A new prescription for the poor

A new prescription for the poor

The United States is developing a two-tier medical system, one for those who have private insurance and the other for those who are not very rich.

The United States is developing a dual health system, one for those who have personal insurance and the other for those who are not so rich.

1October 8th 20 1 1 | new york | from the print edition.

"This is

It's time for dancing with the stars! ",a woman announced enthusiastically.

In new york Health Center, sandwiched between residential projects.

In Chinatown in the east and west, "dancing with the stars" means dancing.

A physical therapist. An old man and a nurse stood up and started a fight.

A determined samba.

"It's time for dancing with the stars!" A lady declared enthusiastically. In this new york Health Center, located in the west of the residential project and east of Chinatown, "dancing with the stars" is dancing with the physical therapist. An old man and a nurse stood up and began to dance the scheduled samba.

comprehensive

The Nursing Management Company (CCM), which runs the center, tries to keep the elderly.

Active. Chief Operating Officer Joseph Healy explained that,

In the best interests of the company. The government pays CCM a capped fee.

To take care of its members. If someone is sick, his health cost.

Rising, the company's profits shrink. Mr Healy thinks that this system

It is the best way to provide good care at low cost. More and more people

Seems to agree.

Ordinary care Management Department (CCM), which runs the center, strives to keep the elderly alive. Joseph Haley, the chief operating officer, explained that this was in line with the company's requirements.

In the best interest of. The government gave this department an allowance to take care of these people. If someone gets sick, his health cost will go up and the company's profit will shrink. Mr. Harry confirmed that this system can

Provide the best care at low cost. Others gradually agree with this view.

Medicaid, America's health plan

For the poor, it is being changed. next

In three years, new york will put all the Medicaid population.

"Managed care" pays the company a fixed ratio to take care of the poor, instead of

Instead of paying for every service. New york is not alone. The country comes from

Managed care is expanding from California to Mississippi. it is

The culmination of a steady change in the way most poor Americans receive relief.

Their health care.

Medicaid, the health plan for the poor in America, is in the process of transformation. In the next

Within three years, new york will include all the people who have received the health plan for the poor in "managed health care", and pay predetermined fees to companies to take care of the poor, instead of paying according to the project. New york is not the only place here.

Just like a country. California, Mississippi is expanding its managed health care program. This represents a continuous and stable change, that is, the way most poor Americans receive medical care has changed.

Federal Medicaid system

It is the largest health program in the United States. About 1% this year.

Five Americans will enjoy Medicaid for one month or more. it

Swallowed up more federal and local funds than any state project.

Not education. When barack obama's

The health care reform expanded the plan by relaxing the eligibility rules in 2005.

20 14. the "super Committee" of congress is already considering cutting expenses. however

Behind the current reform movement, there is more direct pressure.

public

Medicaid is the largest single health plan in the United States. This year, one in five Americans will be included in the program for one month or more. Besides education, it consumes more federal funds than other states' fiscal plans.

And local funds. When the 20 14 Obama health care reform relaxes the applicable population, the whole plan will become bigger and the cost will rise further. The "super committee" of the House of Representatives is already considering cutting the economy.

Expenses. However, if you choose this change, there will be more direct pressure.

The enrollment of Medicaid soared in the 1990s.

Decline, from 42.7 million in 20071February to 50.3 million in 20 10/June. Mr. Obama's

The stimulus bill helped pay part of the cost, but the money has run out.

Up. Faced with the widening deficit, some desperate governors cut back on spending.

Pay for hospitals and doctors, or refuse to pay for travel

Dentist or ophthalmologist. But the most important result is that

Structural: the expansion of managed medical care.

Since 2007, the number of people participating in Medicaid has increased during the economic recession.

65438+ February

42.7 million people jumped to 50.3 million in June of 20 10. Obama's stimulus money can help pay part of it, but it has been used up. Faced with the shortage of funds, some desperate governors

Cut off subsidies to hospitals and doctors, or refuse to pay the travel expenses of dentists and ophthalmologists. However, the increasingly important result is structural: the expansion of managed health care.

state

I have been involved in managed medical care for decades. This trend accelerated in the 1980s.

1990s, the proportion of Medicaid patients under this medical form.

It will reach 72% by 2009. However, there is a strong driving force now.

Remainder States without managed care, such as Louisiana.

Introduce it. Other States have also extended it to people before.

Considered off limits: for example, California and new york are on the move.

The elderly and the disabled are included in this care system. Texas has more goals.

More than 400,000 Medicaid beneficiaries in the Rio Grande Valley. local

Politicians are opposed to this move, fearing that the medical situation will deteriorate.

But the huge deficit means they were rejected.

How many states are involved in managing health care?

Ten years of history. This trend accelerated in the 1990s. Before 2009, 72% of Medicaid patients used this nursing method. Now, for the rest of us, this is also a powerful driving force.

Force. States like Louisiana that have no managed health care are introducing managed health care. Other States have also extended this policy to people who were previously considered inapplicable: for example, California and New York are recruiting the elderly and the disabled.

In this system, Texas aims to cover more than 400,000 Medicaid beneficiaries in the Grand Canyon. Local politicians opposed the move, fearing that the nursing system would deteriorate. But the huge deficit

It means that their views are doomed to be refuted.

The result is that a country has two distinct classes.

