Category: Health Insurance

Healthcare Program

The USA federal government has presently elaborated and introduced many programs that ensure the access of low-income families and different social classes, irrespective of their ethnic affiliation, to high-quality care services. In this regard, being at the forefront of healthcare delivery, nurses play an integral role in achieving established objectives and anticipated outcomes stipulated by a particular program. Moreover, they are regarded as essential stakeholders that help researchers and designers develop, adjust, and improve healthcare policies by providing valuable feedback concerning current requirements and issues. Thus, this paper aims at discussing the nurses role in designing and implementing the Childrens Health Insurance Program (CHIP) and determining the members of a healthcare team most needed to implement it.

The Description of CHIP

CHIP is the program that delivers low-cost health coverage to children aged 18 from poor and near-poor families with income both not enough for private insurance and too high to qualify for Medicaid. The program was administered by the US Department of Health and Human Services through Medicaid and signed into law in 1997 as part of the Balanced Budget Act (Program history, n.d.) The CHIP operates as a block program in the states possessing the right to implement these programs as separate programs, as Medicaid expansions, or as composite programs. Due to this reason, CHIP benefits differ in each state. However, all states ensure full coverage, including doctor visits, prescriptions, routine check-ups, inpatient and outpatient hospital care, emergency services, dental and vision care, immunizations, and laboratory and x-ray services (The Childrens Health Insurance Program, n.d.). In addition, the insurance suggests affordable care for Americans with substance use and mental health disorders, forbidding discriminatory practices that restrict the coverage for behavioral health services and treatment.

Concerning health service costs, regular visits to the doctor and dentist for a healthy child are free under the CHIP program. Nevertheless, some states charge copayments for other services and a monthly fee or premiums for CHIP coverage, accounting for no more than 5 percent of the familys income for the year (The Childrens Health Insurance Program, n.d.). Besides, premiums cannot exceed the sum provided by Medicaid for families with earnings of 150 percent or less Federal Poverty Level (FPL) (CHIP Cost Sharing, n.d.).

Target Population

As has been indicated above, CHIP is intended for children aged under 19, residing in destitute families with income that does not allow them to receive private insurance and fall under the Medicaid category. The additional eligibility requirements for CHIP assume that an individual should be a resident of a particular state or meet immigration requisites. Children who are patients of a psychiatric institution, inmates of a public institution, and who obtain health coverage under a state health insurance program are not eligible for CHIP. Besides, specific CHIP eligibility levels vary by state and range from 170 percent to 400 percent FPL (Eligibility, n.d.). As of the 2018 fiscal year, almost 46 million children were ever enrolled in Medicaid and CHIP, from which 9,6 million children were recorded in CHIP (Reports & Evaluations, n.d.). In some states, the CHIP coverage expands for adults, namely pregnant women and parents of children enjoying benefits from both Medicaid and SCHIP. In this respect, states can allow insurance that includes prenatal, delivery, and postpartum care for low-income non-insured pregnant women.

The Nurses Role in the Design of Healthcare Program

Nurses belong to the primary contributors to the healthcare program design since they are probably the most aware and experienced among healthcare providers regarding the patients demands due to their direct interaction with them. Therefore, they can give practical suggestions while developing healthcare programs in collaboration with other health professionals and senior members of the medical hierarchy. For instance, nurses can provide information about nurse staffing and training problems since this factor significantly influences the programs outcomes. For example, the study by Neves et al. (2020) concluded that adequate nursing care quality and safety require an appropriate nurse staffing level, both in competency and number aspects. Furthermore, nurses can inform the researchers and policymakers about the primary childrens needs and administrative issues that hinder easy access to the program.

An Advocate for the Target Population

While caring for children, nurses gain a holistic picture of a childs health-related information and domestic setting and issues that need urgent consideration. The nurse should represent and advocate for the best patients interests to support the patients dignity throughout treatment and care. For example, nurses can provide recommendations concerning the range of the principal services for children from low-income families, which the program should provide. In this regard, the program can expand the number of affordable services that the insurance cover and that are of the highest need for children. Moreover, the suggestions can be connected with protecting patients from discriminatory practices and increasing access to health care.

The Implementation of the Healthcare Program

Implementing the healthcare program is an essential part of the nursing workflow. First of all, a nurse should provide understandable clarification of different CHIP-related issues the patients face while attempting to access the program. In particular, in case of need, a patient should be informed about eligibility requirements and program benefits, rights, and cost comprehensively. In addition, the active involvement of a nurse in teamwork also promotes the successful realization of the program. In this regard, nurses should facilitate exchanging useful information regarding patients needs and regulatory legal norms. Overall, nurses help the management integrate changes intended by the CHIP in the healthcare system in terms of care access and quality. The difference between design and implementation processes is that the former requires nurses to gather and provide relevant patient-related data, while the latter assumes taking personal responsibility for conveying the programs objectives to reality.

The Members of the Healthcare Team

The first group of critical stakeholders includes nurses, physicians, and allied health staff since the programs success depends on input information obtained from clinicians during the planning process. Another stakeholder is office staff and managers because they are accountable for collecting billing, contact, and demographic data of all the patients and providing it to vendors. Moreover, they deliver information about potential threats and improvements that relate to the plan. The third stakeholder is the administration or board members since they may perform a central role in developing a valid application strategy. Besides, they make financial and operational decisions concerning the program project.

In conclusion, the paper has outlined the nurses role in designing and implementing the Childrens Health Insurance Program (CHIP) and identified the members of a healthcare team most relevant to the program application. In particular, nurses can give practical suggestions while developing healthcare programs in collaboration with other healthcare staff since they are at the forefront of healthcare delivery. Regarding the target population, nurses should represent and advocate for the best patient interests to support the patients dignity throughout treatment and care. In terms of implementation, the nurses role is in providing a clear explanation of different CHIP-related issues for patients and active participation in teamwork. Finally, the healthcare team may include nurses, physicians, allied health staff, office staff and managers, and the administration or board members.

References

CHIP cost sharing. (n.d.). Medicaid.gov.

Eligibility. (n.d.). Medicaid.gov.

Neves, T. M. A., Parreira, P. M. S. D., Graveto, J. M. G. N., Freitas, M. J. B. D. S. D., & Rodrigues, V. J. L. (2020). Nurse managers perceptions of nurse staffing and nursing care quality: A crosssectional study. Journal of Nursing Management, 28(3), 625-633.

Program history. (n.d.). Medicaid.gov.

Reports & Evaluations. (n.d.). Medicaid.gov.

The Childrens Health Insurance Program (CHIP). (n.d.). Healthcare.gov.

Introduction

1.1 Background to the Study

Maternal health is crucial to the production and survival of healthy children in any society. It is often said that ‘health is wealth’. Applying this aphorism to maternal health, it means that the quality of maternal healthcare received by the nursing mothers helps in the production of future healthy population and the wealth of any nation (Kwanga, Kirfi, & Balarabe, 2013; WHO, 2005). Health has been defined by the World Health Organization (WHO) as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”(WHO, 2011). Incidentally, Likewise, Irinoye (2007) defined health as encompassing “a state of physical, mental and social well-being in which the individual is able to lead a full effective life, unimpeded by mental or physical disabilities or frustrations”. Hence, Mmaternal health care will then translate to the ability to provide necessary medical care for nursing mothers in order to prevent mortality and morbidity of both mother and the child(ren).

