Question & Answer: Using your knowledge of healthcare reimbursement in the US, how does reimbursement policy…..

Using your knowledge of healthcare reimbursement in the US, how does reimbursement policy impact the ability of providers, families, health systems and insurance companies to keep patients at home? If you were a policy maker, what would you do?

Expert Answer


Most of the Home based healthcare is long term. Which means, it is either financed through Medicaid or borne by the patient through out of the pocket expenses. Medicare does not cover long-term care, and most U.S. citizens cannot afford or have not purchased long-term care insurance. This leaves no options for millions of older persons or for younger functionally impaired persons without property or income.

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Care recipients who qualify for Medicaid and their families depend heavily on paid, unskilled caregivers who may be in the home from 4 to 16 hours per day for ADL support and standby assistance. Even when they can find work, low-income care recipients and family members avoid seeking employment (income) because they risk losing coverage for needed equipment, medication, and personal assistance. In the worst cases, married people even divorce to secure Medicaid coverage. Long-term care is not covered by most employer-based insurance.

Individual home care agreements are made by private individuals with other private individuals. With no agency overhead, these workers are paid more. Such arrangements are treasured by those who find reliable help and are difficult to count. Initiatives such as the Cash and Counseling Demonstration and Evaluation in which care recipients or families manage home care using public funds, have succeeded in improving quality and afford insight into the human factors dimensions of long-term care in the community.

But with Medicaid, the quality of home health aide and personal care also is a recognised as a huge issue. Here, they generally give minimal training, and caregivers are paid near minimum wage. Commonly reported problems in Medicaid include rapid turnover and aides failing to appear, being rude, stealing, or doing poor work. Of the typical hourly cost of $18, half goes to agency overhead. Conversely, in many cases aides are trusted like family members; donate their own time, money and possessions to the household of the care recipient are invaluable.

If i were a policy maker, i would ensure, people are trained well before they are put on jobs at home based care through Medicaid. Being a government / Federal program should not mean that the quality of the services should be poor. So i would make sure that proper medical equipment, good and trained staff, are good home care assistance should be provided to the patients. Similarly, i would ensure that staff is paid best pay in the industry. By doing so, i could keep quality staff and fire the unqualified staff. I shall also ensure that quality and senior candidates are hired for home help positions.

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