Outpatient Care: Financing and Trends Over Time

Respond to the following questions by providing a full explanation in the context of inpatient care services. 

1. How and by whom are these services covered by? Include any restrictions & eligibility requirements.

• Inpatient care services are usually covered by private insurance plans, Medicare, Medicaid, and out-of-pocket payments. Medicare is an available program for patients aged 65 and older and some younger patients with disabilities. Medicare A covers hospital stays, skilled nursing facilities, hospice care, and some home healthcare. To qualify patients usually meet certain criteria. Being admitted to the hospital for at least 3 days and requiring medically necessary care. Medicaid is a federal and state program that provides health coverage for families of low-income. Eligibility depends on the state you live in. It typically covers low-income adults, children, pregnant women, elderly individuals, and people with disabilities. Private insurance is coverage through employers and has its own policies. Coverage includes hospital services but benefits can depend on the type of plan you have. There are deductibles, copayments, and coinsurance that can affect how much the cost is for a patient. Coverage comes with restrictions for certain types of procedures, and treatments and limits the number of days covered per admission. Sometimes certain plans may not cover certain services and may require referrals from your physician. 

2. What are the trends in patient care services? Have services expanded or declined? Explain your answer. 

• It can decrease the length of stay on many procedures that once required overnight hospitalization can now be performed on an outpatient basis. It can increase outpatient services as healthcare shifted towards value-based care and has been growing emphasis on outpatient care. This includes same-day surgeries and community health services. This can lead to a decline in inpatient admissions for conditions that can be managed for and outside a hospital setting. There has also been a rising cost in value-based care because the volume of inpatient services may not grow dramatically. This can lead to fewer hospitalizations as healthcare providers prioritize preventive care. 

3. what impact did the Affordable Care Act (ACA) have on inpatient care settings and services? 

• The ACA had a significant impact on inpatient care settings and services. It has increased access to care through insurance coverage for millions of Americans and reduced the number of uninsured patients. This caused to have an increase in hospital admissions and uninsured individuals gained access to necessary medical care.