Health care system is inundated with funding challenge in the developing countries to which African countries belong,(Owumi, Omorongbe, & Raphael, 2013). Nigeria is not an exception to this identified challenge faced by the health sector. Instructively, Tthe downturn in the oil price in the world market in the 1980s led to a considerable underfunding of the health care sector by the federal government of Nigeria, (Odeyemi & Nixon, 2013; Okaro, Ohagwu, & Njoku, 2010; Oyekale, 2012). Another factor that can be traced to the underfunding of the health sector is the population upsurge in the country, (Irinoye, 2007). These constraints have is has reduced the quality of service; and made health inaccessible to a considerable number of Nigerians who are confronted with issues of poverty. Importantly, It has been revealed that Nigeria has recorded high mortality and morbidity rates when compared with other countries of the world, (Adeoye, Onayade, & Fatusi, 2013).

In response to the sordid condition of health care in the country, institutionalizing health insurance was a means adopted by the Federal government of Nigeria to deal with the challenges of mortality and morbidity in the country. In the light of the foregoing, NHIS came into being as a means funding and providing health care to the people in the country. In accordance with Act 35 of the 1999 NHIS Decree, NHIS was established in Nigeria with the major objective of increasing the accessibility to quality, equitable and affordable health care by all the citizens of the country. Although, the enactment that established the scheme was signed in 1999, the effective implementation of the scheme did not occur until 2005, (Irinoye, 2007).

The implementation of the National Health Insurance sScheme has raised issues that have undermined the objective of the scheme. This is because 5% of the population of the country are registered on the scheme, (Yusuf & Akinmola, 2009). Disappointingly,Likewise, some state governments in the country are yet to implement the scheme for their workers, (Eboh, Akpata, & Akintoye, 2017). For example, as revealed in the statement of the Executive Governor of Osun state, His Excellency, Adegboyega Oyetola, in May 2019, NHIS has not been implemented for the state government workers of the sState of Osun., (Nasir, 2019). This is in sharp contrast with the original goals of the NHIS, thatNHIS, which is, increasing accessibility to health care for all Nigerians. As a result of the exclusion of some Nigerians from the Scheme, it might be difficult to achieve the goals of the scheme. Owing to the anomalies stated above and few others, the scheme, in its current state of implementation would not achieve the goals for which it was set.

Maternal mortality rate in Nigeria before the effective implementation of the NHIS in 2005 was estimated at 940 per live births for the same year 2005, (WHO, 2015)..Also, Mmortality rate for the “under-five children” was 198 per live births in 2003, (WHO, 2005). By 2015 (ten years after the commencement of the NHIS), Comparatively, ten years after the implementation of the NHIS, 2015 to be precise, statistics have shown that mortality rates are estimated as follows: maternal mortality was 814 per 100,000 live births, (WHO, 2015) and mortality rate of the under-five children was put at 108.8 per 1000 live births, (UNDP, 2016). From these statistics, It is clearly revealed that there is a decline in the both maternal mortality rate and under-five children mortality rate in Nigeria. However, it is difficult to conclude that this reduction can be associated with the success of the NHIS. Painfully, Even with the decline, Nigeria still records one of the frightening mortality rate in the world. is still found among the countries which contribute most to the mortality of the world at large. Furthermore, it is worthy of note that studies have not actually concluded that it is the implementation NHIS that resulted to the reduction in the mortality rate in the country.

Studies on NHIS are mostly focused on the attitude of public workers or enrollees to the scheme. However, women constitute a critical force to the survival of any society. This is not in isolation of the fact that women constitute half of the population of the country. More significantly, reproduction in any society cannot take place without women, nursing mothers especially. It should be noted that for women to give birth to healthy children, access to health care by the nursing mothers is important. must be attended to. It is in appreciation of this fact that it becomes pertinent to interrogate the operations of the NHIS. In the light of the foregoing, in order to increase the accessibility to health care as stated by the goal of the NHIS, the implementation of the scheme must be looked at beyond its present state. Consequently, this study would interrogate the focus on the attitude of nursing mothers to the NHIS.; and interrogate if the scheme has been helpful in reducing mortality amongst women and children.

1.2 Statement of Problem

The NHIS , according to its objective is meant to increase the accessibility to health for Nigerians with a view to reducing equitable, quality and affordable healthcare for the people, thereby raising the level of healthy living and reducing the mortality and morbidity rates in Nigeria. It is also the right of every citizen to be able to access quality health care and at affordable cost. However, the reality is that the NHIS has been constrained from achieving the objectives for which it was set up. But this scheme has been hindered so many issues. There are a number of issues concerning the quality of healthcare or the services provided by Health Care Providers (HCPs) under the provisions of the NHIS.

Several studies have been carried out to examine the effectiveness of the NHIS in carrying out its objectives. First, a number of studies are centered on the relationship between awareness level and the usage of the scheme, (Adewole, Dairo, & Bolarinwa, 2016; Eyong, Agada, Asukwo, & Irene, 2016; Okaro et al., 2010; Oyekale, 2012). Some studies have also investigated the enrollees level of awareness and knowledge of the policies and rules of the (Okaro et al., 2010; Yusuf & Akinmola, 2009). Furthermore, poor coverage of the NHIS among the populace has been identified as a critical limitation of the scheme (Adewole et al., 2016; Eboh et al., 2017; Ibiwoye & Adeleke, 2008). Quality of service provided to the enrollees is another issue that requires attention (Asakitikpi, 2016; Daramola, Adeniran, & Akande, 2018; Oladipupo, Lanre, & Oluwatosin, 2017; Yusuf & Akinmola, 2009). It has also been revealed that the coverage of NHIS favours the people in formal employment than those in the informal employments, (Ibiwoye & Adeleke, 2008). In relation with the quality of service provided by the scheme to the users, Oladipupo et al. (2017) revealed that 45% of its study respondents were dissatisfied with the service delivered by the scheme. The reason for this dissatisfaction was further explained as unavailability of drugs, long waiting periods, referral issues, as well as registration procedure. Ibiwoye & Adeleke (2008) stated that 60% of its respondents encountered problem, and are displeased with the NHIS services or operations based on such issues as long queues and poor reception given them by some unfriendly health workers. Comment by user: This could come in your review of literature or in the analysis of your data.

The gap in literature is that sufficient attention has not been paid to the attitude of nursing mothers to the Scheme. Inferring from this argument, one can say that no particular attention has been paid to the view of the nursing mother on the scheme. It should also be noted that nursing mothers have been regarded as part of the vulnerable population as far as health accessibility is concerend, especially mortality and morbidity rates is concerned, (Oyibocha et al., 2014). As a result of the challenges that plague the operations of the NHIS, some pregnant and nursing mothers are excluded from accessing the NHIS. The consequence of this for those pregnant and nursing mothers is to make use of In a bid to access the health care, the nursing mothers, who may not be able to afford the costly out-of-pocket means of funding healthcare, may turn to other options which include self-medication, traditional medicines, and faith homes.The consequence of this for mortality and morbidity for women and the society is better imagined than being described. , patronage of the incompetent health practitioners. This in turn, if not nipped in the bud, might increase mortality and morbidity rates among the nursing mothers and their wards in the country. This may have adverse effect on the economy of the country in two ways. First, the working population may be reduced as result of sickness or and death, which has the ability to reduce the national production capacity and by implication, national income. Also, the government may have to spend its meager resources on curative rather than preventive care for its citizens. Secondly, the country may have to spend her insufficient income on curative care for the sick citizens in the long run.

