NSG 6605 Task 2 Discussion Board
Units 4, 5, 6
Directions: Read the case study below and in your initial post (not to exceed 500 words) to the discussion board, answer the questions you find at the end of the case study. Include at least one reference to support your answers. This reference may be the course textbook.
In your cross-post (not to exceed 250 words) to a peer, address one of the case study answers from the peer’s initial post and support your response with at least one current (2016-2021), peer-reviewed, scholarly source (not your text).
Case Study: Sharon Jones, a 55 year old woman, visits her primary care physician. Her physician, Dr. Smith, is part of a preferred provider organization (PPO). Mrs. Jones is married, employed, and has healthcare insurance through her employer. She holds a master’s degree in business administration (MBA). Her yearly income is $80,000/year and she and her husband own a house in a suburb of Chicago. Mrs. Jones is a former smoker and has trouble finding the time to exercise.
Her ongoing health concerns include obesity, asthma, hypertension, Type II diabetes, and depression. Her supervisor has noted that Mrs. Jones has had increasing days absent from her job related to her health challenges. Mrs. Jones is worried that she may lose her job and health insurance if she continues to miss days of work.
Dr. Smith is aware of her complex medical issues and that her patient’s health status and quality of life is not as high as it might be. Dr. Smith tells Mrs. Jones about a new program that the PPO offers for patients ages 50-70, who experience multiple chronic illnesses. “Reaching for Better Health” provides ongoing group-setting education classes, health technology applications for Smartphones, and lifestyle classes for participants. Mrs. Jones likes this idea, enrolls in “Reaching for Better Health” for a 6-week period, and agrees to see Dr. Smith again after the 6 weeks have passed.
Questions:
- What do we know about Mrs. Jones’ demand for healthcare as it relates to her private health insurance? Is there an evidence-based relationship between her private insurance plan and her level of health? Explain this relationship using Mrs. Jones as an example.
- Describe Mrs. Jones’ health using the five determinants of health discussed in Henderson, chapter 6 page 173..
- Identify Mrs. Jones’ generation based on her age. What unique demands is this generation placing on the healthcare system?
- How would economists who use QALY analysis evaluate the effectiveness of the PPO’s program, “Reaching for Better Health” (described above)?
NSG 6605 Task 2 Discussion Board Rubric
| Discussion Criteria | 23-25 | 19-22 | 0-18 | Comments |
| Support from Literature | Support from the literature is present and includes discussion-specified number of scholarly resources with matching in-text citations. | Support from the literature is present, but does not meet minimum number specified or resources are not considered scholarly. | No support from the literature is present. | |
| SCORE (Lit Sup) | ||||
| Synthesis of Assignment with Course Content | Demonstrates synthesis of the assigned materials and course content as indicated by comparison and contrast. | Limited synthesis of assigned materials and course content. | Scant to no evidence of synthesis of assigned materials and course content. | |
| SCORE (Synthesis) | ||||
| Interactive Dialogue | Responds substantively to at least one topic-related post of a student peer. A substantive post adds content or insights or asks a question that will add to the learning experience and/or generate further discussion. | Responds to at least one student peer, but the nature of the response is not substantive. | Does not respond to any student peer. | |
| SCORE (Interact) | ||||
| Spelling, Grammar, & APA Formatting | APA, grammar, spelling and/or punctuation are accurate or with no more than 3 errors. | APA, grammar, spelling and/or punctuation contains no more than 4-6 errors. | APA, grammar, spelling and/or punctuation contains > 6 errors. | |
| SCORE (Mechanics) | ||||
| TOTAL SCORE |
Discussion Question on QALY Analysis
- What do we know about Mrs. Jones’ demand for healthcare as it relates to her private health insurance? Is there an evidence-based relationship between her private insurance plan and her level of health? Explain this relationship using Mrs. Jones as an example.
While patients with health insurance are believed to have increased access to healthcare services when compared with those who lack medical insurance, the type of insurance plan, whether private or public, can affect a patient’s demand and access to healthcare services. Mrs. Jones has numerous health demands owing to the fact that she is suffering from multiple chronic conditions. Her current health concerns include obesity, asthma, hypertension, Type II diabetes, and depression, all of which she needs treatment quite often. However, Mrs. Jones’ private health insurance through her employer might limit her access to healthcare services (Henderson, 2022). The reason is that it is highly likely that she can at one time exceed the claims limit set by the private insurer. This might compel her to use her out-of-pocket money to top up the amount not paid by the private insurer.
Published evidence indicates that a private insurance plan can affect beneficiaries’ access to healthcare services and even cause them to incur huge healthcare costs. A survey conducted by Wray et al. (2021) revealed that individuals who possess private insurance plans experience higher healthcare costs, have reduced access to healthcare services, and experience reduced satisfaction with the care that they receive when compared with those or military coverage, Veterans Health Administration (VHA), and those with Medicare coverage. Due to her repeated demand for healthcare services, Mrs. Jones’ private insurance might lead to higher healthcare costs, limited access to healthcare services, reduced satisfaction with the care that she receives from healthcare providers.
- Describe Mrs. Jones’ health using the five determinants of health discussed in Henderson, chapter 6 page 173.
Mrs. Jones’ health status can best be described in terms of the five determinants of health namely; education, income and wealth, employment, health systems and services, and social environment. Although Mrs. Jones is well educated with a Master’s degree in Business Administration, she has limited health literacy as regards to the health risks imposed by lack of exercise. This is a contributing factor to her multiple chronic illnesses (Henderson, 2022). She obtains income from her employment but having private insurance might hinder her from having uninterrupted access to care. The health system does not have current programs in place to address the health needs of older adults in the community which worsens Mrs. Jones’ health status. Improving the social environment by creating programs such as “Reaching for Better Health” can help her to effectively manage her health problems.
- Identify Mrs. Jones’ generation based on her age. What unique demands is this generation placing on the healthcare system?
Mrs. Jones is 55 years old. Her age is placing her at an increased risk of developing numerous health problems. She is currently struggling to manage multiple health conditions which tend to increase her demand for healthcare services (Henderson, 2022). In this respect, Mrs. Jones can benefit greatly from a strengthened health system that can adequately address her health needs.
- How would economists who use QALY analysis evaluate the effectiveness of the PPO’s program, “Reaching for Better Health” (described above)?
Economists often utilize the quality-adjusted life year (QALY) analysis to measure the disease burden among populations. The same model can be applied to assess the effectiveness of the PPO’s program, “Reaching for Better Health”. When using the QALY analysis, the program’s team will confirm its effectiveness when it is able to reduce the disease burden for all participants including Mrs. Jones (Henderson, 2022). The program should offer quality services to participants to enable them to live longer.
References
Henderson, J. (2022). Health economics and policy. (8th ed.). Boston, MA: Cengage Learning.
ISBN-13: 978-0-357-13286-9
Wray, C. M., Khare, M., & Keyhani, S. (2021). Access to care, cost of care, and satisfaction with care among adults with private and public health insurance in the US. JAMA Network Open, 4(6), e2110275. https://doi.org/10.1001/jamanetworkopen.2021.10275