The main purpose of the Affordable care act was to make the expensive healthcare accessible to people from different financial capabilities (Nyman & Trenz, 2016). Medicare is an insurance cover for people of age 65 years and above, together with patients suffering from different conditions such as the renal disease on its late stage. Tricare was a medical care program for veterans and their families in various parts of the world. The program has several comprehensive coverages to the eligible beneficiaries including a dental plan, heath plan, prescription, and other special programs. I have been covered under Medicare plans A and B while makes me also eligible for Tricare and currently Tricare extra where insurance provider covers 80% of my expenses and the I get to cover the remaining 20% from my pocket. In 2010 more than 11% of the healthcare, expenditure was out of pocket spending (Catlin, Poisal, & Cowan, 2015). Out of pocket requires people to pay from their other sources, for instance, saving, loans and others which are not associated with the insurance coverage. For the Tricare Extra, the veterans do not need to worry about the paperwork to be registered by rather need to show their military identification card to access the services covered in this plan. The providers for this services also includes the procedures for reimbursement and beneficiaries do not need to walk around claiming it. A person is eligible for Tricare if you subscribe to Medicare part B. for Medicare part A, an individual may access it free of charge after ten years of successfully paying the social security taxes. For the people who cannot access the free part "A" of Medicare through their work history, they can claim it through their spouse. The relationship with the spouse is not vital despite being deceased, divorced or married at the time of enrollment still the program can be accessed. Initially Tricare was for age 65 year and below, but currently, people above that age can still enjoy the benefits. Part A of Medicare covers inpatients services; it offers services in a skilled nursing institution, some cases have qualified for home health care, and finally hospice care. The part B of Medicare covers outpatient services, preventive care services; it offers particular doctor services such as mental health care, and various medical supplies. Part A and part B are also referred to as hospital and health insurance respectively. Their products when complemented with Tricare plans, it makes the healthcare plan more beneficial to the subscriber.
The Process of Seeking Health Care
Annual Physical Examination
A physical examination is a usual procedure that is conducted by the primary care provider to ascertain the status of a person's overall health. A primary care provider could be represented by a nurse, a physician assistant or even a doctor. The clients are taken through an exam test which is also known as the wellness test and to take the test a person do not need to be necessarily sick. During the exam Test, it is when the patients get the chance to discuss with the primary care provider about the change in health or other suspicious things concerning health. But before all this, the first place to start is booking an appointment to be assigned a physician to conduct the examination on the scheduled date. During the process of making an appointment, the patient has a chance select a particular nurse or another qualified person to conduct the examination. In cases where a person has no particular physician for the physical examination in mind, contact the insurance provider for a list of nearby qualified person is recommended. For my case since Medicare covers both hospital and medical insurance services, I will contact them to redirect me to individuals who can offer the same services. Once the primary care provider has been found, it is time to adequately prepare for the activity to make out the best of the time to be spent in the visit. For instance, it is important to gather information related to surgical and medical history, addressed and names of physicians seen in the recent days, and listing any pain symptom being experienced. Additionally, it is important to collect information concerning the list of current medication used including the over the counter drugs used. The physician will also be interested in getting the result of recently conducted medical tests. Finally avoid things such as make-ups, excess jewelry and some dress code which may hinder the effort of the primary care physician from performing the examination as recommended.
During the medical examination by the primary care physician, the nurse will ask random questions such as allergies, medical history, surgeries, and other symptoms. The nurse will also ask questions related to lifestyles such as alcohol use, smoking, and physical exercise. The next step will be lying down, and various parts of the body such as the abdomen will be palpated. The primary care provider (PCP) will test the heart rate using the stethoscope, and abnormal sounds are detected, the physician will recommend other tests to establish whether there is a problem. Percussion technique will also be used to identify the presence of fluids in the body in areas where they should not be. The PCP will also conduct examination on body weight, the pulse rate, and the height. It is important to ask all question related to the test and the results to understand the healthcare condition. It is the opportunity to get clarification of the tests that are not known and the reason they are performed. The PCP will interpret the findings in all the tests or through a multidisciplinary team and confirm goof health or recommend further checks or treatments.