1.3 Research Questions

1. What is the attitude of nursing mother enrollees to the scheme in public and private accredited NHIS facilities?
2. What are the gaps in the operations of the NHIS that could hinder the scheme from achieving its mandate?
3. What is the assessment of nursing mother enrollees of the quality of service offered by the NHIS accredited hospitals?

1.4 Objectives of the Study

The general objective of this study is to investigate the attitude of nursing mothers towards the operations of the NHIS in accredited facilities in Ile-Ife. Inferring from the general objectives, are the specific objectives:

1. Investigate the attitude of nursing mothers to the scheme in both public and private NHIS accredited hospitals;
2. Identify the gaps in the operations of the NHIS that could hinder the scheme from achieving its mandate;
3. Investigate the quality of the service provided by the scheme to the nursing mothers; and
4. Make evidence-based suggestions to strengthen the scheme.

1.5 Justification of The Study

In order to reduce mortality and morbidity rate in the country, it is important to interrogate the operations of the NHIS with a view to strengthening it. If the country is to have a healthy productive force, it becomes pertinent to make health more accessible to pregnant and nursing mothers. This study would draw its conclusions from the narratives of both pregnant and nursing mothers to suggest empirically based suggestions that would strengthen the operations of the NHIS.

In conclusion, the study would identify the problems that are associated with the operations of the NHIS, which has made some pregnant women and nursing mothers to find it difficult to access the NHIS. In order to identify the efficiency of the NHIS, the evaluation of the scheme needs to be done using the right yardstick and measures.Nursing mothers are important in the reproduction of every society. The reason is not disconnected from their responsibility of carrying pregnancy and also take custody of the infants and under-five children in most cases. Hence, their views about the scheme, which have not really been explored in the assessment of NHIS. Whatever conclusion that is drawn by this study will be based on the views of the nursing mothers of the NHIS and its functioning.

On the other hand, this study will provide a conclusion and recommendation which will be rooted in the context and evidence-based data that would highlight the experience of the nursing mother in accessing NHIS.

References

1. Adeoye, I. A., Onayade, A. A., & Fatusi, A. O. (2013). Incidence , Determinants and Perinatal Outcomes of Near Miss Maternal Morbidity in Ile-Ife Nigeria : A Prospective Case Control Study. BMC Pregnancy and Childbirth, 13(93), 1–15.
2. Adewole, D. A., Dairo, M. D., & Bolarinwa, O. A. (2016). Awareness and Coverage of the National Health Insurance Scheme among Formal Sector Workers in Ilorin , Nigeria. African Journal of Biomedical Research, 19, 1–10.
3. Asakitikpi, A. E. (2016). Healthcare Delivery and The Limits of The National Health Insurance Scheme in Nigeria. Africa Development, XLI(4), 29–45.
4. Daramola, O. E., Adeniran, A., & Akande, T. M. (2018). Community Medicine And Patients’ Satisfaction With the Quality of Services Accessed Under the National Health Insurance Scheme at a Tertiary Health Facility in FCT Abuja , Nigeria. Journal of Community Medicine and Primary Health Care, 30(2), 90–97.
5. Eboh, A., Akpata, G. O., & Akintoye, A. E. (2017). Health Care Financing in Nigeria : An Assessment of the National Health Health Care Financing in Nigeria : An Assessment of the National Health Insurance Scheme ( NHIS ). European Journal of Business Management, 8(27), 24–34.
6. Eyong, A. K., Agada, P. O., Asukwo, E. O., & Irene, C. (2016). Awareness of National Health Insurance Scheme (NHIS) and Quality of Health Care Services among Civil Servants in Cross River State, Nigeria. Research on Humanities and Social Sciences, 6(13), 1–10.
7. Ibiwoye, A., & Adeleke, I. A. (2008). Does National Health Insurance Promote Access to Quality Health Care ? Evidence from Nigeria. The Geneva Papers, 33, 219–233. https://doi.org/10.1057/gpp.2008.6
8. Irinoye, A. I. (2007). National Health Insurance Scheme in Nigerian Tertiary Institutions. National Health Insurance Scheme in Nigerian Tertiary Institutions (First). Ile-Ife: Timade Publishing House.
9. Kwanga, Z. Y., Kirfi, M. M. W., & Balarabe, A. (2013). Social Security Reform and Service Delivery : A Study of NHIS (Client’s-Service Providers’ Relationship ) in Kebbi State, Nigeria. International Journal of Humanities and Social Science Invention, 2(5), 86–94. Retrieved from www.ijhssi.org
10. Nasir, L. (2019). Osun State to Begin Implementation of National Health Insurance Scheme. Retrieved from www.von.gov.ng/osun-state-to-begin-implementation-of-NHIS
11. Odeyemi, I. A. O., & Nixon, J. (2013). Assessing Equity in Health Care Through the National Health Insurance Schemes of Nigeria and Ghana : A Review-based Comparative Analysis. International Journal for Equity in Health, 12(9), 1–18.
12. Okaro, A. O., Ohagwu, C. C., & Njoku, J. (2010). Awareness and Perception of National Health Insurance Scheme ( NHIS ) Among Radiographers in South East Nigeria. American Journal of Scientific Research, 8(2010), 18–25.
13. Oladipupo, O. O., Lanre, A. O., & Oluwatosin, J. S. (2017). Health Insurance Enrollees’ Satisfaction With Health Maintenance Organizations and Non- Enrollees’ Willingness to Participate and Pay for Health Insurance in Abuja , Nigeria. International Journal of Community Medicine and Public Health, 4(11), 3976–3982.
14. Owumi, B. E., Omorongbe, C. E., & Raphael, S. C. (2013). Social sciences. African Journal of Social Sciences, 3(3), 40–52.
15. Oyekale, A. S. (2012). Factors Influencing Households ’ Willingness to Pay for National Health Insurance Scheme ( NHIS ) in Osun State , Nigeria. Ethno Med, 6(3), 167–172.
16. Oyibocha, E. O., Irinoye, O., Sagua, E. O., Ogungide – Essien, O. T., Edeki, J. E., & Okome, O. L. (2014). Sustainable Healthcare System in Nigeria : Vision , Strategies and Challenges. IOSR Journal of Economics and Finance (IOSR-JEF), 5(2), 28–39.
17. UNDP. (2016). Human Development Report 2016 Human Development for Everyone. Washington DC.
18. WHO. (2005). The World Health Report 2005 Make Every Mother and Child Count. France. Retrieved from www.who.int
19. WHO. (2011). Presentation: “Designing the Road to Better Health and Well-being in Europe” at the 14th European Health Forum Gastein. World Health Organization, 14th Europe Health Forum. Bad Hofgastein.
20. WHO. (2015). Trends in Maternal Mortality: 1990 to 2015. Geneva. Retrieved from www.data.worldbank.org
21. Yusuf, T. O., & Akinmola, O. O. (2009). Investigating the Effectiveness of the Nigeria’s National Health Insurance Scheme on The Health Care Delivery System.

