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Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The main difference between the two programs is that Medicaid covers healthcare costs for people with low incomes while Medicare provides health coverage for the elderly. There are also dual health plans for people who have both Medicaid and Medicare. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."
The Bureau of Primary Health Care (BPHC) is a part of the Health Resources and Services Administration (HRSA), of the United States Department of Health and Human Services. HRSA helps fund, staff and support a national network of health clinics for people who otherwise would have little or no access to care. BPHC funds health centers in underserved communities, providing access to high quality, family oriented, comprehensive primary and preventive health care for people who are low-income, uninsured or face other obstacles to getting health care.
The Indian Health Service (IHS) is an operating division (OPDIV) within the U.S. Department of Health and Human Services (HHS). IHS is responsible for providing direct medical and public health services to members of federally-recognized Native American Tribes and Alaska Native people. IHS is the principal federal health care provider and health advocate for Indian people.
A free clinic or walk in clinic is a health care facility in the United States offering services to economically disadvantaged individuals for free or at a nominal cost. The need for such a clinic arises in societies where there is no universal healthcare, and therefore a social safety net has arisen in its place. Core staff members may hold full-time paid positions, however, most of the staff a patient will encounter are volunteers drawn from the local medical community.
The American Health Care Association (AHCA) is a non-profit federation of affiliated state health organizations that represents more than 14,000 non-profit and for-profit nursing homes, assisted living communities, and facilities for individuals with disabilities. The organization's president and CEO is Mark Parkinson. The National Center for Assisted Living (NCAL) is a part of the AHCA.
The HIV/AIDS Bureau is a part of the Health Resources and Services Administration (HRSA), an agency of the United States Department of Health and Human Services. It was established to deal with the growing problem of HIV/AIDS in the United States since the early 1980s.
The Healthcare Systems Bureau is part of the Health Resources and Services Administration (HRSA), of the United States Department of Health and Human Services.
Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.
A rural health clinic (RHC) is a clinic located in a rural, medically under-served area in the United States that has a separate reimbursement structure from the standard medical office under the Medicare and Medicaid programs. RHCs were established by the Rural Health Clinic Services Act of 1977, . The RHC program increases access to health care in rural areas by
- creating special reimbursement mechanisms that allow clinicians to practice in rural, under-served areas
- increasing utilization of physician assistants (PA) and nurse practitioners (NP)
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act, and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965.
The community health center (CHC) in the United States is the dominant model for providing integrated primary care and public health services for the low-income and uninsured, and represents one use of federal grant funding as part of the country's health care safety net. The health care safety net can be defined as a group of health centers, hospitals, and providers willing to provide services to the nation's uninsured and underserved population, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. According to the U.S. Census Bureau, 29 million people in the country were uninsured in 2015. Many more Americans lack adequate coverage or access to health care. These groups are sometimes called "underinsured". CHCs represent one method of accessing or receiving health and medical care for both underinsured and uninsured communities.
An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it".
A prospective payment system (PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided.
Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.
The 340B Drug Pricing Program is a US federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. The intent of the program is to allow covered entities to "stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services." Maintaining services and lowering medication costs for patients is consistent with the purpose of the program, which is named for the section authorizing it in the Public Health Service Act (PHSA) It was enacted by Congress as part of a larger bill signed into law by President George H. W. Bush.
The Affordable Care Act (ACA) is divided into 10 titles and contains provisions that became effective immediately, 90 days after enactment, and six months after enactment, as well as provisions phased in through to 2020. Below are some of the key provisions of the ACA. For simplicity, the amendments in the Health Care and Education Reconciliation Act of 2010 are integrated into this timeline.
