Access to comprehensive health care services is vital to the wellbeing of the community. Comprehensive health care involves health promotion, as well as disease and injury prevention. It also includes treatment services, adequate health care facilities such as clinics, emergency response, trauma centers, and physician offices, among other support institutions. Moreover, access to health care services requires the use of the above resources to achieve significant outcomes, which involve three steps. The steps include easy entry to the system, convenient location and established community trust with the provider to address sociocultural issues among other determinates of health care. As a result, it involves the overall physical, social and mental health status, the prevention of diseases and disabilities, as well as diagnosis of the conditions. Additionally, it impacts the quality of life and prevention of death. Even though, government funded programs program face significant challenges, they enhance the populations access to health care.
Overview of the Program Addressing Access to Health Care
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Medicaid is a federal-state program that funds heath care services for low-income individuals. For examples, it caters for pregnant women, children parents, the elderly, as well as, disabled individuals who are unable to meet health care needs. As a result of the various health care reforms such as the Affordable Care Acts and Supreme Court rulings, states can tailor the programs to meet the need of their community. For example, states can expand eligibility to non-senior citizens with income below the federal poverty line. The aim is to expand access to health care (Parks, 2012).
The federal governments reimbursement of Medicaid funds varies within states. Reimbursements average at 57%; however, due to various health care reforms, the federal government aims at paying for all the costs of covering enrollees eligible to the Affordable Care Act. For example, in 2012, the federal spending was about $251 billion, $223 billion of which were covered for enrollees. In addition, the spending involves payments to hospitals that treat persons from low-income communities, cost of vaccines for children programs, and administrative expenses. In fact, the guidelines provide a minimum service for a category of low-income individuals, such as inpatient and outpatient services. Additionally, the services also include physician and laboratory services, and nursing and home health care (Parks, 2012).
Core Functions and Essential Services Addressed by the Program
To ensure comprehensive care, Medicaid supports the three health core functions and aligns them to ten essential health services. The assessment supports two essential services. The services include monitoring, both environmental and health status in addressing community wellbeing. The second service is the diagnosis of health issues and hazards affecting the community. Policy development is the second core function that Medicaid supports. It promotes three fundamental services, which are the provision of public information, mobilization of stakeholders and strategies to enhance community wellbeing. For example, it provides for adequate public information to create awareness on available services and benefits. As a result, it empowers community in managing care. Additionally, through mobilization of various health stakeholders, the programs aim at identification of health problems. Finally, the core function promotes the development of policies to empower communities in addressing health problems (Dubow, 2010).
Medicaid provides enhanced quality assurance, accessibility and reduces the costs of health treatment. For example, it enforces regulations to ensure health safety. It also links the needs of the community to health services. It also ensures adequate and qualified health workforce in various health care institutions. The program provides an evaluation mechanism based on accessibility and quality of care. Finally, the program promotes research and innovation by funding institution to address emerging health problems (Dubow, 2010).
Health Education Components of the Program
Medicaid promotes preventive health care and improves public health to improve community health. Additionally, it assists in restraining growth in health care costs over time. For example, the program provides senior citizens with free annual visits to create awareness. Medicaid empowers individuals to make decisions about health care. For example, it has a web-based prevention tool that assists in making decisions. Moreover, promoting public health requires chain restaurants to display calories on menus, among other nutritional information. The program also funds for pilot projects to establish the impacts of providing information to at-risk populations through relevant health centers (Parks, 2012).
Medicaid educates individuals and communities on disease prevention and health promotion. For example, it provides a public-private partnership. The efforts aim at establishing educational campaigns that raise public awareness. Areas addressed by the programs involve proper nutrition, exercise, smoking cessation and leading causes of death in the country. For example, between 2009 and 2013, the program allocated approximately $25 million for the Childhood Obesity Demonstration Project. Additionally, Medicaid provides for a national media campaign for health promotion and disease prevention (Parks, 2012).
Social Marketing Elements of the Program
Social marketing influences behavior but not to benefit the marketer. As a result, it targets the audience, which is the general public. The technique is common in heath programs to promote the wellbeing of the community. The campaigns are a result of administrative funds, such as CHIP. States use a mix of television radio and print advertising to influence consumer behavior. States also provide marketing guidelines to providers. They manage permissible and prohibited provider marketing, covering childrens health insurance, dental fees and managed care. The information is not comprehensive to identify applicable states and federal laws and regulations. The provider is, therefore, responsible and must comply with both the sate and federal law (Parks, 2012).
