I’m working on a health & medical question and need support to help me learn.Please read the following lecture and write 500 words regarding the topics. Please do not summarize it but rather use your own words and knowledge about the topics. _________________________________________________On July 30, 1965, Medicare and Medicaid were enacted as Title XVIII and Title XIX of the Social Security Act, signed into law by President Lyndon B. Johnson. Medicare was established to provide coverage for hospital services, postdischarge extended care, and home health services to almost all Americans aged sixty-five and older. Medicaid was established to provide states with the option to obtain federal funds for delivering healthcare services to low-income children, their caretaker relatives, and individuals with disabilities.In 1972 Medicare eligibility was extended to include persons under age sixty-five with long-term disabilities and those with end-stage renal disease. As well, in 1972, Medicaid eligibility for elderly, blind, and disabled residents of a state was linked to eligibility for the new Federal Supplemental Security Income program.
In 1973, the Health Maintenance Organization Act established a trial period of federal funding support for the development of health maintenance organizations (HMOs). HMOs were designed to provide a comprehensive range of healthcare services to subscribers in return for a fixed monthly or annual payment. HMOs were required to have annual enrollment periods. Further, an HMO could not refuse to enroll or re-enroll any member for reasons concerning his health status or needs for health services.In 1986, Medicaid coverage for pregnant women and infants (up to age one year), at up to 100 percent of the federal poverty level, was established as a state option. In 1997, the Balanced Budget Act created the Children’s Health Insurance Program (CHIP). CHIP expanded health insurance coverage to include low-income children whose families had too much income to qualify for Medicaid and too little income to afford private insurance. States have the option to provide CHIP services through Medicaid, as a separate program, or in combination.
As with Medicaid, state CHIP payments qualify for federal matching payments.Medicare covered 55.7 million Americans in 2015 (17 percent of the population). Together, in 2016, Medicare and Medicaid spending represented 37.5 percent of the US$3.3 trillion total national health expenditure. As of November 2017, 68.2 million individuals were enrolled in Medicaid and 6.1 million children were enrolled in CHIP. Altogether, nearly 35.7 million children are enrolled in either Medicaid or CHIP, representing more than 50 percent of total Medicaid and CHIP program enrollment.The Therapeutic MisconceptionThe therapeutic misconception, originally described in 1982, describes the belief of patients who choose to participate in medical research studies that decisions about their treatment are being made solely with their benefit in mind. This misapprehension may manifest in the patient’s belief that the research protocol will advance his own therapeutic interests. The therapeutic misconception occurs when a patient misconstrues the intentions and purposes of medical research and attributes a therapeutic intent to the research project.Informed Consent and the Use of BiospecimensIn Moore v. The Regents of the University of California, the Supreme Court of California ruled that other people may own a patient’s body parts but the patient may not. In 2006, Washington University v. Catalona found that the plaintiff “owns all biological materials including but not limited to blood, tissue, and DNA samples” stored in a biorepository. The Catalona court described “the importance of the research protocol to public health” and noted “the integrity and utility of all biorepositories would be seriously threatened” if ownership of tissue samples were to be granted /to research participants.
In response, the Federal Policy for the Protection of Human Subjects was revised to include the concept of broad consent. A key revision in the proposed final rule improved informed consent procedures so that potential research subjects would be better informed regarding their participation in a research study. By providing the possibility of broad consent, the final rule established enhanced protections for both research subjects, researchers, and research institutions. By agreeing to broad consent, a research subject waives her putative right to ownership of her tissue samples. As well, broad consent eliminates the expectation of any right to privacy regarding the current and future use of those biospecimens.Healthcare Fraud and AbuseHIPAA defines healthcare fraud as knowingly and willingly executing, or attempting to execute, a scheme or deception “to defraud any health care benefit program; or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by . . . any health care benefit program.”
Healthcare fraud may also be described as an intentional attempt to wrongfully collect money relating to healthcare services.The False Claims Act (FCA) prohibits knowingly submitting false claims to the government and imposes civil penalties on persons violating the law. As well, the FCA provides for private persons to file suit for violations of the FCA on behalf of the government. The FCA is implicated when an improper claim for payment is submitted to a federal healthcare program. Healthcare program false claims may arise in terms of billing, such as billing for services not rendered, billing for unnecessary medical services, double billing, or billing for services at a higher rate than provided, that is, upcoding.The Physician Self-Referral Law, or Stark Law, generally prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship.
