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Disease Process Part 4-Obesity

Disease Process Part 4-Obesity

Obesity is one of the fastest-growing public health problems that challenges the norms of traditional health insurance coverage. Subsequently, biological research on the prevalence of obesity has shown that it is higher among people from low socioeconomic status than those from higher socioeconomic status (Spinosa et al., 2019). A majority of the people from low-income backgrounds mostly make out-of-pocket payments to access health services. Considering the need for obese people to access healthcare services regularly, obesity is linked to increased healthcare expenditure.

Obese individuals have more excellent utilization rates of healthcare services in terms of the need for frequent tests, bio-monitoring, coordinated care, medications, and specialized health coaching compared to lean people. Although obesity and related health risks affect the patient alone, the associated costs of managing the disease affect everyone. Out-of-pocket payments cannot sustain the expenses of healthcare services for obese populations, therefore the need for healthcare insurance coverage. Do you need help with your assignment ?

Covering Healthcare Services

A health insurance cover ensures access to quality health services, covering costs related to testing, required supplies, medications, and coordinated care. Insurance makes the burden of disease and other costs of the disease manageable. However, the prices of covering healthcare services and access to healthcare services based on insurance plans vary between government-sponsored insurance plans and marketplace insurance.

Obesity is considered a risk factor for most chronic diseases, including diabetes mellitus, hypertension, stroke, and cardiovascular diseases (Nimptsch et al., 2019). Therefore, choosing a healthcare insurance cover for a patient diagnosed with severe obesity with a risk of developing diabetes mellitus and cardiovascular diseases requires consideration of a plan that covers obesity and these related diseases. The Affordable Care Act of 2010 has allowed patients with preexisting chronic disorders to get insurance coverage. Health insurance companies in the past denied coverage for preexisting conditions such as obesity and diabetes or charged more for such health conditions. Fortunately, the Affordable Care Act has protected patients with preexisting conditions. It also considered low-income families and developed income-based health insurance programs.

Considerations also need to go beyond obesity and consider other socioeconomic factors of the patient, such as the total costs of premiums for the plan and the ability of the patient to raise such premiums. In the context of Cate Teulia’s low-income socioeconomic background, a suitable health coverage plan needs to consider how much the plan covers and how much her family has paid out of pocket for her prescription medication needs, future tests, counseling visits, physical activity coaching, and gym membership (if needed), and cover for bariatric surgery. Furthermore, Teulia’s family needs to consider whether the insurance plan of choice offers coverage on obesity and diabetes-related supplies and devices such as telemetric biomonitoring devices and insulin pumps. Due to these health risks and needs associated with obesity and the child’s family background, the best choice for insurance coverage is affordable and requires a minimum amount of copays.

The Best Health Insurance Plan for Obese Patients

For Cate Teulia, the best health insurance plan is the Medicaid and the Children’s Health Insurance Program (CHIP) cover. Medicaid and CHIP are federal and state government-backed health coverage plans that provide health coverage for low-income children, families, seniors, and people with disabilities in various forms, including Texas. Medicaid and CHIP covers are the best choices for a health coverage plan, as Medicaid for children is free. Further, the CHIP plan’s premiums, enrolment fees, and copays are calculated based on the family’s income level. For instance, if a child qualifies for CHIP in Texas, their family will pay $50 or less yearly. The copays for care-related costs such as clinic visits, consultations, and medications range between $3 and $5 for low-income families (Children’s Medicaid & CHIP, 2022).

Medicaid versus Other Commercial Health Insurance Companies

Compared to the cost of covering health care services between Medicaid and other commercial health insurance companies, Medicaid is more affordable to low-income patients than commercial health insurance. Accordingly, Medicaid and commercial coverage plans differ in the type of insurance offered and the cost per hospital visit. Medicaid has lower copayments with high coverage for outpatient care. In contrast, commercial health insurance coverage is costly for outpatient and inpatient care access due to higher premium prices and copay rates for consumers (Allen et al., 2021). For example, eligible patients for Medicaid healthcare insurance services pay an average of $7.27 out-of-pocket costs per emergency department visit, while patients covered under commercial insurance plans pay approximately $106.21 for the same benefits (Allen et al., 2021). The out-of-pocket costs for low-income subscribers to commercial health insurance coverage tend to be ten times higher than those for Medicaid users, thus exposing the enrollees to the risk of higher health expenditures (Blavin et al., 2018). Furthermore, Medicaid has a retroactive policy for eligibility that allows patients to gain additional coverage even when coverage is taken during treatment, which marketplace health insurance covers do not provide.

References

Allen, H., Gordon, S. H., Lee, D., Bhanja, A., & Sommers, B. D. (2021). Comparison of utilization, costs, and quality of Medicaid vs subsidized private health insurance for low-income adults. JAMA network open4(1), e2032669-e2032669.

Blavin, F., Karpman, M., Kenney, G. M., & Sommers, B. D. (2018). Medicaid versus marketplace coverage for near-poor adults affects out-of-pocket spending and coverage. Health Affairs37(2), 299-307.

Children’s Medicaid & CHIP. (2022). Texas Health and Human Services. Retrieved March 14, 2022, from https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-programs-services/programs-children-families/childrens-medicaid-chip

Nimptsch, K., Konigorski, S., & Pischon, T. (2019). Diagnosis of obesity and use of obesity biomarkers in science and clinical medicine. Metabolism92, 61-70.

Spinosa, J., Christiansen, P., Dickson, J. M., Lorenzetti, V., & Hardman, C. A. (2019). From socioeconomic disadvantage to obesity: the mediating role of psychological distress and emotional eating. Obesity27(4), 559-564.

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Question 


This week, you will continue completing tasks on the project topic selected in Week 1. Remember, only work on the same issue started in Week 1 of this course.

Disease Process Part 4-Obesity

Disease Process Part 4-Obesity

Topic 1: Disease Process
Choose a payer type different from your choices in our discussions this week.
Compare the costs of covering healthcare services this insurance provides in your area.
What insurance type is best suited for healthcare coverage of your hypothetical patient’s disease type?
Submit your answers in a 2- to 3-page Microsoft Word document. Support your solutions with appropriate examples and research.

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