Most states name the programs differently to influence consumers. For example, the CHIP has different names, such as the Health Families in California, and CubCare in Maine. Regardless of whether states implement various programs as part of Medicaid expansions, most states promote their programs jointly. Additionally, the marketing techniques target market niches such as younger women, low-income families, and African-American families. For example, most states have at least one advert translated into Spanish among other languages for target audience. Nonetheless, states partner with community-based organizations, such as schools in their outreach efforts. States agree that paid advertisements are useful, since they have control (Parks, 2012).
Information Provided to the Media Regarding the Program
The media provide a variety of information and content that aim at accomplishing similar goals. The materials used are briefs on the state approaches of the programs. Messages focus on the affordability, convenience and quality to enrollees. For example, secondary messages emphasize on the significance of health coverage to community development, the high costs of health coverage, availability of alternative, and ease of enrollment, among other benefits (Parks, 2012).
Despite the differences, the advertisements encourage enrollment. For example, the ads appeal as commercial, and, therefore, it is not evident that they are for government. Additionally, they provide limited information about the program; for example, there are no specific details on how it works. For example, enrollment and coast may miss from the content. As a result of the above analysis, the Media targets different consumers and incorporate program feature (Parks, 2012).
Cultural Competency
Cultural competence is significant due to three reasons. First, as the US becomes more diverse, health practitioners will treat a range of issues influenced by social backgrounds. Secondly, provider-patients communications influence patients satisfaction, adherence to prescriptions, and outcome. For example, poor health outcomes result from the sociocultural difference between the provider and patient. Finally, the increased importance of patient-centered care and cultural competence in improving quality and eliminating ethnic care disparities is growing (Parks, 2012).
In addressing the above issues, Medicaid raises public and provider awareness. For example, in 2006, 60% of people surveyed report that African Americans receive similar quality care as Whites, while 50% reports that Latinos received the care. The reports were to establish the effects of public health campaigns provided by Medicaid reforms. Secondly, Medicaid allows state to expand health coverage through various national and state policies. For example, compared to the insured, the uninsured, who represent minority groups, are less likely to have regular health checkup. As a result, expansions to health insurance coverage provided by the Medicaid program are significant when addressing ethnic disparities (Parks, 2012).
The Collaboration between Stakeholders for Program Success
Stakeholders partnership is critical to integrating care for Medicaid enrollees. It assists in the development of initiatives to improve care delivery. The support begins with applications design and evaluations which are significant to the success of Medicaid. The program involves stakeholders at every level – federal, state and local in order to build support, provide recommendations and ensure continuous improvement. The stakeholders include senior Medicaid and agency leadership, Governance office, community, patients, advocacy groups, and the state legislature among other programs such as Medicare (AHRQ, 2008).
Stakeholders involvement leads to acceptance and long-term support for the program. As a result, they should be a part of the design and implementation. They include state legislators, senior Medicaid staff, and health providers. For example, communication enables the management to receive feedback on the progress. The primary stakeholders are a part of the process, and the outcomes affect them directly. Communication ensures stakeholders receive adequate and timely information, and, therefore, manage expectations and build support for the program. For example, during the planning and design stages, staff should involve the provider community to establish inputs on clinical aspects of the care management programs. In achieving the above, states establish an advisory board among other groups to provide feedback on program interventions, measures and strategies (AHRQ, 2008).
Policy Recommendations
Effective collaboration allows stakeholders to explore issues and alternatives for the program. A supportive management is crucial to the success of the program. Community efforts undertaken without the support from key leaders may not be sufficient. For example, sustained involvement by the government results in innovative and flexible approaches in responding to community health care concerns. The reason is that the government provides resource and expertise not available at the community level. Secondly, local government should foster additional community-based collaborative, of different scales. The efforts will in improving access to health care. For example, even though some successes occur in large metropolitan, collaboration is more effective if it address smaller areas or neighborhoods (NPCC, 2004).
Additionally, policy leaders and funders should support community-based collaborations. Policy leaders assist in framing the program. For example, community-based vision may be broad and conceptual, but shared objectives must be clear, simple and applicable. On the other hand, providers in collaborations with policy leaders will establish priorities based on community needs and overall strategy of the Medicaid program. Finally, policy leaders should support research on the outcomes of an effectiveness of community-based collaboration that is aimed at improving access to health care. Research enables managers to measure health indicators. For example, it is a challenge to measure access at the community level. Additionally, research assists in the articulation and dissemination of progress, challenges and efforts of the program (NPCC, 2004).