Introduction

Benjamin Franklin said there were only two things certain in life: death and taxes. And as something that is put to comparison with death in its certainty; most people fear even the mention of taxes the same as its counterpart, but it does not have to be that way.

Taxes are considered as a form of a membership to the society, for the person to become of service to their society. To foster economic growth and development governments need taxes since they are considered as a public service fee that covers everything from health, education, social security including pensions and medical care, to infrastructure growth, such as waterworks and roads, as well as to policing, fire-fighting, and national defense.

Taxation not only pays for public goods and services; it is also one of the main elements in the social contract between the taxpayers and the economy of the society.

How taxes are gathered and used can define a government’s legitimacy. Holding governments liable supports the efficient administration of tax returns and, more broadly, good public financial management.

These services are considered essential in our day-to-day lives, but they cost money. For that reason, taxes are collected to fund these public services. For everyone to help each other creating a better society, and yet it is highly important that tax load must be carried justly and widely over the members of society.

Taxes are compulsory contributions that each and every person has to pay in order to raise funds for the development of the nation.

Taxation in a fair manner while considering the different levels of income increases economic growth in the long run and encourages individuals to do more work, save, and invest. It reduces the budget deficit in the country and the dependence on foreign aid, which is an unstable source of revenue for the country.

Taxation when done right; helps international governments to fulfill their traditional functions of providing some goods and services. And organizes trade activities in a manner that preserves the economy. And it gives the government greater flexibility to control development work; by designing a schedule that helps improve the economic environment within it, and last but not least helps to set the appropriate conditions for attracting foreign investment.

While higher taxes may lead to negative effects on the general economy, for example, corporate and shareholder taxes reduce investment incentives and build capital, which in return affects the volume of investment, and consequently a decrease in the number of productive workers, and a decrease in wages.

Higher taxation for higher-income earners reduces educational returns; because high incomes are linked to higher education levels, this leads to a lower incentive for human capital formation. The higher the level of taxation, at the level of personal income, which reduces the incentive to work.

The following is a list of the most common types of taxes:

Income tax: it is a tax required by individuals or beings that ranges with respective income or profits. Income tax generally is computed as the product of a tax rate times taxable income. Taxation rates may vary by type or characteristics of the person paying it. The tax rate may rise as taxable income rises, and it is presented to the government.

Corporate Tax: A corporate tax, which is also might be called as the corporation tax or company tax, is a direct tax required by a jurisdiction on the annual revenue value, or assets of corporations or comparable legal entities. Many countries command such taxes at the nationwide level, and a related tax may be commanded at state or local levels.

Property tax: A property tax or it may be called millage rate is an ad valorem tax on the worth of a property, normally levied on real estate. The tax is levied by the executive authority of the jurisdiction in which the property is located. This can be a national government, a federated state, a county or geographical region, or a municipality.

Goods Tax: Or it may be called sales tax, it is a tax paid to a regulatory body for the sales of certain goods and services. Normally, the laws allow the seller to solicit funds for the tax from the customer at the time of purchase. When a tax on goods or services is paid to a regulatory body directly by a customer, it is normally called a use tax.

Customs Tariff: A tariff is a tax on imports or exports between different states. It is a form of management of foreign trade and a policy that taxes foreign products to support or safeguard the domestic industry. Traditionally, states have used them as a source of income.

In this research proposal, we are directing the effects of the taxation system on the health and education sector. In the health sector, healthcare taxes are used to pay the doctors that treat patients in the hospitals, developing hospitals, health insurance, and such, and in the education sector, it is used to pay for school funding, a prime example for that is the monthly payment for public teachers that guide the students, to cover up the cost of maintenance and building for school facilities and such. Taxes are necessary for the development and maintenance of these two sectors that are considered essential for the overall wellbeing of our society and to our day-to-day lives.

Therefore, we ask the question of; how does the taxation system affect both the health and education sector? And we expect by answering that question in this research proposal; we will be able to reach an answer that serves both as a notice of the importance of the tax system, and shed a light on the beneficiaries who are in this paper are the health and education sectors, and whether the tax system has served its purpose or not.

Accordingly, the aim of this research will be to discover the effects of taxes on the health and education sector, and to find out whether these effects are positive or negative, do they require more taxes or less, and to overall find solutions if there are any challenges ahead by the answer to that question.

By the end of this research, we expect to find if the tax system effects on the health and education sector are prominent, whether they could be positive or negative, and if more tax funding is required or not.

Literature review

In a study made by John F. Cogan, R. Glenn Hubbard, and Daniel P. Kessler, about ‘the effect of tax preferences on health spending’.

It has shown that: ‘The tax preference for health insurance is likely a key cause of inefficiency in the U.S. health care system. By making health spending in general, and insured health spending in particular, appear less costly than they are, the tax preference gives employees an incentive to take compensation as health insurance rather than cash — even if the value of the spending to the employee is significantly less than its cost to society.’

The tax system for the health sector comes ineffective when it comes to health insurance. And to elaborate on that, Nancy T. Greenspan and Ronald J. Vogel; ‘Tax subsidies for private health insurance continue to cause increased demand for health services, which in turn result in higher prices. As long as this is the case, government health programs will have difficulty competing with the private sector.’

Therefore, proving that the taxation impact on the health sector is significant, although there are some areas that need prompt attentiveness such as health insurance which the taxation on varies whether is the company is private or governmental.

‘Individual investments in human capital can account for 73% of the estimated intergenerational earnings elasticity in the United States. Taxation and public education expenditure have a significant impact on earnings persistence through their impact on individual investments in human capital and are significant contributors to the cross-country patterns that empirical researchers have found.”, Hans A. Holter.

Taxation and investment in public education show that it has a significant impact on earning because of their impact on the individual’s investment which in a way is beneficial to the economy as well.

There are positive economic impacts of education spending start with direct spending on the education budget. For example, it includes coverage for teachers, managers, and additional education-related employees; wages for transportation, school safety, environment, and facility maintenance; and purchases of school supplies, materials, tools, and business services.

These direct spendings effects in return generate indirect effects. For example, the wages of school workers sustain consumer spending in the community; developments of school buildings contract local development and maintenance services, and school shopping could make as sales for local businesses.

The negative economic result of taxes begins by taking money out of the pockets of individuals, decreasing household procuring power, and reducing the need for local businesses’ goods and services. Met with decreased sales and declining profits, those local businesses lessen their own investments and salaries, and that in return directs to further cuts in spending in the community.

Therefore, taxation has a significant impact on society as well, because the more tax funds go towards education, the more it is proven that it comes back beneficial on the individuals.

Motivation

The research motivates into pouring more tax funds in the health and education sectors, by aiming to find the impact the taxation system has on both of the sectors and where it does fall short or lacks for prompt attentiveness in future studies and actions towards it.

The health and education sectors go hand in hand in their importance to any society and the overall economic health, and tax funds are a major factor in funding those areas.

Although there are some issues on the taxation impact on the health sector in the health insurances department, while there should be more funding on the education sector since it has a significant impact on earning because of its impact on the individual’s investment which in a way is beneficial to the economy and the society as well. In-depth studies using methods such as the professional judgment method and the successful schools’ method also present a notable gap between contemporary levels of funding and those that are required to reach capacity and equity.

We want to research more of the taxations impacts on those two sectors separately, and conclude in findings that would support those sectors since their importance to the overall wellbeing of the individual, society, and the economy.

