there will never be enough money for everyone to have every health care service they may need or want. Who makes these decisions? Perhaps a government agency, perhaps an insurance company. It is easy to blame a nameless, faceless business for denying care. But what if it was you? What if you worked in that field and the burden to allocate too few resources to too many needy patients sat on your shoulders? Might you have a completely different perspective? How do payors determine what to cover? The answer is simple and complex at the same time. Payers generally do not cover anything experimental. They have clear policies for what specific plans cover. They often require preauthorization to ensure that the test/procedure is truly necessary and that it is supported by best practice showing improved quality outcomes.
In this case you are not working for an insurance company. You are a senior executive in a hospital. The hospital sets aside charity care monies each year to assist needy patients. There are always more needy patients than there are funds. When the funds are gone, they are gone. This year, you are tasked with distribution of the money.
None of the patients have insurance or any significant funds. You have 1 million dollars. It cannot be used for more than one patient.
The patients are as follows:
1. Patient A is a 70 y/o retired business executive who needs a $500,000 heart transplant and $500,000 in post care surgery (i.e. medications, rehab, follow- ups, etc.)
2. Patient B is a toddler with cerebral palsy (affect a person’s ability to move and maintain balance and posture) who needs $500,000 for ongoing care. With expert care the expected lifespan is teenage.
3. Patient C is a 32 year old mother of 2 who needs a $750,000 bone marrow transplant and $500,000 in post care surgery (i.e. medications, rehab, follow- ups, etc.).
4. Patient D is a 38 y/o athlete who needs a hepatitis C drug that costs $30,000/ month. The patient could live a normal life span as long as the drug is provided.
5. Patient E is a micro-premature baby who is costing $10,000 day with a 20% chance of survival. The hospital stay is expected to be 12 months minimum, not including any needed surgical procedures, and not including likely life-long health care needs if he survives.
Determine the distribution of health care funds
Include the following aspects in the assignment:
Ø Which patient should receive the funding and why?
Ø If the funds were available to be shared among the patients, would you have chosen differently?
Ø How did you feel having to make a choice?
Ø Discuss if this exercise has changed your view of the challenges behind paying for health care.
View your assignment rubric.
question 2. Urgent Care and Primary Care
You receive a fax from a local urgent care clinic describing the recent visit of a patient that has come to the primary clinic where you work. You notice this patient has been seeking care at the urgent care clinic and has not been seen by the primary care health care providers for more than a year. The manager asks you to educate patients about urgent care clinics and traditional primary care clinics.
Distinguish between two health care models.
Include the following aspects in the assignment:
Ø Expand on what urgent care and primary care is.
Ø Describe the advantages and disadvantages of each
Ø Explain the difference in the quality of care provided at each facility
Ø How many of each type of facilities (urgent care and primary care offices) exist in the U.S. and tell me your personal experience with utilizing them.
View your assignment rubric.
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