Effectiveness of the Program
Health care reforms on Medicare make the uninsured buy coverage or get it through employers health insurance or incur tax penalties. The efforts will increase persons insured that currently approximate at 160 million. Additionally, the program targets 50 million uninsured persons. Ledue (2009) reports that the Medicaid health plan reduces the cost of care and, therefore, increased access. For example, he reports that the programs reduce the cost by 20%. Additionally, the program is significant for Supplemental Security Income, since it improves quality and values for beneficiaries (NASADAD, 2010).
A study of three states Maine, Massachusetts and Vermont exhibits significant effects of Medicaid on access and funding health care services. For example, in Maine, access to Federal funded SAR increased by 32% between 1999 and 2008. The program is a part of the Medicaid expansion in the state under SAR. Secondly, Massachusetts enrollments increased by 20% between 2006 and 2008. The Medicaid expansion program is aimed at addressing workforce development by incorporating benefits. Finally, the number of persons treated under public SAR system in Vermont doubled between 1998 and 2007. Through the Green Mountain Care program, which is a part of the Medicaid expansion plan, the state aims at increasing the number of uninsured persons (NASADAD, 2010).
Challenges within the Program
Since the enactment of Medicaid legislation in 1966, the program experienced significant growth and challenges. The program aimed at providing cost-based reimbursement with no incentives. Healthcare providers received compensation, but which were not sufficient to cover the costs of delivery. Additionally, there was little or no surplus for capital improvement. As a result, healthcare provider would restructure services to increase Medicaid reimbursement, and maintain patient mix to achieve the goal. For example, healthcare facilities face fiscal constraints due to a reduction in reimbursements. Depending on Medicaid funding, healthcare facilities have fixed cash budgets subjected to change by the government. Additionally, given the challenge, facilities may also face delays in funding, resulting in cost overruns. Nonetheless, with the increasing number of ageing citizens, patients require additional care. As a result, healthcare needs of a resident continually changes, hence increasing the cost of care (Koenig & Peterman, 2009).
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A significant number of the US population lost investments during the 2008 financial crisis. As a result, the population results in Medicaid coverage. The approach has resulted in the shortage of nurses. Consequently, healthcare providers resort to agency usage, which is expensive and does not foster quality suitability. Secondly, due to shortage of nurses, the healthcare system faces a dilemma in addressing the rural population. Residents in such communities travel long distances to access the services. As a result, the program does not effectively promote access to health care by all citizens (Koenig & Peterman, 2009).
Next Steps for the Program
Medicaid enrollees receive coverage for about three-quarters of the year. The coverage period is shorter for non-senior citizens and non-disabled adults at 68%. Lower percentages in insurance coverage have negative consequences to people with reduced access to care. The reason is that the population faces interrupted health management plans, managed through primary care. As a result, continued Medicaid enrollment is efficient, both medically and administratively. Federal law provides for quality and improvement process for capitated management care organizations. However, for a significant percentage of enrollees, such as the ones served by Primary Care Case Management, there is no federal requirement for comparable quality monitoring or development.
The Medicaid Continuous Quality Act would provide 12-month eligibility standards for enrollees. The options target children and not adults or disabled. The proposal supports bipartisan goals for health reforms. For example, it would reduce the number of persons lacking insurance coverage. Additionally, it would ensure efficiency, cost-effective care, as well as improved quality of care. To the consumer, the above means of quality care are offered at a convenient location. Finally, Scully (2003) argues that in order to reduce costs faced by increased enrollees, states might drop optional Medicaid benefits or populations. Additionally, state may establish innovative revenues, enhancing mechanisms such as legal and regulatory loopholes to increase federal funding.
Comprehensive health care services are essential to the wellbeing of the community. It involves health promotions, disease and injury prevention, and treatment services. Secondly, it provides for adequate health care facilities, such as clinics, emergency response, trauma centers, and physician offices, among others support institutions. The federal government in partnership with states establishes the Medicaid program to funds heath care services for low-income individuals. States can tailor the programs to meet the needs of communities. The program is comprehensive, since it aligns core health functions to the ten essential health services. Additionally, it promotes preventive care, public health and efficiently in managing expenditure. It uses social marketing techniques to promote enrollment among at-risk groups. Even though, the program faces challenges such as shortage of nurses, it ensures that a significant access percentage of the US population can access comprehensive health care.