Conclusion

In this research proposal, we have aimed to discover the effects of taxation on the health and education sectors, those effects will be further explained in the future based on their state (positive/negative), their need for more or less funding, and to find solutions to some of the early findings in past studies that have been done on the same or a similar topic.

All while separating these two sectors individually by the impact of taxation on them, to be able to dissect the data more analytically, to determine the best suitable method of solution to the findings. So far, based on past studies there were more issues with the health sector than education. For the health sector; especially in the health insurance department; the tax preference for health insurance is likely a key cause of inefficiency in the U.S. health care system; by making health spending appear less costly than what they really are, the tax preference gives employees an incentive to take compensation as health insurance rather than cash.

Therefore, it is quite clear that governments must focus their attention on containing prices in the private health sector. One alternative is to reduce the present tax payments in the private business for both the consumers and sellers of health insurance; this act would assist to make the procurement of private health insurance more costly, and that would make the sellers’ market more competing, and would generate less extensive benefits packages to be sold. Nevertheless, the removal of tax payments eventually converts into a legislative question that has not answered with a positive reply in history.

While on the impact of taxation on education, the findings based on past researches were quite on the positive side. The positive net employment and economic impacts grow over time, same as the improved educational spending work develops the perceived quality of life in the multiple countries and as education-related productivity of the regional work-force allows workers to demand bigger incomes and makes businesses more lucrative. The overall economic profits from education spending gains stem from both the budgetary outcomes of educational spending and from the improvements in regional competitiveness.

In summary, when countries face the necessary, tough choices in regard to public spending versus taxation, they should keep in mind that both components of the balanced-budget equation have implications for jobs and income in the state, and that goes for both sectors of health and education. With the heath sector, governments must focus their attention on containing prices in the private health sector, while for the education sector they must already notice the positive impact taxation has on it, and improve it by extra funding. Policymakers should, therefore, devote careful consideration to the likely results of those specific sectors in relation to taxation.

References

1. Greenspan, N.T. and Vogel, R.J. (1980). Taxation and Its Effect Upon Public and Private Health Insurance and Medical Demand. Health Care Financing Review, [online] 1(4), pp.39–45. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191128/.
2. ‌G. Sims, Richard. School Funding, Taxes, and Economic Growth. (2004). [online] Available at: http://www.nea.org/assets/docs/HE/schoolfunding.pdf [Accessed 20 Jun. 2020].
3. portal.edukasyon.ph. (n.d.). Edukasyon.ph: Making the Future Less Scary. [online] Available at: https://portal.edukasyon.ph/blog/taxes-and-students-whats-the-connection [Accessed 20 Jun. 2020].
4. ‌www.doingbusiness.org. (n.d.). Why it matters in Paying Taxes – Doing Business – World Bank Group. [online] Available at: https://www.doingbusiness.org/en/data/exploretopics/paying-taxes/why-matters.
5. Macek, Rudolf. “(PDF) The Impact of Taxation on Economic Growth: Case Study of OECD Countries.” ResearchGate, Jan. 2005, www.researchgate.net/publication/276088447_The_Impact_of_Taxation_on_Economic_Growth_Case_Study_of_OECD_Countries. Accessed 20 June 2020.
6. Cogan, John F., et al. “THE EFFECT OF TAX PREFERENCES ON HEALTH SPENDING.” National Tax Journal, vol. 64, no. 3, 1 Sept. 2011, pp. 795–816, www.ncbi.nlm.nih.gov/pmc/articles/PMC3322613/.
7. Holter, Hans A. “Accounting for Cross-Country Differences in Intergenerational Earnings Persistence: The Impact of Taxation and Public Education Expenditure.” Quantitative Economics, vol. 6, no. 2, July 2015, pp. 385–428, 10.3982/qe286. Accessed 11 Mar. 2020.
8. ‌“Tax Reform Impact on Health Care and Life Sciences.” Deloitte United States, www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/life-sciences-health-care-tax-reform.html. Accessed 20 June 2020.
9. Wikipedia Contributors. “Tax.” Wikipedia, Wikimedia Foundation, 6 Apr. 2019, en.wikipedia.org/wiki/Tax.

The Children’s Health Insurance Program (CHIP) is one of the current and robust healthcare policies targeting children in the United States. Children who are below the age of 19 years are covered by the CHIP medical policy. Mostly, these are children whose parents or guardians do not qualify for Medicaid because of their higher-earning brackets. At the same time, they should be unable to cater for private coverage.

It is vital to mention that each state has its own model or system of implementing CHIP. Nonetheless, each state works within the core objectives, spirit, and mandate of the medical policy (Children’s Health Insurance Program, n.d). There are a few exceptional cases where this policy has been extended to young pregnant women and parents.

Policy goals

The main goal of the Children’s Health Insurance Program (CHIP) is to offer medical insurance coverage for children who do not benefit from Medicaid policy and cannot afford private healthcare coverage. There is a growing need to ensure that children who are completely left out of all legible medical policies. The policy aims to provide affordable coverage to the young and growing population, preferably among those who have not clocked 20 years. There are households that earn more than the requirements of Medicaid, and hence, the policy is keen on including them in a comprehensive medical plan (Flores & Lesley, 2014).

The policy goals have also been extended to expectant mothers in some states. The coverage as documented in CHIP’s policy blueprint also collaborates with the Medicaid program in order to provide affordable healthcare programs to children.

Another broad policy goal of CHIP is to assist parents who do not have any form of coverage so that they can also enjoy the benefits of healthcare coverage. Through the policy, children who have no access to doctors can now access individualized healthcare services.

Benefits and/or services provided

The Children’s Health Insurance Program offers a number of healthcare benefits that vary in each state. However, the policy ensures that each state is in a position to provide basic coverage based on the prevailing local and state needs. Comprehensive coverage alongside benefits offered by CHIP includes emergency and ambulatory services, scanning services such as X-ray, laboratory tests and checkups, hospital care for both in-patients and out-patients, dental and vision checkup as well as treatment, drug prescriptions, visits to and by healthcare experts (nurses and doctors), immunization programs and regular screening and tests.

Eligibility status

The policy states that households that are comprised of four members and secure an income of up to $45,000 per annum are eligible for the program. However, eligibility status tends to vary from state to state. For instance, some states may set a higher limit of the threshold income per year than others. Since CHIP’s policy program collaborates with Medicaid, parents are usually encouraged to apply so that their children can be considered. This implies that making a formal application is the initial step before being accepted into the program. Parents who spend more than 50% of their time with children are also eligible to apply for the policy on behalf of such children.

Co-payment is also included as one of the eligibility criteria in some cases when accepted in CHIP’s medical policy. Under CHIP routine checkups are free. A number of states also require monthly premiums from members (Olson, 2013). Nevertheless, the premium is not supposed to go beyond 5 percent of monthly family income. In addition, an ability to pay is the major determining factor when it comes to the required co-pays and enrollment fees.

Eligibility assessment is accepted at any time of the year. The CHIP policy has no ceiling for the enrolment period. After passing the eligibility test, coverage can begin without further delay.

Service delivery system

As already hinted out, the Children’s Health Insurance Program policy model of delivery differs across the states. However, basic healthcare services such as prescriptions and doctor visits are offered in all states. This implies that the delivery system takes place around the various states. Each state administers the policy goals uniquely.

