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Earthquake : : How the Ever-shifting Healthcare Model Victimizes Americans.
- Format:
- Book
- Author/Creator:
- Casull, Brian H.
- Language:
- English
- Subjects (All):
- Medical care.
- Medical policy.
- Health services accessibility.
- Physical Description:
- 1 online resource (312 pages)
- Edition:
- 1st ed.
- Place of Publication:
- Ocala : Atlantic Publishing Group, 2019.
- Summary:
- Healthcare in America is littered with confusing rules and unclear systems. The discussion is oft centered on misconstrued facts and downright lies. Some politicians claim that nobody ever died from lack of access, that the Affordable Care Act is unnecessary and American healthcare isn't cost-prohibitive. Some claim no one has lost Medicare or Medicaid coverage and pre-existing conditions don't threaten coverage. One thing that can't be denied about American healthcare is how often the average consumer is left confused. "Earthquake: How the Ever-shifting Healthcare Model Victimizes Americans" uses an easy-to-understand metaphor that equates the ever-shifting healthcare system with tectonic plates: just as earthquakes create victims with every shift of tectonic plates, so does the unstable American healthcare system. Dr. Brian Casull, a physician and physician executive of over 40 years, provides information that will help you escape to solid ground, including discussions about:* What drives healthcare cost and what you can do about it;* What the Affordable Care Act does and doesn't do;* The on-going political assault on your healthcare including pre-existing conditions, preventive care and the 10 essential categories of care you rightfully deserve."Earthquake" aims to give you, the average healthcare consumer, the information necessary to become informed about America's healthcare system and understand the tectonic plates that make your healthcare shake and tremble. With this book in hand, you can stay up-to-date on America's Healthcare in Transition.
- Contents:
- Intro
- Foreword
- Preface, For Americans Who Wish To Become Informed Consumers Of Healthcare
- Big Picture
- The Ballpark, or "Healthcare Park"
- A Call To Arms
- Introduction
- What Will You See Along the Way?
- The Ballpark
- Where is your seat at the ballpark?
- Part A
- Your Top Healthcare Concerns
- Chapter One
- Losing the Benefits of Medicare and Medicaid
- Medicare
- Traditional Medicare
- How do physicians charge?
- Medicare Advantage
- Prescription Drug Coverage
- Medigap Plans
- Medicaid
- Other Government Health plans
- The Veteran's Administration
- The Tricare Program
- Indian Health Service
- Chapter Two
- Seeing The Doctor of Your Choice
- Understanding ACCESS to Healthcare
- The Three Steps
- Gaining Entry into the Healthcare system
- Geographic Availability
- Personal Relationship
- Chapter Three
- Healthcare Costs
- What Drives Healthcare Cost?
- An Introduction To Healthcare Cost And Variability
- What Is The Return on Investment (ROI)?
- Non-Medical Drivers Of Healthcare
- Non-coverage of a relatively large portion of the population
- A snapshot in time
- Uninsured
- Underinsured
- Chapter Four
- Healthcare Costs and Provider Variability
- How Providers Code
- Payment Models
- Physician Fees
- Chapter Five
- Healthcare Costs And Procedures
- The Cost Of Procedures
- Variability
- Medical Devices
- A CASE STUDY The Call To Arms
- Chapter Six
- Healthcare Cost And Prescription Drugs
- Prescription Cost Drivers
- Monopoly rights
- Medicare drug benefit
- Availability of generic drugs
- Physician prescribing practices
- How It's Done: Marketing and Direct-to-consumer Advertising (DTCA)
- Direct-to-consumer advertising
- Indirect marketing
- Research and development
- CASE FILE Pharmacy Cost
- The "market value" of a drug
- The Tectonic Plate.
- Lowering Drug Prices
- Chapter Seven
- Healthcare Cost and Patient Compliance
- Patient Compliance
- Compliance Along the Healthcare Continuum
- CASE STUDY in Compliance
- Compliance Along The Healthcare Continuum
- Are You An Informed Consumer?