DHS include clinical laboratory services, radiology and other imaging services, durable medical equipment and supplies, inpatient and outpatient hospital services, and outpatient prescription drugs.Healthcare Provider Conflict of InterestHealthcare provider conflict of interest arises whenever circumstances, owing to inducement or coercion, predispose him or her to act other than in a patient’s best interest. Also, a conflict of interest might arise owing to “pay for performance” standards that result in avoidance of treating the sickest patients, who might negatively impact a provider’s or institution’s successful outcome rates.Antitrust LegislationNational priorities in healthcare include improving efficiency in delivering healthcare services, ensuring access to coverage, and promoting public health.
Antitrust laws prohibiting private anticompetitive organization and conduct help society attain these objectives. Key antitrust statutes include the Sherman Antitrust Act of 1890, the Clayton Antitrust Act of 1914, and the Hart-Scott-Rodino Antitrust Improvements Act of 1976.Professional License and Certificate AbuseState professional licensing boards license and discipline physicians, nurses, dentists, physical therapists, occupational therapists, psychologists, and other healthcare practitioners. Disciplinary action may be filed against a practitioner for gross negligence, repeated negligent acts, and incompetence, as well as for sexual misconduct, substance abuse, filing false claims, and engaging in kickback schemes.
Electronic Health Records and the HIPAA Security and Privacy RulesElectronic health records (EHRs) have their origin in the Institute of Medicine’s 1991 report (revised in 1997), the “Computer-Based Record: An Essential Technology for Health Care.” Effective design and deployment of EHRs was intended to enhance and optimize the delivery of healthcare services from intake through discharge and beyond. EHRs would create a repository for all patient data, including chart notes; laboratory, imaging, and diagnostic testing reports; and medications. EHR systems designs have the capability of providing assistance in clinical decision making and treatment recommendations, including delivery of general clinical knowledge and guidance in evidence-based best practices for managing patients with specific disease states.
The goals of EHRs are to provide uniformity and consistency, improve coordination of care, and foster patient participation in care. Possibly the greatest disadvantages of EHRs compared with paper records are the potential threats to patient privacy and security breaches. Through HIPAA, HHS was directed to adopt security standards for health information, including administrative, technical, and physical safeguards to ensure integrity and confidentiality of the information, and to protect against threats or hazards to the security or integrity of the information and unauthorized uses or disclosures of the information.
The HIPAA Security Rule provides definitions for confidentiality and security. The HIPAA Privacy Rule protects all individually identifiable health information held or transmitted by a covered entity. The Privacy Rule requires that each covered entity, with certain exceptions, must provide a notice of its privacy practices regarding protected health information.
HIPAA privacy and security requirements protect an individual’s identifiable health information and define specific rights of an individual related to protected health information.Health Disparities/Health InequitiesThe term “health disparity” was coined in the United States around 1990 and represents differences among socioeconomic groups in the areas of availability, access, and quality of healthcare; health status; and health outcomes. The National Institutes of Health defines health disparities as “gaps in the quality of health and health care that mirror differences in socioeconomic status, racial and ethnic background, and education level.”Bias in Healthcare DeliveryBias (or prejudice) may be defined as an unjustified negative attitude toward another based on that person’s group membership.
Healthcare providers, as all other persons, are likely influenced in their racial and ethnic attitudes by pervasive social trends. Members of racial/ethnic minorities report greater dissatisfaction with their healthcare providers, particularly when the providers are not of the same ethnicity/race, and perceive significantly more bias in healthcare delivery compared with whites.Compared with whites, members of racial/ethnic minorities, including Hispanic Americans, African Americans, and Asian Americans, reported greater difficulty in communicating with their healthcare providers, were approximately fourteen times as likely to believe they would receive better healthcare if they were of a different race or ethnicity, and were more likely to feel treated with disrespect during a healthcare visit. As well, regarding LGBT persons, sexual minority status is a marker of elevated risk for mental, physical, and sexual health problems. The health of LGBT individuals may be compromised by chronic stress associated with minority status, legal barriers to health insurance, providers who receive minimal training in culturally competent care of LGBT persons, and experiences and expectations of discrimination within the healthcare system.Sarbanes-Oxley Act of 2002The Sarbanes-Oxley Act (SOX) was designed to regulate corporate oversight of for-profit entities. Overall, there is a relationship between good governance and organizational effectiveness. Thus, compliance with SOX specifications contributes to the success of nonprofit healthcare institutions. Voluntary adoption of SOX provisions by nonprofit healthcare institutions will strengthen governance, increase transparency and accountability, and enhance the credibility of the organization’s financial reporting.Emerging Infectious DiseasesEbola virus disease is the prototypical emerging infectious disease. Infectious diseases such as EVD, cholera, Rift Valley fever, and schistosomiasis are endemic worldwide and many of these disorders maintain a broad reservoir of agents with the potential for rapid dissemination. Despite more than a century of progress in combatting these disorders, infectious diseases continue to cause extensive human suffering, interfere with and inhibit social and economic development, and contribute to global instability.Human factors contributing to emergence of infectious diseases include migration, urbanization, increased air travel, increased vehicular traffic across regions, and dam building.