Medical care. Most Americans with private insurance still

Afraid of the idea of health management organization, more willing

Pay for each medical service. For the poor, managed medical care is

Become the norm.

The result is that a country has two different health insurance systems. Most Americans with personal insurance are still afraid of the idea of health management organizations, preferring to pay for separate medical services. For the poor, managing health care has become a routine.

advocator

Have high expectations for managed medical care. First, they hope it will

Improve the predictability of costs. Second, they believe that change will

Improve the health of patients. In managed medicine, patients have a network.

Doctors and experts. If the project works properly, doctors can

Monitor all aspects of nursing, rather than acting in isolation.

Charge service system. Contracts between the government and enterprises can

Set quality standards. For example, Texas will cut taxes by 5%.

If it does not meet the requirements, the company will pay.

Advocates of managing health care have a high reputation.

Expect. First, they hope that this will make the cost predictable. Second, they think that this change can improve the health of patients. In management nursing, patients have a network of doctors and experts. if

The plan works well, and doctors can monitor all aspects of care instead of a separate payment service system. Contracts between state governments and companies can set quality standards. For example, Texas will pay.

5% will be deducted if the company fails to meet the required standards.

The next step is to integrate care for these people.

Eligible for Medicaid and Medicare

Old. These "dualists" account for almost 40% of Medicaid expenses.

65438+ 05% of its population. "If managed medical care can really provide better medical services,

Diane Rowland, chairman of the Committee, said

Advise Congress on Medicaid, "This is a provable population.

It ... "

The next step is to integrate those who are eligible for both public Medicaid and Medicaid for the elderly (federal Medicaid for the elderly). These "double-matched" people account for nearly 40% of the public medical supplement.

The cost and population of help are only 15%. "If managed care can really bring better service than project-based payment", Diane Rolland, director of the committee (guiding Congress to make a decision on Medicaid policy).

"This is a group of people who can prove the feasibility of managing health care," he said.

But some people, such as Norma Viscovo, are.

Doubt. As the head of the non-profit independent living center

In southern California, Ms. Wiskovo provides medical assistance to Medicaid patients

Serious health problems. For years, she often sued California.

A policy that she thought would hurt her vulnerable clients. October

Her case was transferred to the Supreme Court.

But some people, such as Norma Fanskov, are skeptical. As the director of the Center for Non-profit Independent Living in Southern California, Ms. Fanskov provides services for patients with serious health problems and receiving Medicaid. Over the years, she often accused the California government of hurting some of her vulnerable customers in some policies. 10 year 10 3, her case was moved to the court of appeal.

this

The outcome of the independent living center of Douglas V will have a far-reaching impact.

Impact on the future of Medicaid. Ms viskovo's lawsuit is related to cuts.

To hospitals and doctors. But this case will also guide

Managed medical care. If ILCSC and its co-plaintiffs win the case, private groups will

Continue to be able to challenge policies that States consider to be in violation.

Federal Medicaid law. Ms. Wiskovo thinks that California's payment

She is worried that cutting expenses will weaken her clients' access to services.

Under managed care, disabled people may not see experts.

They need.

Douglas v

The results of independent living center will have far-reaching significance for public medical assistance. Ms. Fanskov's lawsuit affected the reduction of subsidies for hospitals and doctors. But this case will lead the process of management care. If the center and its

His plaintiff won the lawsuit, and private groups will continue to challenge the state government's policies, which they believe violate federal laws. Ms. Fanskov believes that California's payment reduction plan will make her customers lose the opportunity to get services. She

I am also worried that under the care of management, those disabled people may not see the experts they need.

The question is how

Supervise the ongoing managed medical experiment.

In different states. So far, Medicaid beneficiaries have been able to

Challenge the government in court. However, if the Supreme Court ruled that

Against the International Civil Service Commission, this road will be closed. Medical insurance and medical insurance center

If the state government does not intervene, Medicaid services (CMS) can technically intervene.

Provide appropriate medical services. In fact, CMS has few tools to do this.

ask

The problem is how to supervise the management care of the trial operation in each state. So far, Medicaid beneficiaries have been able to challenge the government in court. However, if the result of the court of appeal is not favorable to the center, then this road will be

Close. If the state government does not provide proper care, Medicaid and the elderly medical care center can theoretically intervene, but in practice, they have little choice.

"I am.

Sarah rosenbaum, a professor at George University, said: "I am a loyal supporter of managed medical care."

University of Washington, "but this shift may happen.

There is no federal supervision. "Medicaid beneficiaries are vulnerable and the situation is even worse.

Healthier than Americans as a whole. The company may try to cut costs.

And provide good care. If the state does not draft the contract

Appropriate, or failed to vigilantly monitor the health of patients, their

The experiment of managed medical care may be a disaster. On the other hand, if

States are careful to provide answers to this question.

Puzzled America for many years: how to provide quality and cheap medical care.

"I am.

Sarah Rosenbaum, a professor at George Washington University, said. But this shift may occur without federal supervision. "The beneficiaries of Medicaid and your vulnerability, health

Generally speaking, the degree is worse than that of ordinary Americans. Companies may try to provide quality services while cutting costs. If the state government does not properly draft contracts or vigilantly monitor patients' health,

Their experiment in managing health care may be a disaster. On the other hand, if the state governments are serious, they can provide an answer to the question that has puzzled Americans for years, that is, how to provide quality and cheap medical care.

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