Healthcare delivery is a crucial aspect in the maintenance of a decent physical, mental, and social stability of the population. For an adequate healthcare delivery, there is a need for optimal functioning of the providers of care, group of employers, insurance companies, government agencies, and regulators. This group of bodies, when desirably effective, will ensure an encompassing healthcare system, and this has been the primary objective of the regulators of healthcare in Idaho.
As herculean as it may appear, availing tip-top medical services to persons living in the urban and less accessible areas of Idaho should be a leasing quest. And in this case, the major aim of the government is, to make health care readily available to the population, and at a cost-effective rate. This, however, will require maximum cooperation between both the public-owned and private institutions, and between the institutions and the healthcare providers.
Accessing the healthcare
Several private and public provisions have been created to secure sufficient provision and penetration of modest healthcare to bucolic areas of Idaho through several strategies. In 2013, up to 50% of Idaho residents enjoyed insurance through their employers, this is the largest amongst its neighboring states, though a less percentage of them was insured through medicare. Idaho is one of the states that enjoy an above-satisfactory level healthcare service in the country, local hospitals like Idaho Falls Community Hospital have also stepped up to the task, pulling in a galactic amount of funds to its emergency care facilities. For more info on this hospital go to idahofallscommunityhospital.com. However, to create a welcoming environment that will guarantee hitch-free access to proper healthcare, a significant effort should be channeled towards the activities of these medical set-ups:
- Health Maintenance Organization (HMO): This is an organization saddled with the responsibility to arrange or provide coverage of specific healthcare services as requested by its plan members who pay a regular fixed prepaid premium.
HMO programs can be operated via four basic models:
- Group mode
- Staff model
- Network model
- Individual practice association (IPA).
According to the Federal HMO Act, for an organization to become an HMO, it must possess: (1) an organized system for providing healthcare in a geographical area, (2) an agreed-on set of basic and supplemental health maintenance and treatment services, and (3) a voluntarily enrolled group of people.
- Integrated Delivery System (IDS): This is a health system established with the aim of a holistic approach to healthcare delivery involving the integration of the provision of health care unlike the conventional disorganized and bit by bit healthcare system. In this approach, there is a synergy between an institution or group of affiliated bodies that provide a wide range of routine and emergency healthcare, and tertiary care services. Allowing for the provision of care across various settings of the healthcare continuum.
- Exclusive Provider Organization (EPO): This is a common healthcare plan in the United States. It is a health insurance plan structured to encourage accessibility to healthcare providers Provision of primary health care may not be necessary, but the healthcare providers must be seen within the scope of an authorized network. The payment scheme is usually a fee for a service, whereby the healthcare provider is paid only when a patient is seen. Doctors are paid only as a function of the care they provided, as opposed to the health maintenance organization (HMO) where care providers are paid grossly, and receives a regular monthly stipend irrespective of whether the patient was seen or not.
- Preferred Provider Organization (PPO): This is a system of healthcare management that runs a program in which contracts are established between a third party or an insurer with providers of medical care like doctors and hospital to provide health care to its members at a lower cost, and a high standard. The preferred providers are the providers under the PPO contract, and they usually avail significantly better services to contract benefactors, thus the members of the benefiting organization are encouraged to use these preferred providers.
- Point-of-Service (POS) Plan: A system of a healthcare management plan that allows a covered person, who is a member of the contracting organization to choose to receive a service from a participating or a nonparticipating provider. These members are required to choose from a limited option, a primary care physician from within the health care network who becomes their “point of service”. Medical services within the network are usually completely covered by the company but referrals by the “point of service” outside the network will attract lesser compensation from the patient’s health insurance company.
Government policies and strategies
Securing easy access to emergency healthcare in the under-served areas of Idaho will require extensive efforts from the government via its policies. With a population of about 1.6 million people, these policies will regulate and determine the availability, quality, and cost of healthcare to the citizenry.
These recent laws are:
- Revising the licensing standards for Idaho hospitals: Idaho’s Department of Health and Welfare (“DHW”), last year, established a new regulation for patient rights. Though this regulation was progressive, it was not in tandem with the Medicare conditions of participation, therefore, it was quite constraining to the hospitals in Idaho. Consequently, the Idaho legislature amended the regulation and limited that the hospital licensure laws that were stricter than the conventional Medicare conditions of participation do not apply to hospitals that are certified and accredited by Medicare. This was to enable existing Medicare accredited hospitals, mainly in the underserved areas, who might have issues with the changes from the new DHW regulations to still function fully. However, hospitals in Idaho that do not participate in Medicare will have to follow the tighter state regulation, and it is not so lucid if the new regulation will be applied when there is no exact Medicare act for a particular rule.
- Telehealth Clarification: Also in a bid to make healthcare readily available to everyone and people in the under covered areas, the Idaho legislature has simplified telehealth services and smoothened them so healthcare providers can use them seamlessly, so far as the healthcare provider complies with the Idaho Telehealth Access Act. These services include “The use of synchronous or asynchronous telecommunications technologies by a provider to deliver patient health care services, including but not limited to the assessment of, diagnosis of, consultation with, treatment of, and remote monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration.” In line with HIPAA rules, but not “telehealth services” do not include “audio in isolation without access to and review of the patient’s medical records, electronic mail messages that are not compliant with the health insurance portability and accountability act (HIPAA), or facsimile transmissions.” The clarification also stated that not only the telehealth laws of the healthcare provider’s location but also, the telehealth laws governing the patient’s location must be put into consideration.
- The Idaho Patient Act: This act was to protect patients from unaccountable charges for products and services rendered by a healthcare facility. Encourage individuals to seek medical assistance, it will ensure that individuals are given enough time to offset bills, and will also not have to pay extra fees or interests for services they never received. It requires healthcare providers to have performed some mandatory actions before they are allowed to employ “extraordinary collection action” against a patient in Dept recovery.
- Qualification for Nursing Home Administrator: In response to the shortage of health workers, and also due to the need to assign as many health workers to these undercovered areas, the legislature amended the prerequisites to becoming a nursing home administrator, to allow health workers to overcome the challenges of huge on the job training demands provided he has either 1, a master’s degree from an accredited institution in health administration related to long-term care. Or, 2, a master’s degree from an accredited institution that includes an emphasis on health care and has at least one year of management experience in a health care facility that provides in-patient care.
- The Use of Medical Students in Free Medical Outreaches and Clinics or Community Screening Events: Also in an attempt to increase the healthcare workforce, the Idaho Code have extended the immunity it provided to volunteer healthcare providers who are participating in free medical outreach and clinics or community health screening events to medical students who are enrolled in an accredited medical education or training program, provided 1, the services provided by the student is directly supervised and within the scope of practice of a physician or other licensed persons under Title 54 of the Idaho Code, and 2, the patient is fully notified that the provider is a student.
Benefits and Challenges
As much as there is a myriad of challenges, there are several benefits that will arise from a wider coverage and easy accessibility to sufficient healthcare. A minimal burden on the public health department through prompt response to health problems will decrease the need for specialist care and artificial supports, thereby relieving some financial and economic burdens, preventing and halting the progression of disease conditions, decreasing mortality rate, and increasing life expectancy.
The few challenges expected to be encountered are issues of cybersecurity in the case of Telehealth services, funding and acquisition of advanced healthcare technologies, information integration and dissemination, abuse of protective laws by the patients.
In recent times, the state of Idaho has made satisfactory efforts to improve its healthcare programs, especially those that will enhance the penetration of sufficient health care services to its under-served areas.
With proper enforcement of these new legislative acts in Idaho and the cooperation of both healthcare providers and patients, we hope to see an upgrade in the state’s health sector.