Infectious pathogens demonstrate extraordinary adaptability in their capacity to replicate and undergo mutational change. Therefore, countering the ever-changing threat of emerging infectious diseases necessarily entails effective public health measures. In the best case, countermeasures observe what has been termed the fundamental maxim of public health: The health of the individual is best ensured by maintaining or improving the health of the entire community.International Readiness and ResponseThe United Nations Sustainable Development Goals include the following:
No poverty
Zero hunger
Quality education
Gender equality
Clean water and sanitation
Affordable and clean energy
Reduced
Sustainable cities and communities
Responsible consumption and production
Climate action
Clean Water and Sanitation and Maternal and Newborn HealthLack of safely managed drinking water and safely managed sanitation facilities are associated with serious health risks, including diarrhea, infection with intestinal parasites, and malnutrition. Further, improved water, sanitation, and hygiene (WASH) is an essential intervention that impacts maternal and child morbidity and mortality globally.Optimizing maternal and newborn health (MNH) remains a global challenge. For example, in 2015 the overall maternal mortality ratio was 239 per 100,000 live births in low- and middle-income countries compared to 12 per 100,000 live births in developed countries. strategies for reducing maternal mortality include the following:Community-based health insurance programs
Expanded access to maternity services
Expanded access to modern family planning methods
Increased school attendance and literacy rates among women and girls
Expanded emergency obstetric care services
Training of midwives
Undernutrition and PovertyAs of 2013, 767 million people worldwide were living in extreme poverty, that is, on less than US$1.90 per day. As of 2016, 13 percent of the world’s population was undernourished. Child stunting, that is, low height for age, affected 27.8 percent of children under age five. Children growing up in extreme poverty obtain inadequate nutrition, lack early stimulation and learning, and are exposed to significant stress. The consequences include stunted development, low levels of skills required for life and work, and limited productivity as adults.The World Health Assembly Comprehensive implementation plan on maternal, infant and young child nutrition specified six global nutrition targets to be achieved by 2025:40 percent reduction in stunting in children under age five
Ensuring no increase in childhood overweight
50 percent reduction in the rate of anemia in women of reproductive age
30 percent reduction in the incidence of low birth weight
Achieving a 50 percent rate of exclusive breastfeeding in the first six months of life
Achieving rates of childhood wasting of less than 5 percent
Community health worker programs and community-based nutrition programs integrate nutritional and therapeutic interventions, linking nutrition with maternal, newborn, and child health. Specific interventions include the following:
Family planning
Delayed age of first pregnancy
Preconception care
Multiple micronutrient supplementation
Early initiation of breastfeeding
Early management of severe acute malnutrition
Obesity prevention
Malaria prevention
WASH
The Future of HealthcareOverall, distribution of the global healthcare workforce and distribution of global financial resources for healthcare are unequal and inequitable. For example, in 2007, the United States and Canada accounted for 14 percent of the world’s population, but possessed 37 percent of the global healthcare workforce and spent approximately 50 percent of the world’s financial resources for healthcare.
Building a global healthcare workforce will require addressing core competencies including cultural competency, community dimensions of practice, and leadership and systems thinking. As well, an increasing educational focus on the social determinants of health is required, which includes health literacy, lifestyle choices, and cultural diversity. Consistent access to healthcare underlies solutions to all major global health problems.
Requirements: 500 words
