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Public health preparedness refers to the level of hygiene and cleanliness in the environment. It is mainly connected with the environmental aspects such as housing, disaster management, health and medical as well as natural calamities. Preparedness implies the ability to identify, respond, contain, and mitigate a situation either life threatening or disease causing. It should have the ability to approach all types of hazards, which is mainly achieved through the correct number of qualified personnel, adequate resources, and proper training/education helping to achieve the essentials in the preparedness of public health.
Principal Effects of Essential Services as a Framework
The most important services to our health facility would be Essential Services (ES) 1, 2, 5, and 10:
- Monitor health status (ES 1). The facility will identify health problems within its community and devise methods to solve such problems. The ED will need to be equipped with appropriate technology such as mapping methods in order to meet this essential service. For example, it is a necessity to have an electronic medical record system.
- Diagnose and investigate (ES 2). This involves the diagnosis and investigation into community health problems and hazards. Therefore, this requires that our facility must be well-equipped with diagnostic services to enable timely identification and study of the health problems during emergency cases.
- Develop policies and plans (ES 5). These policies and procedures should help the medical personnel at the facility support individual and community levels of care. This would call for emergency response planning and an effort to align resources available in the facility to ensure quality care and optimization in resource use in order to avoid wastage or misappropriation.
- Research for new insights and innovative solutions (ES 10). Solving health problems within our community involves innovative approaches possible through the obligatory research. Thus, the facility will need to have an established Research&Development to meet this objective of essential public health services.
Importance of Continued Evaluation of Patients as Stipulated by EMTALA
Consistent effort to monitor and document health care status of our community is crucial in assuring the community of quality care and the healthcare system. Besides, this would lead to the decrease of the healthcare costs (Simonet, 2008) as the key drivers of high healthcare expenditures are chronic illnesses and infectious diseases. Thus, by having continued evaluation of our patients as stipulated by EMTALA, our facility will be better positioned to address these issues before they are impossible to control.
Measures to Maintain Electronic Medical Record System during Emergency
Some of the important tools used to maintain electronic medical records during an emergency are a thin client devise and an audio tape recorder. On the one hand, a thin client device is important is accessing the facility database from anywhere in order to update it with the information of the incident at hand as well as accessing evidence-based practice to address the emergency case. On the other hand, Bitterman (2013) argues that there is a need to keep all records of conversation between physician and the patient to mitigate any legal issues that may arise thereafter. Similarly, there is a need to quote directly what their patients said (Bean, Rishon, & Garvey, 2003; Bitterman, 2013). These two kinds of records can best be captured with the help of audio tape recorders which might later be transcribed and still maintained as evidence to support what appears in the record.
Health Insurance as Cost Reduction Strategy for EDs
The rationale for having health insurance as part of the emergency services to assure cost reduction in this area is ensured by three advantages: behavior change, improved care delivery, and overall reduction on the cost of EDs. To begin with, when health insurance is used in emergency cases, there will be deductibles involved which the patient or his/her family would want to minimize. In turn, this will ensure that emergency cases reported at ED are all genuine as well as guarantee that such cases where non-emergency visits cause delay and overcrowding at EDs are reduced. Daniel Simonet (2008) reports that introduction of co-payment of between $25 and $35 was effective enough to reduce ED consultation by 15% in California for Kaiser Permanente clients.
Secondly, this will enhance behavior change among patients who would want to avoid ED visits at all costs because of the deductibles involved. If this method coupled with public education, is applied, healthcare facilities will be in a position to reduce ED visits. Finally, the invitation of health insurance organizations to emergency cases will help to improve care delivery as it will easier for even private practitioners to deliver services because the patient's healthcare plans will cover the expenses. According to Simonet (2008), the investigation among HMO patients indicates that there was no delay due to imposed co-payment of between $25 and $100 per ED visit.
Impact of Health Insurance Inclusion by EDs on Quality of Care
The invitation of insurers in emergency cases is a controversial issue that has been seen as likely to worsen the health of patients. There are legitimate concerns with this issue that must not be ignored. However, there appear to be important opportunities available. The following three impacts are important to consider in this approach.
Primarily, it is difficult to get the majority insurers involved in ED cases due to the fact that health plans do not allow deductibles among their customers. The rationale for refusing to incorporate this aspect of healthcare is because there is no time during emergency cases for patients to “shop around” for cheaper options causing delay that may worsen their health situation. Thus, this may mean higher costs in the long run for HMO patients as reported by Simonet (2008), which destroys the logic of reducing healthcare costs by inviting insurance.
Secondly, some health insurers may require that their clients pay the full cost of ED services possibly causing a delay in care delivery when the patient in question is not able to cover the full amount. Acute care may be negatively impacted by this kind of arrangement for less advantaged patients as well as those with chronic illnesses (Simonet, 2008). Therefore, the costs associated with acute care are likely to supersede the deductibles.
Finally, for some health insurers, a waiver is offered for co-payment between $50 and $100, which is deemed as a safety net presenting another challenge. As observed by Simonet (2008), while an inexpensive co-payment may not cause an individual to avoid seeking care, it is likely to result the client’s desire to seek care elsewhere.
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