Financing

The respective states and the Federal government jointly fund the Children’s Health Insurance Program (CHIP) policy. Through the FMAP’s formula, the two levels of governance assist each other in pooling funds together to facilitate the healthcare policy. As a boost for individual states to improve healthcare funding policies among children, Congress developed an “accelerated” federal compatibility ratio that would be used in CHIP. The rate is approximately 15 % more than the ratio applied in Medicaid. So far, the CHIP policy has disbursed an estimated $20 billion in one decade to assist children not covered by Medicaid and is also unable to afford private insurance policies. In order to facilitate the process of providing for this coverage, the enhanced federal match is received by each state. The latter amount is higher than the Medicaid match of respective or individual states (Barusch, 2015).

In summary, this policy perceives children as victims because some of them are not covered at all by either Medicaid or CHIP policies. It also explains the reason why the program was initiated: to offer comprehensive medical coverage policy for children who are victims of Medicaid or marginalized family income.

References

Barusch, A. S. (2015). Foundations of social policy: Social justice in human perspective (5^th ed.). Belmont, CA: Thomson Brooks/Cole.

Children’s Health Insurance Program (n.d). Web.

Flores, G. & Lesley, B. (2014). Children and U.S. federal policy on health and health care: seen but not heard. JAMA Pediatr, 168(12), 1155-1163.

Olson, K.L. (2013). The Politics of Medicaid. New York: Columbia University Press.

In order to choose the proper health insurance approach that involves the assistance of the Preferred Provider Organization (PPO). Since an organization requires that a network of healthcare specialists should provide their services to the company’s staff, it is reasonable to suggest that the PPO approach, which involves the choice of a primary care physician for the employees, should be adopted. As soon as the specifics of the staff’s role in the organization and the threats that they are exposed to are taken into account, the implementation of the PPO strategy should help improve the quality of the environment, in which the employees are to carry out their assignments and be located in the course of the working day (Gilmore et al., 2007).

In order to purchase health insurance for the organization, one will have to reduce the costs for some of the operations within the company. At present it seems that the logistics department could use cheaper services for transportation; therefore, the cost for the transfer of goods and final products will have to be cut in order to promote better working conditions for the staff, as well as provide them with the health insurance of the desirable quality. It is assumed that, by financing the above-mentioned element properly, the organization will be able to reduce the cost for healthcare for the staff, as well as provide the latter with full access to the healthcare services that they need (Teitelbaum & Wilensky, 2013).

It should be noted, though, that the lifestyle of the organization members defines the choice of the insurance type to a considerable degree. To be more exact, the fact that most of the staff leads a sedentary lifestyle and are, therefore, predisposed to developing the related diseases and disorders, needs to be taken into account when choosing the insurance model that will be appropriate for the organization and meet the needs of the key stakeholders.

There is no need to stress that the choices made above depend on the Affordable Healthcare Act (AHA) extensively. To be more exact, the promotion of the ACA in the workplace setting has opened new opportunities for companies to boost staff satisfaction rates by offering them efficient healthcare. Thus, the ACA reform created the premises for the company to develop a more flexible approach towards staff’s medical insurance.

It would be wrong to claim, though, that the adoption of the ACA has not triggered any major problems for the organizations similar to the one under discussion. Quite on the contrary, the integration of new health insurance principles in general and the creation of a set of more stringent regulations in particular have posed a significant threat to the financial wellbeing of organizations.

Regardless of the aforementioned fact, the ACA system allowed a range of companies including the one under discussion to focus on staff satisfaction and enhance the motivation rates of employees by providing them that they are valued. In other words, by purchasing the insurance mentioned above, the organization proves to its staff that each and every employee is valued and that the firm is ready to invest in its members. Despite the rapid and quite radical changes, which the adoption of ACA triggered across the country, the implications of the health reform provided the tools for enhancing the provision of essential healthcare services to the staff.

Reference List

Gilmore, A. S., Zhao, Y., Kang, K., Ryskina, K. L., Legorreta, A. P., Taira, D. A. & Chung, R. S. (2007). Patient outcomes and evidence-based medicine in a preferred provider organization setting: A six-year evaluation of a physician pay-for-performance program. Health Research and Educational Trust, 62(6), 2140–2159.

Teitelbaum, J. B., & Wilensky, S. E. (2013). Essentials of health policy and law (2nd ed.). Burlington, MA: Jones & Bartlett Learning.

Health insurance has been a major part of the modern society and has come hand in hand with the way people view daily routine and responsibilities in a civilized populous. Year 2014, is said to bring major changes into insurance industry and more specifically, noticeable increases in the necessity to get insured.

The ever changing world has increased the pace both economically and industrially. People’s rights have received more attention than ever and so, the way people treat their health and governmental responsibility towards it, has also, dramatically changed.

Not only does society demand guarantees that the health of an individual will be protected but the government itself understands that it is better to go ahead and get involved with proper insuring. In a book titled “Basics of the U. S. Health Care System”, Nancy Niles examines the benefits to both parties but mostly for the government, as people get their health benefits and the government makes sure that people do not sue for large sums of money.

People will be closely examined on their health status—medical issues and present conditions, the environmental factors that might affect any changes and even genetic predispositions, in some cases will be determined. Of course the mandatory criteria will be decided according to the amount of income and in case insurance the sum is not of significant amount, these individuals will be exempt (Niles, 2010).

As with other laws, the government will set up penalties and fines which will be of strict amount, so it would be simply impractical to avoid responsibility. But as with any new policy, some aspects of such mandatory insuring are not easy to predict just yet. Author Anthony Kovner gives an inside look on the future and how insurance policies will be shaped.

The general outline has set the framework but there are many criteria that would have to be analyzed on an individual bases. Different categories of people, their living conditions, social status and environmental hardships will be taken in consideration when calculating mandatory insurance policy.

The interaction between different governmental institutions and administrations will be closely involved in the monitoring and setting up of the regulations. Even though the government may require minimal protections and standards, the local policy makers and laws will have to be taken into account (Kovner, 2011). It is clear that the changes will not be totally unreasonable. In 2010, the plan was set to specifically focus on the most essential needs of people and the provision of health care.

Labor communities, as well as corporations will take a great part in the setting of limits and minimums for insurance, so the process is still under much deliberation. Nonetheless, president Obama has played an influential role through campaigns and advertisements that have guided American citizens in understanding the changes, outlining the necessities and parts of the reform plan that are still developing (McDonough, 2011).

Another perspective in regards to insurance necessity is given by John Dicken in “Private Health Insurance Coverage”—whereas, before it was said there will be an individual approach but some employees will be automatically enrolled into the new plan, without questions or conditions offered. This might cause some outrage, as people are never welcoming absence of choice. Beginning January 2014, the results of changes will be clearly seen and then, enrollments and requirement ratios will be more evident for further analysis (Dicken, 2011).

The four sources set up the basis and criteria for what to expect from the new insurance plan. They all have informative points that will aid in forming an opinion, as to what specifics will take precedence.

References

Dicken, J. (2011). Private Health Insurance Coverage. Washington, United States: DIANE Publishing.

Kovner, A. (2011). Jonas and Kovner’s Health Care Delivery in the United States. New York, United States: Springer Publishing Company.

McDonough, J. (2011). Inside National Health Reform. Los Angeles, United States: University of California Press.