The Need to See a Specialist
Specialists are doctors who are qualified to offer particular services, for instance, a bone and joint specialist are known as an orthopedic surgeon. He has specialized in that area of medicine and can only see patient with issues concerning their skeletal systems such as joints, ligaments, and muscles for treatment or other referrals. These specialist are few when considered in term of specialist per a given number of people across the world (Fujisawa & Lafortune, 2008). Hence getting their attention requires patience and waiting when an appointment has been confirmed. When in need to see a specialist, in most cases it has to be a referral from a PCP examination. The PCP will either recommend a given specialist or help in booking one or even propose those enlisted by the insurance provider. For this case, the specialist will have to confirm availability and after that schedule a visit with the client. In case there are fees to be paid, for instance, booking and consultation fees most specialists prefer that it happens before the meeting, maybe as a sign of commitment and in case the patient does not show up they will be aware that they are risking their finances. Before the visiting day, regular reminders are sent to the patient to ensure they keep the date and agreed the time. In some unavoidable circumstance, the specialist may choose to reschedule the visiting day which will be informed early to the patient for proper re-arrangement of the visit and avoid inconveniences. In that context, the patient has the liberty to decline and suggest a flexible date.
The Need to Be Admitted To the Hospital for Elective Surgery
Elementary surgery is used to define those medical conditions which are non-emergency but requires care which can be delayed for more than 24 hours. The first step is to be examined a medical specialist who will place determine the category of the elective surgery based on the kind of treatment required. The categories are non-urgent, semi-urgent, and urgent with each having a maximum of one year, three months, and one-month waiting time to be admitted. Once the case has been categorized a specialized and facility is identified on the patient's behalf and then a message via various platform is sent to notify of the waiting list status. The patients are provided with information on how to stay fit in preparation for the surgery. It is important to attend the pre-admission clinics as requested. Once the day for surgery has reached, arrive in time and attend post-surgery clinics to enhance recovery and healing.
The Difference between Public Health Differ From Personal Health
Public health is a term that I used to define healthcare status of a population or a group of people while, individual health focuses on the health of a single individual (El-Sayed, 2016). However, the health of each within a population is what constitutes public health. When public health interventions are rolled-out the target is a community with the hope that in that process each person with will benefit. Public health focuses on preventive measures that aim to keep the whole population safe, but personal health focuses on the high-risk individual to ensure they do not affect the rest of the population (Charlton, 1993). Public health is interested in the health of the whole community, and it is considered most beneficial and cost-effective since it caters for the health needs of all people within the target population. For instance, if an individual within a population is encouraged to take fresh tomatoes without salt and with time the person experiences low levels of blood pressure, the impact to the population will be minor. On the other end when the population is encouraged to avoid excessive salt intake to control blood pressure cases when the target population considers the message, the impact will be considerably massive. For this reason, public health is to consider important than individual health. When population health is being assessed, people are selected as a sample to represent the status of the whole population (Arah, 2009). If the sample shows they are healthy or sick, the community will be perceived in the same manner. For this reason, public and individual health are inseparable concepts that are used to define healthcare status of people within a group.
References
Arah, O. A. (2009). On the relationship between individual and population health. Medicine, health care, and philosophy, 12(3), 235-244.
Catlin, M. K., Poisal, J. A., & Cowan, C. A. (2015). Out-of-pocket health care expenditures, byinsurance status, 2007-10. Health Affairs, 34(1), 111-116. doi:http://dx.doi.org/10.1377/hlthaff.2014.0422
Charlton, B. G. (1993). Public health versus personal health. Public health, 107(6), 397-399.
El-Sayed, A. (2016). What is "public" about public health: Lessons from Michigan. American Journal of Public Health, 106(7), 1171-1172. doi:http://dx.doi.org/10.2105/AJPH.2016.303243
Fujisawa, R., & Lafortune, G. (2008). The remuneration of general practitioners and specialistsin 14 OECD countries.
Nyman, J. A., & Trenz, H. M. (2016). Affordability of the health expenditures of insured Americans before the affordable care act. American Journal of Public Health, 106(2), 264-266. doi:http://dx.doi.org/10.2105/AJPH.2015.302958
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