A Contrast of Health Care Policy Approaches Applied in both Missouri and Pennsylvania.
According to the Center on Budget and Policy Priorities, Healthcare policies include the development and implementation of laws, rules, and regulations to govern the health care system of a State (Center on Budget and Policy Priorities, 2019). The health care system consists of medical practitioners who deliver facilities for the diagnosis, treatment, and prevention of mental and physical disorders and injury. A healthcare policy influences not just the costs for care that people have to pay, but also their access to treatment and the standard of care they receive, which impacts their overall health. A key concern is the growing cost of healthcare, which has put an increasing strain on consumer’s disposable income and state budgets.
Missouri State changed the Medicaid system from a provider centered model to an individual-centered model, which focused on results. By combining case management, care planning, disease prevention services, and reduction of risk. According to HCA, it led to improvements in outcomes for chronic disease patients such as adherence, service use, and cost. Finally, visits to the emergency department for the population involved in the scheme significantly decreased.
State Medicaid plans to take a variety of steps to monitor drug expenditure for both the Pennsylvania and Missouri systems by setting up approved product lists and prescription drugs immediately covered by the policy and securing discounts with manufacturers for both brand name and generic medications.
In 2003 a pay-for-participation program was launched with selected facilities in Pennsylvania to reduce the inpatient admissions and ED visits of Medicaid beneficiaries. Studies show that recipients of medical assistance associated with the P4P program received fewer hospital admissions and visits compared to those recipients who sought care from a doctor but refused to receive extra payments. Around half of Missouri residents earned benefits from their employers in 2013 as Medicaid covered 13 percent of the population and Medicare-enrolled 19 percent, compared to more than half of Pennsylvania residents who were insured by their jobs, a smaller 13 percent enrolled in Medicaid, while 17 percent enrolled in Medicare(Kaiser,2014).
According to (National Council of State Legislatures,2018), Missouri is one of 46 states that self-fund, meaning the state covers health insurance premiums from employer and workplace out of pocket premium payments rather than buying policies, while an insurer administers the benefits. Whereas Pennsylvania is one of 20 states where all of their health insurance services are self-funded, the country covers out of pocket premiums from employer and employee contributions while the insurer administers the benefits. As of 2013, 24 states provided plans with a limit of $0; this community of countries includes Pennsylvania (National Council of State Legislature, 2018).
Missouri was the only state in the nation to have not enacted legislation requiring a prescription drug monitoring system as of August 2015. Nonetheless, Pennsylvania has an active prescription drug surveillance system tracking the dispensing of medications. The Food and Drug Administration regulates access to experimental drugs by terminally ill patients, which are known as rights to try, which enable patients to obtain access to investigational drugs without FDA’s permission. Though Pennsylvania had proposed the right-to-try legislation as of March 2016, no such bill was passed (Cosgrove, 2015). Improving community health management approaches should include increased quality of treatment, coaching support programs, and comprehensive implementation and application of Health IT.