Healthcare financing

Introduction:

It is essential that nurses understand the issues related to healthcare financing, including local, state, and national healthcare policies and initiatives that affect healthcare delivery. As a patient advocate, the professional nurse is in a position to work with patients and families to access available resources to meet their healthcare needs. Nurses also have an ethical responsibility to be fiscally prudent in all practice settings, to eliminate inefficiencies, and to promote best practice.

Task:

Scenario 1:

Note: For parts A and B, the suggested length is a combined total of 1–2 pages.

Mrs. Zwick, a 77-year-old widow and permanent resident of the United States, was admitted as an inpatient and hospitalized for 5 days following a mild stroke. She was then transferred to a skilled nursing home for rehabilitation. The original projected time she would spend in the skilled nursing home was around 21 days. Mrs. Zwick was diagnosed with a hospital-acquired urinary tract infection 10 days into her stay at the skilled nursing home and required IV antibiotics. She was very weak and unable to participate in her rehabilitation for a full week. She remained in the skilled nursing home for a total of 40 days. A recently hired new graduate complained that the facility was not following the current evidence-based protocol related to urinary catheter care.

Upon discharge from the skilled nursing home, Mrs. Zwick is prescribed several medications and a walker. Mrs. Zwick has Medicare Part A, Part B, and Part D. Her daughter is involved in her discharge plan and will be handling all of her medical bills. The daughter admits that she does not understand Medicare and confuses it with Medicaid. Before taking her mother home she asks you, the nurse, for assistance. Neither Mrs. Zwick nor her daughter is aware that the urinary tract infection was considered a hospital-acquired condition.

A. Discuss with Mrs. Zwick’s daughter, based on coverage requirements, which of Mrs. Zwick’s costs will be fully or partially covered by the following:
1. Medicare Part A
2. Medicare Part B
3. Medicare Part D

B. Explain how Medicare policies would affect reimbursement for the additional care Mrs. Zwick needed when she developed a hospital-acquired infection.
1. Discuss the ethical implications of Mrs. Zwick’s incurring costs related to her hospital-acquired condition.

Scenario 2:

Note: For parts C through E, the suggested length is a combined total of 1–2 pages.

Mr. Davis was diagnosed with sickle cell anemia in childhood. He is very familiar with his chronic condition that requires laboratory testing, hospitalization to manage sickle cell crisis, blood transfusions, oxygen, medications, vitamin supplements, hydration, pain management, and rest. In the past year, he has been hospitalized twice and, due to his long absence, was terminated from his factory job where he was covered by a group health insurance. The factory has more than 100 employees. Mr. Davis is very frustrated with the healthcare delivery in the United States. He says he wishes he lived in some other country where he could have better access to healthcare.

C. Explain how the Consolidated Omnibus Budget Reconciliation Act (COBRA) will allow Mr. Davis to continue his insurance coverage while he is out of work.

D. Discuss two challenges that state or local government face in providing care for patients like Mr. Davis who lack insurance coverage and have long-term, chronic illnesses that require ongoing care.
1. Recommend one step that state or local government could take to address one of the challenges you have discussed.

E. Discuss whether it would be better for Mr. Davis if he were a citizen of Great Britain, Japan, Germany, or Switzerland based on his healthcare concerns. In your discussion, include the following points:
• Access for children, the unemployed, and retired persons
• Coverage for medications
• Requirements to get a referral to see a specialist
• Coverage for pre-existing conditions

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