Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Integração de Sistemas , Continuidade da Assistência ao Paciente/organização & administração , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/normas , Eficiência Organizacional , Custos de Cuidados de Saúde , Disparidades em Assistência à Saúde , Humanos , Qualidade da Assistência à Saúde/normas , Estados UnidosAssuntos
Infecções por Coronavirus/economia , Atenção à Saúde/economia , Governo Federal , Seguro Saúde/economia , Pandemias/economia , Pneumonia Viral/economia , Saúde Pública/legislação & jurisprudência , Mecanismo de Reembolso , COVID-19 , Capitação , Disparidades em Assistência à Saúde , Humanos , Cobertura do Seguro , Estados UnidosAssuntos
Atenção à Saúde/tendências , Custos de Cuidados de Saúde/tendências , Patient Protection and Affordable Care Act , Atenção Primária à Saúde , Reembolso de Incentivo , Centers for Medicare and Medicaid Services, U.S. , Humanos , Inovação Organizacional , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Estados UnidosAssuntos
Cobertura do Seguro/legislação & jurisprudência , Medicaid/legislação & jurisprudência , Patient Protection and Affordable Care Act , Adulto , Custos e Análise de Custo , Financiamento Governamental , Trocas de Seguro de Saúde/tendências , Humanos , Cobertura do Seguro/tendências , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Medicaid/economia , Estados UnidosRESUMO
Health care delivery systems, including academic medical centers (AMCs), are increasingly focused on improving care for vulnerable, high-need, high-cost patients, in part because value-based payment models offer the promise of financial returns, or the avoidance of losses, for doing so. AMCs and other providers that have participated in Medicare and Medicaid demonstrations and value-based payment programs have important insights to offer about the features of successful and promising programs for high-need, high-cost patients. As more AMCs embrace value-based payment, they may have greater flexibility to provide services that address the medical and nonmedical needs of clinically complex patients and thereby reduce avoidable health care utilization. AMCs have many opportunities to create high-performing health systems, establish operational evidence for how to transform delivery systems, and train the next generation of providers to better address the care of high-need, high-cost individuals.
Assuntos
Centros Médicos Acadêmicos/economia , Atenção à Saúde/economia , Gastos em Saúde/tendências , Análise Custo-Benefício , Humanos , Medicaid , Medicare , Qualidade da Assistência à Saúde , Estados UnidosRESUMO
There is a formidable historical arc to health care policy: Every modern US president has sought to expand coverage. Democrats eagerly placed the issue on the agenda. Republicans vociferously opposed Democratic proposals but countered with creative ways to expand coverage on their own terms. Democrats eventually absorbed elements of the latest Republican plan-which Republicans, in turn, attacked, and the cycle began anew. The dynamic interaction between the parties slowly, often haphazardly, expanded health insurance as each sought to extend coverage in its own way. We speculate about whether the recent Republican efforts to repeal the Affordable Care Act constitute a sharp break with the past, perhaps because opposition to government, exacerbated by racial anxieties, has changed the Republican calculus. Alternatively, there are still some reasons to conclude that the arc of health policy continues to bend toward increasing coverage.
Assuntos
Governo/história , Reforma dos Serviços de Saúde/história , Política de Saúde , Cobertura do Seguro , Seguro Saúde , História do Século XX , História do Século XXI , Humanos , Medicaid , Medicare , Patient Protection and Affordable Care Act , Política , Estados UnidosAssuntos
Registros Eletrônicos de Saúde/economia , Disseminação de Informação , Confidencialidade/legislação & jurisprudência , Coleta de Dados/economia , Coleta de Dados/legislação & jurisprudência , Registros Eletrônicos de Saúde/legislação & jurisprudência , Humanos , Disseminação de Informação/legislação & jurisprudência , Estados UnidosRESUMO
ISSUE: The number of Americans insured by Medicaid has climbed to more than 70 million, with an estimated 12 million gaining coverage under the Affordable Care Act's Medicaid expansion. Still, some policymakers have questioned whether Medicaid coverage actually improves access to care, quality of care, or financial protection. GOALS: To compare the experiences of working-age adults who were either: covered all year by private employer or individual insurance; covered by Medicaid for the full year; or uninsured for some time during the year. METHOD: Analysis of the Commonwealth Fund Biennial Health Insurance Survey, 2016. FINDINGS AND CONCLUSIONS: The level of access to health care that Medicaid coverage provides is comparable to that afforded by private insurance. Adults with Medicaid coverage reported better care experiences than those who had been uninsured during the year. Medicaid enrollees have fewer problems paying medical bills than either the privately insured or the uninsured.
