Healthcare Coverage and Vulnerable Population

Healthcare Coverage and Vulnerable Population

Healthcare Coverage and Vulnerable Population

Introduction

Vulnerable populations experience adverse health outcomes because they live in areas excluded from services which makes them unable to participate in health programs due to a lack of awareness. Health coverage is important because it makes it easy to afford healthcare services and protects people from financial strain when unexpected illness or accident happens. Insurance helps people avoid huge medical debts and protects the acquired financial assets. Vulnerable populations do not have access to healthcare coverage because their socio-economic status does not favor them. Another advantage of healthcare coverage is that it connects people to a constant source of care which enables easy access to the infrastructure where the providers work with patients in providing continuous, comprehensive, and coordinated healthcare services.

The vulnerable populations often struggle to get healthcare coverage because of their backgrounds such as financial strain, homeless, elderly, and people with disabilities (De Chesnay & Anderson, 2019). Healthcare coverage makes people more productive because they can lead better lives by ensuring they get healthcare services conveniently because of constant premium contributions. A reduction in mortality rates of people is important to vulnerable individuals in society as it increases awareness of leading healthy lives and ensuring they improve their status.

Purpose statement: To identify how healthcare coverage is linked to vulnerable populations, describe the purpose for diagnosis of related groups, select a major and alternative healthcare plan, and the impact of nursing interventions.

Diagnosis Related Groups (DRG)

Diagnosis Related Group is utilized when grouping patients who have the same conditions and treatment. DRG is used by Medicare to help reimburse hospitals for inpatient stays depending on patient diagnosis and care given during the stay (Enewold et al., 2020). It means that the hospitals get paid a fixed amount for every patient depending on the DRG assigned to the patient. DRGs are more specific because they represent specific groups of people with similar conditions or diseases and they classify them according to diagnosis and treatment.

The Diagnosis Related Groups make hospital funding depending on a predefined payment rate on the diagnosis processes in the 495 classification. It incentivizes the appropriate utilization of services provided which lowers the length of stay, appropriate use of treatment and diagnostic procedures, and a reduction in the general bed capacity. Implementation of a DRG system in a hospital contributes to a reduction in admissions and advocates for more outpatient services and a steady decline in the bed occupancy rate and per capita hospital bed supply (Shi & Singh, 2022). Despite its positive impact, it is affected by falsification of reported case severity to increase revenue collection which ensures a balanced health service system is achieved.

Payment for DRGs has contributed to reduced overuse of health services because it has a financial risk to healthcare providers. DRGs have contributed to an improvement in efficiency, control of the cost of treatment, and a reduction in the length of stay which contribute to the maintenance of the standards of care. It is important to note that providers’ behaviors determine the quality, efficiency, cost, and equity of healthcare services provided to patients.

Medicaid Healthcare plan (major option)

Medicaid has been considered the major healthcare option for patient X aged 67. Medicaid covers many people like people with disabilities, the elderly, children, pregnant women, and low-income adults. It covers both state and federal governments hence it caters to the health of many Americans (Geruso et al., 2023). Patient X qualifies for Primary Care Case Management Option in Medicaid coverage. In this case, patient X is to be provided with a primary care physician who will provide the required care (Shi & Singh, 2022). The physician will be paid every month for the services given. Another option is the Comprehensive Risk-based Managed Care which is an additional treatment choice that can be used for patient X. The additional plan offers services such as X-ray tests, home healthcare, outpatient services, and therapeutic and diagnostic therapies. The additional treatment option provides a variety of home-based services needed by patient X.

Unfortunately, both care plans may limit access to care for patient X because of the Medicare Advantage Care plan. There are some restrictions such as the use of physicians only in the plan’s network which may be utilized by this choice. The restriction limits Patient X’s choice