Health Care Population

Health is dynamic and determined by the determinants of health that have factors that can both benefit and hinder our overall health (Liamputtong, Fanany, & Verrinder, 2012, p. 9). The primary health care (PHC) principles accessibility, inter-sectorial collaboration, appropriate technology, emphasis on health promotion and public participation helps all individuals at different social standings based on income levels and geographical location determined by the social determinants of health to access PHC and make an equitable health care system (McMurray & Clendon, 2011, pp. 36-44; Liamputtong, Fanany, & Verrinder, 2012, pp. 13-14).

Many factors can influence a person’s access to health care. Age can influence access to health care because some physicians will treat only children or only the elderly. Income can influence access to health care because specialty driven health care usually involves significant out-of-pocket expense to the patient because some procedures are not covered by health insurance. Location also can be an influence on access to health care. Many patients do not have transportation because of age, dependency on family members, health reasons, or financial reasons. According to the Journal of the National Medical Association, Access to health care can influence the prevalence of chronic disease risks and cancer screening utilization in many ways (Shavers, Shanker, Alberg, 2002, p. 955). If patients are not given

A variety of challenges including personal, social, economic, and environmental factors can determine the health of an individual as well as its community. Others determinants of health include genetics, access to medical care, and socioeconomic measures such as education and poverty. Any interference among these factors can often lead to health disparities, which are health gaps that exist between different communities and populations. Health disparities can affect communities based on gender, age, race, social status, economic status, or special care needs. Therefore to understand which factors affect the health of a community, it is necessary to examine the social and economic conditions in which people live in, as well as the rates of diseases

The Joint Commision (a not-for-profit) is known as a symbol of quality for performance standard in hospitals and organization in the United States. Their purpose is to accredit and certify that nearly 21,000 health care organization are providing safe and effective care. If a hospital or organization chooses to maintain their accreditation they are provided with a manual which includes a list of chapters such as, the environment of care, leadership, provision of care, treatment and services, life safety, and information management. In each chapter, it describes specific standards/requirements that must be met to maintain compliance. The Joint Commission also addresses health record documentation standards and elements that include, legibility,

The RHC’s main form of increasing coverage is the continuation of the St. Louis Healthcare Safety Net. After the last free, public hospital in St. Louis closed in 2001, the St. Louis RHC stepped in to redirect around $30 million dollars from the federal government back into the St. Louis City and County healthcare net. Their program Gateway to Better Health is a bridge for healthcare access for low-income, uninsured residents of St. Louis, covering 40% of the uninsured residents in poverty in the St. Louis region. Their access to care is provided by 5 Federally Qualified Health Centers (FQHCs) that are distributed across the city and county region. These FQHCs are state-of-the-art facilities with amazing doctors who provide a wide variety of services under one roof. The comprehensive model of FQHCs includes but is not limited to dental, WIC (women with infants and children), mental health, psychiatry, and primary care services. This comprehensive coverage all under one roof helps to reduce the transportation barrier, since patients are able to keep and meet their appointments. Additionally, FQHCs are open to all patients regardless of ability to pay or immigration status, though there are still challenges

CMS is regulatory agency which works within the United States Department of Health and Human Services. It administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (SCHIP), and health insurance portability standards.

As healthcare reform initiatives progress organizations have focused on balancing the triple aim of access, cost, and quality to improve outcomes for patients while decreasing the overall cost of care. This focus has resulted in increased technology innovation as well as the development of new care delivery models. Population health management programs (PHM) supported by patient engagement innovations such as wearable's, remote monitoring and telehealth are facilitating the shift from episodic care to the comprehensive management of patient healthcare. The population health market is expected to grow from about 12 billion in 2013 to 40 billion by 2018 representing a compound average growth rate of 26%1. Along with population health management

The setting is a community health center at the St. Joseph Health Center in Jamaica Queens, New York. This is a community health center in a low income area of New York. The center deals with all types of patients from expectant mothers to the elderly. They offer a range of services for low income families and individuals without insurance. The doctors are volunteers, and the staff is committed to disease prevention and awareness. They periodically arrange a health fair to reach out to patients who may otherwise not see a physician for the entire year.

