preventative care, are diagnosed at more advanced disease states, once diagnosed receive less therapeutic care, and have higher mortality rates compared to those insured (1). Not only does the affordable care act provide free preventative care, but by doing so, many diseases can be caught at an earlier stage and dealt with on a lower, less expensive level.

From a patient perspective, it has to be considered if one will be paying more for insurance or for out-of-pocket costs due to not having insurance. When going to an emergency room, who is paying for the uninsured patient who could have received preventive care prior to being admitted had they had insurance? The affordable care act may initially be costly, however in the long term for effective; especially for those who currently do not have insurance.

1. http://www.kff.org/uninsured/upload/The-Cost-of-Care-for-the-Uninsured-What- Do-We-Spend-Who-Pays-and-What-Would-Full-Coverage-Add-to-Medical-Spending.pdf

Is it failure if a change in company procedure and/or policy saves thousands of lives? In the case of the insurance company, failure is defined as a dollar limit that won’t be reached; a profit that the Board of Directors and Shareholders are requiring is met. In reality, those who are denied coverage because they are considered too high of a risk factor – they will cost the insurance company too much money – those are the ones who are truly set up for failure. In the case of the patient denied coverage, deemed too high of a risk to cover, failure to that patient is not only about not reaching a dream to have insurance coverage, but failure to that patient can also mean death, due to failure to receive the necessary healthcare.

Preexisting conditions allow insurance companies to deny thousands of people from receiving healthcare and insurance yearly. This denial is based on the insurance company clauses that decide who is sick enough and who is not. Why is the fate of the unhealthy, sick, or even terminally ill left up to the business person and money handlers who are really only focused on the bottom line – profit? More than likely, these business people are not medical professionals in the sense that they cannot fairly decide who is worthy of medical care.

It is understood that insurance companies should be concerned about costs, money outlay and money coming in. However, an insurance company is designed to protect and support their clients, those are the people providing the money in the form of payments for health insurance premiums. Therefore, it seems the companies should worry more about the taxpayer (their client) being able to afford the treatments they need and thus provide the plans they deserve.

There have also been programs that have shown positive results that savings can be realized under the bundled care program that insurance companies would utilize under the Affordable Care Act. In one instance, a 15% to 30% savings was realized in hip and knee replacement surgeries where the bundled-care plan was utilized.

Insurance companies should be encouraging health-care providers to be more efficient, creative and focused on keeping patients healthy. They should help the health care providers be more focused on quality of care rather than quantity of patients, and on value rather than volume. According to Emmanuel, et. al, “only 10% of patients account for nearly two-thirds of costs. Today, there is little financial support for physicians and hospitals to coordinate their care or focus on keeping them healthy. Instead of paying a fee for each service, providers should receive a fixed amount for a bundle of services or for all the care a patient needs. Physicians and hospitals will then be empowered to use their clinical skills to craft the right care for their individual patients. Insurance companies need to embrace this idea.”

Reference:

Emanuel, E.J., Tanden, N., and Berwick, D. (2012). The Democrats' Market-Friendly Health-Care Alternative. The Wall Street Journal, U.S. edition. A19. Retrieved September 25, 2012.

The Patients are PRO Patient Protection and Affordable Care Act for the following reasons:

1. Decreases the number of uninsured Americans

2. Offers free preventative care

3. Offers expanded healthcare coverage

4. It’s more affordable for those with lower income

5. There is no denial to children being covered under a parent's coverage if the child has a pre-existing condition

6. It offers seniors better prescription benefits and better long term care benefits

7. Offers better drug discounts to everyone

8. There are no co-pay, coinsurance and deductibles for preventative care

9. Children will be covered until the age of 26 under their parent's coverage

10. Offers tax breaks to help moderate income people buy healthcare

11. Insurances can't rescind coverage if a covered member becomes ill

12. People cannot be denied coverage for preexisting conditions

13. Dollar amount caps can't be placed on the policy by the insurer

14. 80 percent of money paid towards healthcare must be directly used on medical care or reimbursed to the patient

References:

The Health Care Law and You: Take health care into your own hands. Retrieved from http://www.healthcare.gov/law/index.html. Retrieved September 21, 2012.

"Selected Patient Protection and Affordable Care Act (PPACA) implementation dates of interest to RNs as caregivers, RNs as patients, and RNs as employees". Nursingworld.org. Retrieved September 21, 2012.

Holan, Angie D. (March 20th, 2012). "RomneyCare & ObamaCare: Can you tell the difference?" PolitiFact.com. Tampa Bay Times. Retrieved September 21, 2012.

Enrollment Policy Provisions in the Patient Protection and Affordable Care Act. Families USA. Retrieved September 21, 2012.