Medicare part D program is voluntary and approximately 55% of the program’s costs are covered by premiums from the program’s participants (International Common Wealth Fund, The US Healthcare System, 2019). Although most medications and insulin are covered, some specific medications are excluded from coverage under Medicare part D. Participants on the Medicare part D plan implemented in 2006 had to deal with the program’s medication payment “coverage gap” problem, which was subsequently corrected by closing this medication payment gap, when the ACA was implemented in 2010 (Scott, 2016). The Medicaid program, which provides healthcare for the poor and low-income people of the USA, is not mandated to use the federal funds to provide outpatient prescription medication coverage and individual states simply have the option to provide this coverage to their residents if they choose to do so. As a result, this can leave many low-income people without coverage for necessary outpatient prescription medications. In addition, the many millions of Americans without healthcare coverage are simply left with few options regarding access to prescription medications (Scott, 2016).
ORGANIZATIONAL SYSTEMS TASK 3 9 However, vulnerable and low-income people in the USA, who continue to be uninsured, have the option of receiving healthcare and assistance with prescription medications at free healthcare clinics located throughout the country (Scott, 2016). A2B. Referral to See a Specialist In Great Britain patients’ are entitled to request a referral to see a healthcare specialist on the NHS. Patients’ are required to go through their registered Primary Care Physician (PCP) for a specialist referral, as the registered PCP is considered to be their medical home, maintains all the patients’ medical records and is considered to be gatekeeper for specialist referrals. The majority of patients’ referred to a specialist within the NHS are referred to the hospital. Actually being referred to a specialist depends on the clinical assessment of the PCP, as he/she is generally considered to be knowledgeable regarding the patient’s health history and is therefore responsible to determine the medical necessity of a specialist referral. Patients cannot generally self refer to healthcare specialists within the NHS and the only exceptions to this are self- referrals to sexual health clinics or emergency care needs (NHS, Referrals for Specialist Care, 2019). Once a PCP has received a specialist referral request from a patient, they will usually recommend various tests or treatment options be tried first to see if the patient’s condition improves prior to referring them to a specialist. If the PCP ultimately determines a healthcare specialist referral is recommended, he/she will write a letter of referral to the applicable specialist, which will include details pertinent to the patient’s medical history and conditions for the specialist to reference (NHS, Referrals for Specialist Care, 2019).
ORGANIZATIONAL SYSTEMS TASK 3 10
- Spring '16
- International Common Wealth Fund