Disparities in access to health services affect people and lead to unmet health needs, preventive medical services, and poor health. Low-income people are less able to afford the out-of-pocket costs of care, even if they have health insurance coverage. Public health insurance programs have expanded coverage for the poor and not enough to close the disparity gap. In order to improve health care services, we must make sure that the District 17 communities have usual and ongoing source of care as people with a usual source of care have better health outcomes. District Council 17 needs increased access to quality care regardless of their ability to pay, insurance status, or other potential barriers to

Medicare is administrated by the Centers for Medicare and Medicaid Services (CMS). It is divided by subdivisions which is the Center for Medicare Management who overseas development of payment policy and management of fee-for-service contractors. The Center for Beneficiary provides beneficences with information on Medicare programs, and research grievance and appeal functions. The Center for Medicaid and State Operations focuses on federal and state programs like Children’s Health Insurance Program and the Clinical Laboratory Improvement and CMS who enforces insurance portability and transaction and code set requirements of HIPAA.

The National Committee on Quality Assurance set the “gold” standard on health plans and their quality ratings. There was no other regulatory agency to oversee the health plan upon its initiation. Now we have other organizations; however NCQA provides the most stringent, ridged regulatory guidelines of the managed care organizations. In order for a health plan to do business with CMS, or state agencies, and to the public; they must show they meet NCQA guidelines. Health insurance has become a hot button topic with ACA and CMS. The Organization was established to set the tone of quality in the health/managed care environment. There are other governing bodies such as HHHAC for ambulatory centers and dome care URAC another nonprofit organization, who reviews health plan, clinical integration, health care, healthcare accreditation. Also AAAHC accreditation means that a health care organization meets or exceeds nationally-recognized Standards for quality of care and patient safety

When assessing the current state of healthcare in the United States, properly forming an answer requires the separation of healthcare by geography, demographics, and economics. These factors influence the quality and availability of services and resources available to clients and professionals. The urban areas will usually have greater access to an array of services and resources, whereas the rural areas will see limitation in this regard. The rural community is normally a place with an eclectic collection of self-reliant people many of whom have never been exposed, within the context of healthcare, to the complexities contained within the healthcare organizations in urban environments. This factor does not eliminate or alleviate, for that

The existing arrangement of the U.S. health care system leaves large numbers of the American population without access to adequate health care. Currently, about 45 million Americans do not have any health insurance, resulting in inability to receive the necessary care required for a healthy and productive life (NCHC). Further, government run programs such as Medicaid and SCHIP, the State Children’s Health Insurance Program, are not sufficient and effective means of providing care for those eligible for them. Poor Families in America’s Health Care Crisis by Ronald J. Angel, Laura Lein, and Jane Henrici illustrates how the safety net for health care through current government programs does not work and how access to health care cannot be

Social structure, such as education, job, and location along with insurance status also influence health care utilization. These factors almost always have an impact on each other. An individual with an education is more likely to get a good job, and therefore have insurance benefits. Availability of health care services correlates with location. Those who live in certain areas are more likely to have health care services readily available. On the other hand, there are areas with plenty of well educated individuals who have good jobs and insurance benefits, but because of their location access to health care services is limited. Changes in insurance have also impacted health care utilization. Cuts in payments combined with an increase in paperwork have been met with unwillingness by health care providers to participate with government programs, such as Medicare and Medicaid. Unfortunately, this also affects health care utilization for those who are poor or living with disabilities (Barsukiewicz et al., 2010).

Changes in access to health care across different populations are the chief reason for current disparities in health care provision. These changes occur for several reasons, and some of the main factors that contribute to the problem in the United States are: Lack of health insurance – Several racial, ethnic, socioeconomic and other minority groups lack adequate health insurance coverage in comparison with people who can afford healthcare insurance. The majority of these individuals are likely to put off health care or go without the necessary healthcare and medication that is needed. Lack of financial resources – Lack of accessibility to funding is a barrier to health care for a lot of people living in the United States