- Part B
- The Law Of The Land
- Chapter Eight
- What Is Healthcare Insurance?
- Setting the Stage: The Affordable Care Act
- The Affordable Care Act
- A Summary Of The Pros And Cons
- The Bumpy Ride: How The ACA Repeal Might Impact You
- Coverage for people with preexisting conditions
- Mandates to buy insurance
- Other insurance market reforms
- Cost-free preventive services for patients
- Medicaid expansion
- Subsidies in the market place
- Innovation Center and value-based payments
- Closing the Medicare prescription drug 'donut hole'
- Taxes funding the ACA
- Independent Payment Advisory Board
- The Challenge Continued
- Chapter Nine
- Tectonic Plates
- Healthcare Consumer's Concerns About The ACA
- The Tectonic Plates
- Tectonic Plate Impact on the Affordable Care Act (ACA)
- ACA revamp must include conservative values
- Preexisting conditions
- Coverage mandates
- Other insurance market reforms including cost-free preventive services
- Subsides in the marketplace
- Addressing Your Concern About Stabilizing the ACA marketplace
- Changes in the Individual marketplace Premium and Out-Of-Pocket Costs
- ACA exchange plans
- Premiums
- Impact of the Tectonic Plates on the ACA Individual marketplace
- Out-of-pocket costs under the ACA
- Tectonic Plate Alert!
- Tax provisions
- "Nobody Dies because they don't have access to healthcare."
- Literature Review:
- My Research
- Part C
- The Tectonic Plates You May Not Have Known About
- Chapter Ten
- Hospitalization
- When to Hospitalize? When to Observe?.
- The "two-midnight rule"
- The Issue of Readmission
- Impact on the Second Party?
- Hold harmless
- Chapter Eleven
- Quotes on Mental Illness &
- Addiction
- Mental Health
- CASE STUDY Suicide Attempt by Any Other Name
- How Prevalent is Alcoholism?
- The Issue Of Drug Addiction
- The issue of overdose and death
- Decline in U.S. life expectancy
- Relapse
- Chapter Twelve
- The View from the Parking Lot
- The Uninsured
- Relationship between cost and access
- For the individual marketplace
- Chapter Thirteen
- Medical Errors and Torts: Death From Medical Care Itself
- Medical Errors
- Quality Assurance
- CASE NUMBER Space, The Final Frontier
- CASE STUDY Medication Error Resulting in Death
- Medical Malpractice Cases, Or Torts
- A CASE STUDY In (Alleged) Malpractice
- Chapter Fourteen
- When There Is No Consensus
- Grading the Medical Literature
- CASE STUDY The Case In Point
- Part D
- Food For Thought
- Chapter Fifteen
- The Basics Of Healthcare Coverage
- Healthcare 101
- The Third-Party Payor
- Deductibles
- Copayment
- Coinsurance
- Summary of Benefits and Coverage
- Benefit Coverage
- The Cost
- Medical Necessity
- Experimental
- Utilization Review
- Chapter Sixteen
- Protection Against Tectonic Plates
- The Appeal Process
- Appealing Health Plan Decisions
- The scorecard
- Accreditation
- The Joint Commission
- NCQA
- URAC
- Chapter Seventeen
- Accountable Care Organizations
- Return On Investment
- Tectonic Plate Alerts
- Alert #1
- Alert #2
- Chapter Eighteen
- A Case Study In Health Plan Engineering
- A Case Study In Health plan Engineering: Abu Dhabi
- A Case Study In Health Plan Engineering: United States
- Postscript
- Are You Listening?
- Consumers Of Healthcare.
- Providers Of Healthcare
- Decision-Makers
- Moving Forward
- Find the return on investment
- How I Would Approach Healthcare
- Three Things Are Clear
- About the Author
- Acknowledgments
- Endnotes.
- Notes:
- Description based on publisher supplied metadata and other sources.
- ISBN:
- 9781620236109
- 1620236109
- OCLC:
- 1101034638
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