Navigating the Healthcare System- A Case Study on Disease Management, Costs, and Accessibility

Navigating the Healthcare System- A Case Study on Disease Management, Costs, and Accessibility

Moving through the Healthcare Delivery System for Obese Patients

Cate Teulia is among the millions of severely obese Americans. Her severe obesity condition puts her at risk of developing chronic non-communicable diseases like type 2 diabetes, high blood pressure, and metabolic syndrome. As with most patients, her movement through the healthcare delivery system was reactionary. She only sought medical care when she was already feeling sick. The phases of obesity care include prevention, the identification of the problem via physical screening, diagnosis of the condition, and the prescription of medication and other recommendations. In extreme cases of obesity, a physician may suggest a need to carry out a procedure such as bariatric surgery to manage the condition better. If an operation is required, the risks associated with the procedure or carrying out the procedure must be assessed. A decision on the most appropriate procedure must be made between the doctor, the patient, and their family. After the procedure, follow-ups over time are necessary to determine whether the procedure is helping manage the condition and offer assistance.

Before she visited the hospital, Teulia was already extremely fat. She had started having constant pains in her knees, back, and shoulders. She was also experiencing issues with falling asleep, and once asleep, she had problems with her breathing. Consequently, she visited the hospital due to these issues. The doctor did physical screening and tests and diagnosed her with severe obesity. Her obese condition caused the problems she had visited the hospital for. In addition, the doctor also noted that she was at a high risk of developing conditions related to severe obesity, such as diabetes mellitus, high blood pressure, heart disease, and metabolic syndrome. Her doctor prescribed medications and non-pharmacological methods, including individualized physical exercises, to help with her obesity and prevent the development of chronic diseases. The doctor also suggested bariatric surgery if the condition did not improve within the given time. Teulia was to join gym classes and have an instructor observe her progress. She also needed to get checked regularly to assess the level of risk for chronic diseases.

As a child from a low-income family, Cate Teulia did not have the money or insurance to pay for her medical bills. As a result, as an obese patient without insurance and with the risk of chronic health conditions, it was hard for her to access quality healthcare services as needed. The cost of marketplace insurance was high for her family to afford due to her condition. Efforts were made to register her and her family for Medicaid benefits. With Medicaid, she currently has access to health facilities and prescribed medications. Although the family has not been able to raise enough funds for Carter for her private gym sessions and instructor, she is currently receiving formal and informal support from her family, friends, and the local community centre. Additionally, her movement through the healthcare delivery system has been challenging due to her health condition and poor financing.

Paying for Cost of Treatment for Obesity

Cate Teulia’s case presents an example of the majority of obese Americans from low-income households without insurance and in need of access to critical healthcare services. She has been registered under Medicaid post-diagnosis as she meets the eligibility criteria. The Medicaid program’s provision regarding her situation allows most of her bills to be cleared in full or via a copay system. However, the Medicaid program in her region only carters for her prescribed medication and outpatient visits. Subsequently, her family will have to make out-of-pocket payments for the essential components of her treatment procedure, such as gym sessions, private instructors, and the planned bariatric surgery.

The State of the Healthcare Delivery System for Obese Patients

The follow-up of the Cate Teulia movement through the healthcare delivery system as an obese patient creates a clear picture of the current challenges and gaps in access to healthcare services for uninsured obese patients. There is a clear lack of coordination of care across the continuum of care for obesity. The complexity of care for obese patients and the need for regular care requires coordination of all care settings for obesity. These include the individual, the community, the healthcare system, and all care providers and financing organizations. However, as observed from the delays in providing the necessary care for Teulia, communication and collaboration are limited, especially due to the lack of adequate financing. The Teulia obesity case has also shown that the coordination among the various entities for obesity care in the US is majorly incidental. Most coordinated efforts on care delivery emerge only when obesity cases are severe and diagnosed or when other comorbidities have been identified in obese patients. Accordingly, this justifies the lack of knowledge, proper organization, and structure to counter the threat of obesity (Osmundsen et al., 2019).

Significantly, the high obesity incidence rates and prevalence threaten the fall of the American healthcare system due to the high risk of incurable chronic diseases. The costs of obesity complications and the associated chronic diseases are considered the highest compared to other diseases. According to current research, obesity is viewed as a contributor to the higher utilization of healthcare services, increased health expenditure, and decreased productivity (Biener et al., 2018). Evidently, the care for obese patients offered by associated entities lacks the people-centred aspect of good care service delivery. The state of care for obesity and related diseases focuses more on the disease and financing the people affected by the disease or at-risk populations.