Niles, N. (2010). Basics of the U. S. Health Care System. Sudbury, United States: Jones & Bartlett Learning.

Introduction

Texas regulations permit insurance firms to sell a broad range of small company healthiness care schemes. The multiplicity of choices can end up rendering the exercise of establishing the appropriate worker health scheme taxing.

At the same time it can as well make it possible for employers to pick best schemes to appropriately suit them and their members of staff. It is therefore advisable to look around so as not to miss important details whenever out to select a health scheme for whatever kind of business or establishment.

The reference small employer in connection to insurance in Texas refers to an establishment with eligible workers ranging from two to fifty in number. The regulations offers such establishments extra safeguards, entailing a 15% once a year cap on rate augments connected to fitness aspects, an assurance that carriers cannot illogically put an end to coverage, and a proviso that permits small companies to team their procuring power to bargain cheaper insurance tariffs.

For workers of small establishments, the regulations offer a number of means to keep up benefits following departure from a job and restrict the waiting time ahead of a health scheme catering for pre-existent terms.

Away from these conditions, small-employer bearers may provide a broad array of schemes, with practically any arrangement of conditions and benefits.

Federal Health Reform

The national health care development regulation calls for insurance firms to offer considerable extra coverage(s) and makes stronger purchaser safeguards beginning with health insurance guidelines given or revamped after September 23, 2010.

Establishments with twenty five or lesser full-time workers that forfeit for at any rate 50% of bounties and remit mean yearly wages under $50,000 may be qualified for a tax acclaim of up to 35% of the bounties that the enterprise remits. These credits will go up later in 2014.

Small-Employer Coverage Eligibility

Texas establishments having two up to fifty members of staff may take small-worker coverage from an insurance firm or a health protection firm. Qualified workers are those who normally work leastways thirty hours in a week.

These are not provisional, or cyclic, and are not by the time of taking the coverage covered by any other group health scheme. Individual property owners, associates, and autonomous contractors are also entitled workers if the business decides to provide them with health care coverage. A venture(s)’s proprietors count toward the worker entirety.

The amount of qualified workers, as opposed to the total workers, verifies whether an establishment is a small worker under Texas insurance regulation(s). For instance, if one’s venture has sixty total workers, it could still make the grade if six of the employees are part-time and four hold coverage through some other scheme, such as a partner’s health scheme.

If the owner of a given business decides to provide a health scheme to his or her workers, he or she has to make it by the same token available to all of the qualified workers and their dependants.

Leastways 75% of a small employer’s qualified workers have to take part in the health scheme for the employer to acquire coverage. Carriers have to at all times round out when working out the amount of qualified staff members. For instance, a five-worker set would attain 75% involvement if three qualified workers take part. 75% of 5 are 3.75, and this figure is rounded out to 3.

In the instance of a venture with just two qualified workers, the regulation offers that there needs to be 100% involvement. A husband and spouse working at the same establishment are taken as two distinct workers. None of the two is qualified for coverage as a dependant of the other.

For those who offer a health scheme, national and state regulations permit workers to keep up benefits for a span of time following parting from the occupation. It is the insurance provider’s legal obligation to bring up to date workers of their liberties to uphold coverage.

Previous workers who choose to maintain their coverage have to pay the full charge of the scheme. The insurance provider is not required to throw in toward their bounties, regardless if the provider earlier paid a contribution.

Types of Schemes

Health insurance schemes are categorized as either government-consented schemes or end user preference schemes. A government-consented plan offers a given obligatory least aspects and coverage(s). An end user preference scheme is any scheme built up by a carrier that leaves out some government-consented benefits. One will normally have a lesser bounty for end user preference schemes.

Even though end user preference schemes are at times referred to as regular schemes, the coverage(s) offered are not evened out. Every carrier’s end user preference scheme may be diverse, and a carrier may provide a number of various end user preference schemes.

End user preference schemes cannot leave out a number of government-consented coverage(s). These include difficulties of pregnancy, least hospice stay following childbirth and restoration surgery.

Whenever presenting would-be insurance subscribers with an end user preference plan(s), providers have to incorporate on paper an expose that catalogs the government-consented scheme that are not offered.

The functioning of any healthcare institution is organized in accordance with specific rules that are introduced to guarantee its further rise and positive outcome when working with patients. The given paper is devoted to the investigation of the role some states play and the impact they have on the healthcare sector.

Besides, HIPAA Administrative Simplification Statute and Rules provides the necessary information related to the rules that should limit the functioning of both specialists and organization. For instance, the enforcement rule outlines the standards required for the enforcement of all Administrative Simplification Rules and guarantees the increased efficiency of the collaboration between different departments, collectives, teams, etc. (“The HIPAA Enforcement Rule,” n.d.) The given rule could also be considered in terms of the health information system. It creates the basis for the further rise of the sector and the creation of long-term links between the integral elements of any care provider. In other words, a health information transaction becomes less complicated and contributes to the improved outcomes of the whole sphere. Additionally, the given rule also guarantees that the most essential requirements will be met, and crucial tasks will be performed. In this regard, enforcement, as one of eight major components of HIPAA, becomes a central concept for the given rule that should be appreciated and given great attention.

There is also a Security Rule that is also created to guarantee the protection of crucial information and provide specific safeguards that are needed to prevent the appearance of different complications. There could be administrative, technical, and physical safeguards introduced to protect PHI (“Summary of the HIPAA Security Rule,” n.d.). All these elements of the security system are essential as they contribute to creating an efficient security system. For instance, technical safeguards audit controls the hard and software that are needed to store and protect PHI. Additionally, technical safeguards are also responsible for the transmission of security, which means that they trace any attempt of unauthorized access and guarantee that all information is protected. Hence, any health information professional should obviously possess in-depth knowledge of the given safeguard. There are several reasons for this statement. First, knowledge of the essential elements of this safeguard will contribute to the increased efficiency of a professional. Moreover, it will help to protect certain information better and guarantee that all problematic areas will be covered. Finally, good comprehending of these peculiarities might also ensure that a specialist will perform the major tasks on a high level.

Finally, there is also a specific Privacy Rule, which provides a set of national standards for the protection of certain health information (Rothstein, 2013). It means that any person who addresses any healthcare establishment has the right to privacy and might insist on the protection of the information that he/she shares with a health care specialist. Additionally, another main goal of the privacy rule is to assure that all information related to the functioning of a hospital or other establishment is adequately protected (Rothstein, 2013). This very rule covers all patients and workers functioning in the given sphere and presupposes specific penalties for those who act not in accordance with the basic principles outlined by the given statute.

Altogether, all the above-mentioned rules are introduced to guarantee the efficient functioning of the health care sector and other institutions that belong to it. Investigation of these postulates ensures increased efficiency and positive outcomes.

References

Rothstein, M. (2013). HIPAA Privacy Rule 2.0. The Journal of Law, Medicine & Ethics, 41(2), 525-528. Web.

Summary of the HIPAA Security Rule. (n.d.). Web.

The HIPAA Enforcement Rule. (n.d.). Web.

