Introduction
Currently, a large population of United States residents possesses health insurance. It is circumvented on the probability of someone becoming sick unexpectedly. Therefore, people with health insurance have easier access to prescription drugs, receive more preventative care, are better able to pay for necessities, and live in better health (Dang et al., 2021). Additionally, the costs involved in managing chronic illnesses, such as hypertension, diabetes, and heart disease are insured, thereby promoting the health of these patients. For vulnerable populations, healthcare coverage protects them from unexpected high medical costs and provides insurance for health conditions exacerbated by the vulnerability (Dang et al., 2021). Therefore, health care insurance plays a significant role in preventing, curing, and promoting the health of the distinct populations that benefit from it.
Diagnosis-Related Group
A diagnosis-related group (DRG) is a sophisticated method of classifying patients with specific clinical diagnoses to control hospital expenses and fully set reimbursement rates from payers. Hospitals have decreased, the average duration of stay has reduced, and the center of care has changed from inpatient to less expensive outpatient settings (Zou et al., 2020). Inpatient hospital benefit growth has slowed, and the Medicare trust fund’s looming insolvency has been averted. However, optimal treatment may be jeopardized in some instances, such as the lowering prescriptions of appropriate medicines at hospital admission.
Preferred Providers Option
Preferred provider option plans facilitate access to the patient as they are flexible, and individuals can choose when and where to receive healthcare. This healthcare plan will enable participants to make their own healthcare decisions (Dang et al., 2021). However, the provider option plan limits access to the patient as they have a higher monthly premium, and participants are responsible for managing and coordinating their care without a primary care doctor.
Health Maintenance Organization
Health Maintenance Organization (HMO) facilitates access to the patient as it provides a lower healthcare cost. It gives a high coordination level between providers where members choose a primary care physician to offer primary care. However, it limits access to care by patients as it requires one to remain within the care network except in a medical emergency (Zou et al., 2020). Moreover, if the current member’s doctor is not part of the plan, one must select a new primary care doctor.
Nursing Interventions
Holistic nursing care focuses on a person’s entire wellbeing and not only on the disease (Dang et al., 2021). Nursing interventions, especially for patients with long-term conditions, should focus on supporting and enhancing the ability to manage the disease. Nurses provide self-care and management support as they possess the necessary medical skills and knowledge that positively impact the patient’s life. Encouraging a patient to participate in self-care actions actively is critical as it ensures that a sense of control is maintained and symptoms are managed. Lastly, patient education strengthens their healthcare abilities and efforts, thereby preserving the patient’s life and wellbeing.
Conclusion
Currently, health coverage is being used by a considerable population in the United States. It is beneficial as it caters to one’s medical needs in case of unexpected sickness, avoiding a financial crisis. Additionally, it increases accessibility to healthcare and ensures that health is maintained and promoted. A diagnosis-related group guides the classification of patients and their clinical diagnoses to control hospital expenses. Preferred provider options and health maintenance organizations are care options that facilitate access to care for the patient. However, these care options also hinder access to care. Lastly, self-care is essential in providing high-quality patient care, hence the need for patients and nurses to strengthen their practice.
References
Dang, A., Dang, D., & Vallish, B. N. (2021). Importance of evidence-based health insurance reimbursement and health technology assessment for achieving universal health coverage and improved access to health in India. Value in Health Regional Issues, 24, 24-30.
Zou, K., Li, H. Y., Zhou, D., & Liao, Z. J. (2020). The effects of diagnosis-related groups payment on hospital healthcare in China: A systematic review. BMC Health Services Research, 20(1), 1-11. Web.