Assuntos
Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Adulto , Financiamento Pessoal , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/estatística & dados numéricos , Setor Privado , Qualidade da Assistência à Saúde , Estados UnidosAssuntos
Política de Saúde/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Política , Reforma dos Serviços de Saúde/história , Reforma dos Serviços de Saúde/legislação & jurisprudência , História do Século XX , História do Século XXI , Patient Protection and Affordable Care Act/economia , Sistema de Fonte Pagadora Única/história , Estados Unidos , Cobertura Universal do Seguro de Saúde/históriaAssuntos
Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Avaliação das Necessidades , Continuidade da Assistência ao Paciente , Acessibilidade aos Serviços de Saúde , Humanos , Qualidade da Assistência à Saúde , Serviço Social/economia , Seguro de Saúde Baseado em ValorRESUMO
BACKGROUND: Studies have shown an association between the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) scores and clinical quality. The mortality risk on admission predicts adverse events. It is not known if this risk also portends a suboptimal patient experience. OBJECTIVE: To determine if the admission mortality risk identifies an experience of care risk. DESIGN: A retrospectively assembled cohort in which individual HCAHPS survey responses were linked to the admission risk of dying. SETTING: Five community hospitals of various sizes in Michigan. PATIENTS: There were 17,509 HCAHPS medical and surgical respondents; 2513 (14.4%) were at high risk of dying. MEASUREMENTS: Odds ratio (OR) (high-risk patients to low-risk patients) for providing a top box score for HCAHPS dimensions, controlling for hospital and the standard HCAHPS patient mix adjustment factors. RESULTS: High-risk respondents were less likely to provide the most favorable response (unadjusted) for all HCAHPS domains, although the difference was not significant (P = 0.09) for discharge information. Multivariable analyses indicated that high-risk patients were less likely to report a top box experience for doctor communication (OR: 0.85; 95% confidence interval [CI]: 0.77-0.94) and responsiveness of hospital staff (OR: 0.77; 95% CI: 0.69-0.85), but were more likely to have received adequate discharge information (OR: 1.30, 95% CI: 1.14-1.48). CONCLUSIONS: Patients at high risk of dying who completed surveys were less likely to report favorable physician communication and staff responsiveness. Further understanding of these relationships may help design a care model to improve both outcomes and experience. Journal of Hospital Medicine 2016;11:628-635. © 2016 Society of Hospital Medicine.
Assuntos
Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Mortalidade , Satisfação do Paciente/estatística & dados numéricos , Idoso , Comunicação , Feminino , Hospitalização , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoAssuntos
Atenção à Saúde , Patient Protection and Affordable Care Act , Qualidade da Assistência à Saúde , Controle de Custos/economia , Controle de Custos/métodos , Atenção à Saúde/economia , Atenção à Saúde/normas , Gastos em Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Medicare/organização & administração , Patient Protection and Affordable Care Act/economia , Melhoria de Qualidade , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/normas , Estados UnidosRESUMO
As millions of Americans gain Medicaid coverage under the Affordable Care Act, attention has focused on the access to care, quality of care, and financial protection that coverage provides. This analysis uses the Commonwealth Fund Biennial Health Insurance Survey, 2014, to explore these questions by comparing the experiences of working-age adults with private insurance who were insured all year, Medicaid beneficiaries with a full year of coverage, and those who were uninsured for some time during the year. The survey findings suggest that Medicaid coverage provides access to care that in most aspects is comparable to private insurance. Adults with Medicaid coverage reported better care experiences on most measures than those who had been uninsured during the year. Medicaid beneficiaries also seem better protected from the cost of illness than do uninsured adults, as well as those with private coverage.