HEALTHCARE SYSTEMS, ORGANIZATION, DELIVERY AND ECONOMICS

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Taneyea Cooley
DB 1

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From what I could understand from the course work, an ongoing trend in healthcare is our ever changing access to it due to many roadblocks to obtaining quality insurance due to cost.

To start, the number of private insurance patients has steadily declined over the last forty years with few changes to the number of those who are uninsured (Wendel, Donohue, & Serratt, 2014). These numbers do not include the elderly who typically qualify for Medicare; however, this can also be an issue when discussing integrative healthcare.

In terms of integration, there is a genuine struggle in Arizona with patients transitioning from Medicaid to Medicare. With Medicaid, patients are eligible to receive a full range of behavioral health services including counseling and medication services for no out of pocket cost to the patient. When the individual transitions, many are unable to afford the change in cost of medication, co-pays and struggle with limitations on providers due to credentialing. Credentialing limits with Medicare also impact integration as we struggle to have medication and primary care providers credentialed by all of the same insurers. This takes a significant toll on clinics who primarily serve low income, publicly insured patients.

Economically, at least in Arizona, this creates an interesting trap for many families. Those who do not receive healthcare from work rely on public insurances like Medicaid. Unfortunately, this leads a large population to stay in low income jobs to maintain this insurance as going over the income limits puts these individuals in a position where they cannot afford the cost of Affordable Care Act insurances. With the growing number of people staying on public insurance, this leads to an increase on the public’s burden to support a larger number of patients for a longer span of time.

Conflicts between employment, wages, and insurance are discussed at length within Understanding Healthcare Economics that supports workers will at times accept lower wages in order to qualify for or remain with companies that offer insurance (Wendel, Donohue, & Serratt, 2014).

Wendel J., O’Donahue W., & Serratt T., (2014) Understanding health care economics: Managing your career in an evolving healthcare system (1st Edition). Boca Raton, FL: CRC Press.
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1 hour ago

James Jobin
RE: DB 1

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Taneyea,

Appreciated your post and agree with most of your insight. In Nevada we are having a similar problem as you are in Arizona. People here are often finding themselves in the no-win situation of having access to medicaid due to low income on the one hand and increasing premiums and deductibles on the other. Nevada expanded medicaid alongside the ACA which I don’t believe AZ did, so in that sense we have a larger pool to draw from our citizens have more room to earn up to 300% the poverty line before they lose medicaid. That being said we are still seeing the problem of avoiding the insurance mandate by refusing to employ anybody has 32 hours a week. The bottom line is we are seeing a similar problem here of too many without access to insurance, and among those who get it through a employer their new plans have much higher deductibles and increasing premiums.

On the behavioral health front things are unique here. Medicaid patients who have a severe mental illness can not get adequate access to care through the two state sanctioned MCO’s, and are not allowed to switch to Fee For Service unless they have gotten SSDI – which is all sorts of discrimination and wrong. The two MCO’s have achieved their primary goal of saving money at the cost of providing adequate care, but the State hasn’t been able to oversee the MCO’s sufficiently to capture health goal metrics. Recently our Medicaid overseers have begun a listening tour to ask consumers and providers if the MCO’s are doing a good enough job – of course they have been hearing a resounding “NO”.

But the problem in Nevada is not merely the MCO’s or the lack of Government oversight.I continue to believe that the problem of healthcare quality compared to cost is probably inherent in the system which differentiates payer from consumer. I’m not sure how this is fixed but it just feels like a broken model of supply and demand.
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