Moreover, although the American healthcare system is described as the best in the world, the organizational structure means that the uninsured majority find it hard to access quality care as per their needs. The majority of uninsured obese patients only have the option of paying out of pocket throughout the continuum of care for obesity. Despite the Affordable Care Act provisions that improved the spending and accessibility of programs to reduce obesity, like Medicaid (Medicaid.gov, n.d.), program flaws allow the federal and state governments and marketplace players to control the programs. They determine the type, scope of provisions, amount paid, and duration of Medicaid. Such flaws have allowed the existence of variations among health insurance plans across states within the public and commercial domains of eligibility, benefits, cost-sharing, plan restrictions, and reimbursement policies. Besides, the variations in Medicaid plans across states create program confusion, inequalities in access to quality care, and an unfair burden for both providers of care and consumers (Baker et al., 2020). They also undermine the national health financing and delivery organization, leaving a majority of lower socioeconomic populations vulnerable to chronic diseases. Despite the prevalence of obesity in the rural US, People living in rural areas (regardless of state) find it hard to access or afford the costs of care for obesity.

Conclusion

In conclusion, the number of obese adults and children across the US is fast growing. Subsequently, obesity is the precursor to many chronic non-communicable diseases, such as diabetes mellitus, high blood pressure, and heart diseases. The disease symptoms include increased accumulation of body fat and a high body mass index (BMI). The prevalence of obesity across the US is associated largely with societal and individual factors. A whole-system approach is required to create a healthy America and protect the healthcare system from collapsing due to the growing weight of obesity cases and the threat of chronic disease epidemics. As the government pushes to reduce the incidence and prevalence of obesity nationally, nongovernmental actors such as local communities, individuals, the business community, food manufacturers, the mainstream media, academia, and individuals have a role in countering obesity.

Furthermore, the effectiveness of treatment, preventive measures, and efforts against obesity will only give better health outcomes if coordination is achieved among the various actors and the various aspects of care for obese patients, such as access to health information and financing. The coordination of the multi-sector efforts will help shift the obesity care trends from a reactionary approach to a preventive approach. Accordingly, a preventive approach in the management of the obesity epidemic will reduce obesity health risks and eliminate the higher levels of health expenditure and access barriers in treating obesity. Conclusively, the efficiency of movement throughout the healthcare delivery system for obese patients is critical for successful obesity management.

References

Baker, W., Rivlin, M., Sodha, S., Nakashian, M., Katt, B., Fletcher, D., & Beredjiklian, P. (2020). Variability in Medicaid reimbursement in hand surgery may lead to inequality in access to patient care. HAND, 1558944720964966.

Biener, A., Cawley, J., & Meyerhoefer, C. (2018). The impact of obesity on medical care costs and labor market outcomes in the US. Clinical chemistry, 64(1), 108-117.

Medicaid.gov. Reducing Obesity | Medicaid. Medicaid.gov. Retrieved 17 March 2022, from https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement-initiatives/reducing-obesity/index.html.

Osmundsen, T., Dahl, U., & Kulseng, B. (2019). Enhancing knowledge and coordination in obesity treatment: a case study of an innovative educational program. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4119-9

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We’ll write everything from scratch

This week, you will continue to complete the tasks of the project topic selected in Week 1.

Topic 1: Disease Process
Write an imaginary case study for your hypothetical patient.

Explain how the patient moved through the healthcare delivery system.

Navigating the Healthcare System- A Case Study on Disease Management, Costs, and Accessibility

Concerning the costs you calculated last week, describe how the patient will pay for the cost of treatment.
Analyze the healthcare delivery system as illustrated in this case. What problems did you notice? Would some people find it difficult to pay for treatment? Are there areas where treatment for this illness is unavailable or unaffordable to the common person?
Provide an overall conclusion for the work that you have done in this project.
Final Task
Your answers for Topic 1 and Topic 2 should be in about two pages.
Incorporate the feedback you have received from your instructor for all the tasks of the project topic you selected, including the corrective feedback or suggestions for more information.
Ensure that your completed project meets all of the expectations of each week’s tasks.
Combine what you have developed in Weeks 2–5 into a single 14- to 16-page Microsoft Word document, applying appropriate headings and formatting to make it one complete document, including works cited or referenced on the final page of the document. Cite all references in APA format.
Remember this is a high stakes assignment. Review the rubric prior to completion to ensure you have covered all the necessary points.