Throughout the United States, many rural communities are faced with severe healthcare workforce shortage issues. These regions often consist of a larger percentage of medically underserved individuals, in conjunction with fewer physicians, nurses, and other healthcare workers. The shortage of healthcare workers negatively impacts the quality of medical care due to decreased access to health services as well as an increase in workload placed on providers. Healthcare systems in rural communities generally have fewer personnel and infrastructure, creating substantial healthcare disparities among the United States population. Rural communities tend to have a higher incidence of chronic diseases, infant and maternal morbidity, and occupational injuries. These communities also consist of individuals who tend to be older and have a lower socioeconomic status, which directly relates to the high rate of uninsured individuals. Ethnic minorities are also increasing in number throughout rural areas, further adding to the size of healthcare disparities.
Patient navigators educate and assist United States citizens in enrolling into health benefit plans stipulated in the Patient Protection and Affordable Care Act (ACA). Patient navigators are also called "insurance navigators" or "in-person assisters" who have defined roles under the ACA. Although their roles might overlap, patient navigators are not community health workers or health advocates. "Navigators" work in states with Federally-Facilitated Exchanges (FFEs) or State Partnership Exchanges.
A safety net hospital is a type of medical center in the United States that by legal obligation or mission provides healthcare for individuals regardless of their insurance status or ability to pay. This legal mandate forces safety net hospitals (SNHs) to serve all populations. Such hospitals typically serve a proportionately higher number of uninsured, Medicaid, Medicare, Children's Health Insurance Program (CHiP), low-income, and other vulnerable individuals than their "non-safety net hospital" counterpart. Safety net hospitals are not defined by their ownership terms; they can be either publicly or privately owned. The missions of safety net hospitals are rather, to focus and emphasize their devotion to providing the best possible care for those who are barred from health care due to the various possible adverse circumstances. These circumstances mostly revolve around problems with financial payments, insurance plans, or health conditions. As per America's Health Care Safety Net: Intact but Endangered, safety net hospitals are known for maintaining an open-door policy for their services.
The United States has many regions which have been described as medical deserts, regions with inadequate access to one or more kinds of medical services. An estimated 30 million Americans, many in rural regions of the country, live at least 60 minutes drive from a hospital with trauma care services. Limited access to emergency room services, as well as medical specialists, leads to increases in mortality rates and long-term health problems, such as heart disease and diabetes. Regions with higher rates of Medicaid and Medicare patients, as well patients who are uninsured are less likely to live within an hour's drive of a hospital emergency room.
References
- 1 2 Michelle M. Doty; Melinda K. Abrams; Susan E. Hernandez; Kristof Stremikis; Anne C. Beal (May 2010). "Enhancing the Capacity of Community Health Centers to Achieve High Performance". The Commonwealth Fund.
- ↑ "About the Health Center Program". bphc.hrsa.gov. Retrieved 2018-03-28.
- 1 2 3 4 5 "Special Populations". Department of Health and Human Services. Health Resources and Services Administration. Archived from the original on 12 January 2012.
- 1 2 3 4 5 6 7 8 9 10 11 "Federally Qualified Health Center". Department of Health and Human Services. Centers for Medicare and Medicaid Services. November 2011.
- 1 2 "Health Center Program Compliance Manual" (PDF). bphc.hrsa.gov. 2017. Retrieved 2018-03-27.
- ↑ "About the Federal Tort Claims Act (FTCA)". bphc.hrsa.gov. Retrieved 2018-03-28.
- 1 2 3 "New Affordable Care Act support to improve care coordination for nearly 200,000 people with Medicare". Department of Health and Human Services. June 2011.
- 1 2 3 4 "Medicare Demonstrations: FQHC APCP FAQs". Centers for Medicare and Medicaid Services. Archived from the original on 2012-03-16. Retrieved 2012-02-01.
- ↑ "Health Center Data". Department of Health and Human Services. Health Resources and Services Administration. Archived from the original on 2012-02-01. Retrieved 2012-02-01.
- 1 2 "Summary of New Health Reform Law". The Henry J. Kaiser Family Foundation. April 2011.
- ↑ "Number of Federally-Funded Federally Qualified Health Centers, 2016". The Henry J. Kaiser Family Foundation.