First, contacting the patient over the phone due to account delinquency without patient authorization contravenes the Health Insurance Portability and Accountability Act (HIPAA). There are civil and criminal penalties accruing the contravention of HIPAA rules. HIPAA Privacy Rule allows health care providers to reach out or open communication with the patient only for treatment purposes. The rule restricts communications related to advertising, telemarketing, and solicitation. In this case, the physician is calling for solicitation purposes since the intention of calling is to request the patient to settle her delinquent account. Willful violation of HIPAA rules attracts minimum fines of $10,000 and maximum penalties of $250,000. Violating HIPAA rules for malicious gains such as solicitation can result in a maximum prison term of 10 years.

Calling the patients’ workplace is another contravention since it compromises the security or privacy of the Protected Health Information (PHI). Calling the patients’ workplace improperly disposes PHI to violate HIPAA security rules. The HIPAA security rule dictates that ePHI transfers should restrict access, recording, or reconstruction. Calling using workplace lines could result in recording and reconstruction of PHI hence not authorized by HIPAA. Health care administration should avoid using public or insecure channels of relaying PHI.

Finally, disclosing patient information without prior permission to a co-worker contradicts the Breach Notification Rule. The rule requires health entities to notify their patients when their health data is impermissibly used or disclosed in a manner that compromises the security and privacy of the PHI. Disclosure of PHI without consent is only allowed when there is sufficient risk to public health. Disclosing information to the third party is a deliberate violation of HIPAA and may result in the withdrawal of the clinics’ and the physicians’ operating licenses.

Introduction and Summary

The Dubai Health Authority is anchored on two major ideals. First, all residents of the city ought to have access to healthcare. Secondly, healthcare must be of high quality that can fulfil the needs of the targeted population. It is a requirement for all residents and nationals of Dubai to have mandatory healthcare coverage. In Abu Dhabi, the mandatory health insurance law was enacted in the year 2005. The requirement is extended to companies in Abu Dhabi and migrant workers in the company.

There are several relevant outcomes deduced from these laws in the United Arab Emirates. First, all residents of the two cities of the country are mandated to have insurance covers. Secondly, companies are obligated by the laws in the country to cover all workers with insurance covers. Thirdly, recognition of non-residents as part of targets of insurance covers has helped put all under favourable access to health care.

These elements of healthcare policies in the two cities point to a country focussed on enhancing quality healthcare in the country. However, there are still a number of shortcomings in the two healthcare insurance cover policies. As a way of providing effective mandatory health insurance policies in Abu Dhabi and Dubai, the administrations should focus on the overall cost, localities of coverage by the insurance policies on the insured and the network of services provided in the insurance covers.

Background

Abu Dhabi and Dubai now have mandatory insurance policies enacted in 2005 and 2014, respectively. These laws target nationals and residents of the two cities. The laws also obligate companies in the two cities to cover their employees, whether they are originally from the country or immigrants. According to Jabbour & Yamout (2012), effective healthcare insurance covers are supposed to maximally relieve health burdens of the insured. Insurance covers covering only parts of required healthcare requirements fail to capture the aspirations of the insured, and essentially, is a challenge to the county in attracting foreign investment. There are several shortcomings in Abu Dhabi and Dubai mandatory healthcare insurance policies.

Chapter two, Article 3 of the Law Number (23) of 2005 in the Emirate of Abu Dhabi exempts a number of categories from the health insurance cover. For example, a non-UAE wife who is married to a national in the country is exempted from this healthcare plan.

Also, there is no particular health provision in the law for tourists coming to the country. Chapter 2, Article 4 of the law state that the nationals are not mandatorily required to subscribe to the cities healthcare plan. Such kind of exemptions and non-requirements are general challenges that may harbour or have harboured effective implementation of an effective healthcare scheme. Jabbour & Yamout (2012) is of the view that an effective healthcare insurance scheme is one that is mandatory to all nationals of a country. To non-residents, it is supposed to be voluntary.

The shortcomings witnessed in the two laws governing healthcare access in the United Arab Emirates, and specifically in Abu Dhabi and Dubai compromise the quality of healthcare. Important in good access to healthcare and in instituting insurance healthcare schemes is the leverage of costs, widening the network of access and increasing the scope of access to healthcare. The following discussion looks at major options for an effective insurance scheme.

Option one: Leverage Cost of Insurance Healthcare Schemes

Cost is always a great concern for ineffective access to healthcare. In Dubai, contributions by individuals range between AED 500 to AED 700. While this is recognized as a minimal contribution, the coverage is very minimal. Members in the scheme are therefore expected to contribute more if they are to access wider services of the healthcare plan. Annually, the limit of the claims is AED 150,000.

This includes even coinsurance that is paid by each and every other member. It is possible that the cost may be more than this amount, especially when there are emergencies. This, therefore, does not fully remedy the health problems members may be suffering from. In Abu Dhabi, the annual limit is AED 250,000. While this is significantly high as compared to the limit in Dubai, it still does not offer a comprehensive medical cover as emergencies may push costs higher than the amount quoted. In this, therefore, it is important to leverage contributions. For example, increasing the amount contributed by members as a way of increasing the annual limit will significantly offer members the most needed health relief.

Option two: Increase Network of Services in the Insurance Healthcare Schemes

Based on the contribution, the number of services listed in the two schemes is limited. Essentially, emergencies are not covered by the schemes, while a number of drugs are not accessible through the schemes. For example, for child delivery, AED 500 will be deducted in Abu Dhabi, while in Dubai; there is a 10% co-insurance with AED 7,000 as the limit for normal delivery and AED 10,000 for C-section operation.

For maternity checkups, a member in Abu Dhabi will be required to pay AED 20 for consultation, while in Dubai; there is a limit of 8 visits in the 10% coinsurance plan. This kind of limitation in service provision in the two schemes significantly limits the quality of access to healthcare in the two cities. An effective health care plan is one with total coverage. The solution to this is to put the optimal cost in contribution.

Option Three: Increase the Localities of Access to the Insurance Healthcare Schemes

The two insurance healthcare schemes are listed in the two cities. In Dubai and Abu Dhabi, the schemes are limited to the two cities, with only the emergency treatment being spread to all emirates. This means that a member suffering from an ailment covered by the schemes apart from emergencies can only access the services in the two cities. This clearly highly limits access to quality healthcare. For example, if a member goes to work in another city, he or she would be required to go back to the city of membership to the insurance schemes so as to get the needed medication. This is not a limit to effective healthcare.

The administrations of the two cities need to give reviews to the insurance healthcare schemes to cover localities other than the two cities, but only for members of the schemes. It is also important to increase the network of access to people affiliated to members. For example, non-UAE wives married to nationals cannot access healthcare. This is discrimination as the non-nationals become part of the country on marriage. As a remedy, therefore, it is critical to the increasing locality of access in healthcare.

Recommendations

There are several negative outcomes noticeable in Abu Dhabi and Dubai Mandatory Insurance Healthcare schemes of 2005 and 2014, respectively. The shortcomings are related to the limitation of services, limitation of regions to access Medicare and limitation on annual claims. These shortcomings hamper good delivery of healthcare services in the United Arabs Emirates, and specifically, Abu Dhabi and Dubai.

It is therefore recommended that; one, the cost of a membership to the healthcare schemes be leveraged to increase the limit to annual claims. To, it is important to increase the network of services provided by the two insurance healthcare schemes. Three, it is important to increase localities and regions that the members can access healthcare services covered in the two schemes.

Reference

Jabbour, S. & Yamout, R. (2012). Public Health in the Arab World. Cambridge: Cambridge University Press.