Medicare part (A) covers skilled nursing facility, hospice, home health facilities homecare, nursing home care and inpatient hospital care (Hess, 2012, p.560). Medicare part A will normally recompense for the charges during the first sixty days after one pays the deductibles.
Medicare part A willfully cover Mrs. Zwick’s impatient hospital care for the five days stay. It will cover fully the cost of the first 20days, and partially the cost of the 21st day. It fully covers the homecare services as well. This premium will cater for Mrs. Zwick’s medical expenses while at the skilled nursing facility for the first twenty days; however, Mrs. Zwick’s daughter will have to pay the bill for the rest twenty days she had stayed in the skilled nursing facility. For the hospice, she will get the benefits attached because of her terminally ill condition. The daughter to Mrs. Zwick should therefore claim for these premium benefits.
Medicare part B covers Doctor services, laboratory tests, outpatient hospital care and outpatient physical therapy. Medicare part B will cover Mrs. Zwick’s 80% of the durable medical equipments that will be used by Mrs. Zwick upon discharge and the impatient bills. It will fully cover the expenses that were incurred during the diagnosis of the urinary track infection. It will also cover clinical research, ambulance services, limited patient’s prescription, and durable medical equipment.
Medicare part D covers the cost of drug prescription and operates along with the private insurance companies. This medical premium will cover Mrs. Zwick’s medical expenses while at home and the four antibiotics given to her to cure the urinary track disease. This premium will partially cover drug prescription depending on whether the patient had paid for the deductibles for that year and the level of medication the patient is in. In this case, Mrs. Zwick had paid for this premium; she is therefore eligible for this.
I would advice Mrs. Zwick’s daughter that this is how Medicare works. He can get more information by visiting the official Medicare website for more guidance on Medicare benefits and conditions. However, the daughter to Mrs. Zwick should keep in mind that, these expenses would be fully covered if only the Quality Improvement Organization approve that indeed Zwick’s medical condition is reasonable eligible to the three premiums.
- How Medicare policies will affect reimbursement for the additional care Mrs. Zwick
Needs when she developed a hospital-acquired infection
Based on the current Medicare policies, health insurance will not cover the costs of preventable conditions or mistakes that were acquired due to the mistakes and conditions during the hospital stay. Instead, the bill on this will be picked up by the hospital itself. (Bennett, Jarvis & Brachman, 2007, p.251). Zwick’s daughter will have all the rights to demand for the bills to be covered. The reimbursement will be effected immediately after confirming that indeed the infection was acquired during the stay in the hospital.
Ethical implications of Mrs. Zwick paying for the hospital's mistake.
- How the Consolidated Omnibus Budget Reconciliation Act (COBRA) will allow Mr. Davis to continue his insurance coverage while he is out of work
Under this act, it is well stated that the company or the employer should cater for employers’ insurance plans for eighteen months after termination from work. Considering that, Mr. Davis is a qualified beneficiary; he is therefore eligible for the eighteen months continuation coverage.
Davis was terminated from work because of his underperformance; COBRA will follow the legal procedures in ensuring that Davis gets the medical attention he requires (Casenotes, 2008, p. 79). The organization will only conduct these procedures after determining Davis eligibility and qualifications to the continued health coverage from the company. From the story about Davies, it is clear that he fully qualifies for the benefits stated by the COBRA commission. There will be no limitation since the company is sufficient to cover the health bills of the patient. A factory with 100 employees is able to meet the health check requirements of Davis. Additionally, the act under COBRA can only isolate a company with less than 20 employees, considering that the factory in which Davis was working for has more than 20 employees, this law is be applicable to it. In case the company decline to cater for the expenses, COBRA will have an obligation to go seek justice for Davis. COBRA has a legal procedure that will be followed to help Davies.
- Two challenges that state or local government face in providing care for patients like ongoing care.
Chronic illness like cancer that last longer requires persistent medication, an individual cannot meet the requirements without government support or volunteers. People with chronic diseases like Davis have common problems that include medical costs that are often not catered for by the medical insurance leading to high medical bills (Mayhew & Huhti, 1998 p. 75). This therefore presents a huge challenge to the government. The following are two major challenges a government face in combating with such situations.
- Both the state and the local government is faced with many constraints, the major constraint in this case is the financial constraint.
- Another challenge faced by the government is how to reduce effects of chronic illness in the country’s productivity. Poor health in people reduce their level of production hence affecting the country’s Gross Domestic Product, bringing in government’s concern into this case.
These two challenges can be attached to the situation of Davies. It is evident that Davies condition will pose a challenge to the government. Chronic disease is not only expensive but also poses a high risk of infecting others.
Recommendations
In order for the government to reduce increased cases of chronic diseases to its citizens, the government should campaign for people to live healthy lifestyles. People should be trained on how to live healthy lifestyles by taking balanced diets and enough exercise. Conducting a regular medical checkup is also very important since a disease will be identified at its early stage hence avoiding the disease reaching its critical chronic level. This will help the government reduce financial constraints that arise from spontaneous expenses. The government has the obligation to isolate those people with contagious chronic diseases from others, by putting them under high medical care.
- Whether r it would be better for Mr. Davis if he were a citizen of Great Britain, Japan,
Germany or Switzerland based on his healthcare concerns
Switzerland has the best healthcare system. Swiss citizens buy insurance cover by their own. In Switzerland, there is no government sponsored insurance. The insurance prices are therefore transparent to the beneficiaries. The government subsidizes health care for the less privileged and the poor in the country. This move by the Swiss government is to prevent the poor from spending more than 10% of their income on health care insurance. Their government has introduced high deductable plans, so that those citizens who want to acquire supplement medical coverage are at liberty to go for it.
More than 98% of the Swiss citizens have health insurance; they have over 100 insurance companies that offer insurance cover to the citizens. Notably, due to the high number of insurance companies in the country, there is a high competition for customers hence a favorable adjusted price on insurance covers. Most beneficiaries are at liberty to choose the Doctor they prefer.
The Swiss government have enacted Medicare-style price controls, this has helped the citizens a big deal in avoiding huge expenses on health care. The government dictates the prices on healthcare for both hospitals and private physicians. Insurers should charge same rates on insurance premiums to both the young and the old. They must cover the preexisting circumstances and operate as non-profit entities.
In conclusion, Switzerland could have been a better country for Davies since he could have enjoyed subsidized medical care for the less privileged, choose his preferred doctor, use low priced insurance cover and the many deductable supplements by the government as compared to the United States that relatively favorable conditions.
- References
Bennett, J. V., Jarvis, W. R., & Brachman, P. S. (2007). Bennett & Brachman's hospital
infections. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Casenotes. (2008). Employment Law, Keyed to Rothstein & Liebman. Aspen Law & Business.
Hess, D. (2012). Respiratory care: Principles and practice. Sudbury, Mass: Jones & Bartlett Learning.
Mayhew, B., & Huhti, T. (1998). Lonely Planet travel guide South-West China. Melbourne: Lonely Planet Publications.
