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John Q

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Submitted By mommyof2kids
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John Q. Crystal Beere HCS/235 March 16, 2015 Steve Linerode

John Q. John is like many people in the country that have a low income job. He is working a full time job but still doesn’t make enough to afford insurance on his own so he has Medicaid. This limits his options on coverage and who he can go to. He has a condition that needs medical attention, high blood pressure, but because of his insurance he is finding it hard to get the care he needs. Many people have that problem but there are solutions to get the care you need. John lives in a rural area that doesn’t have any primary care doctors that take his insurance. He was able to find two doctors in his area but not a primary care physician. The closest primary care physician he found is forty minutes away from his home. This is a challenge for him because he catches a ride to work or relies on public transportation. These problems are mutable, which means they can change. He could move to a different place, closer to the doctor he needs to see. Although with his low income job he might not be able to afford a place closer to the doctor he needs to see. He could also invest in getting a car. The cheapest option for him would to be get a car so he doesn’t have to rely on others to take him and possibly miss an appointment. He could still catch a ride with a friend or use public transportation if he wants to save on gas so he has it to get to his appointments if he wants. Sometimes the best option for people on low incomes is to use the car as little as possible to save the gas in case you need money for something else. If he was to miss an appointment at the doctor it could take him a while to get back in since you have to schedule appointments two weeks in advance. It could take him months to get back in because of the two weeks in advance, chances are there are a lot of people going to that office. He could keep calling to see if there was a cancelation but chances are slim. He could go without the care he needs, with John’s high blood pressure, he needs to make sure he gets to every appointment. He doesn’t want to end up like his father and have a heart attack. He can’t miss appointments. Another mutable problem he has is his job, he works full time hours and the doctor doesn’t have evening or weekend hours. Now he could take a day off work but that is going to make the amount he brings home even less and taking too many days off could get him fired. He could look for a new job that has different hours so he can make it into the doctors but with little openings now a days he might end up losing money that way. The doctor could extend hours on certain days of the week so patients that are working full time can come to them when needed. Another way John could help himself is try to get a second job and maybe get better insurance to find a different doctor. John could also try to get in touch with the other stakeholders of the Medicaid program. Stakeholders should be involved during each stage of the program to build support for it, provide suggestions for its design, and participate in evaluation and continuous quality improvement activities(“Engaging Stakeholders In a Care Management Program”, 2014). He could talk to them about setting up new offices to better serve the rural communities or offer suggestions for longer hours for working people. Some of the stakeholders besides his primary doctor are Congress, Centers for Medicare and Medicaid Services, and the Medicaid Integrity Program. Congress was the creator of Medicaid and continues to wield influence by originating and passing legislation to amend the staute(“Home Health Care Management Practice” Aug, 2009). The Centers for Medicare and Medicaid Services or CMS purpose is to guarantee that recipents receive state of the art health care and to support the staes efforts to provide quality and safety. In the CMS si the Center for Medicaid and state operations. They help Medicaid provide safe, effective, efficient, patient-centered, timely and equitable care. The Medicaid Integrity Program is there to eradicate fraud and abuse of Medicaid. These groups along with a variety of other agencies and facilities are there to coordinate and provide care to people with Medicaid. John should be able to get help from one or more of these agencies to make sure he is taken care of properly. They are in place to help people on the program. It might take some time for new policies or offices to be put in place but at least there will be hope for people to get the proper care without having to go out of their way to get it. Conclusion John has a lot of challenges that stand in his way. The area where he lives has limited doctors and he has to see a doctor. He also has to rely on others to get places and they might not always be available. His insurance is another challenge for him since only certain doctors take it and that’s all he can get with his low income job. All these challenges can be fixed with a little effort on not only John’s end but the stakeholders end too. The stakeholders of Medicaid can do certain things to not only help John but help everyone that is currently on Medicaid. Those people are there to make sure the people on their programs are well taken care of and get the care they need. If John can get other people like him to “stand up” and talk with the other people involved there could be improvements to the Medicaid program. If it starts with just opening some more doctor’s offices in rural areas they are helping many people out. He could even talk to them about setting up a bus route for the offices in the mean time until the new offices are open. There are many different ways to overcome his challenges and the challenges others face on Medicaid and other programs like it.

References Engaging Stakeholders in a Care Management Program. (2014). Retrieved from http://www.ahrq.gov/professionals/systems/long-term-care/resources/hcbs/medicaidmgmt/medicaidmgmt2.html Home Health Care Management Practice. Aug, 2009. Vol.21 No. 5. 338-345. Retrieved from hcc.sagepub.com.contentproxy.phoenux,edu/content/21/5/338.full.pdf+html…...

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