Question

Question:

Stephanie runs a small retail business in a poor rural community.  She has 4 employees, 2 of them part time, all of them older adults who have grown up in the area.  She has had only modest success so she has never been able to afford to provide health insurance for her employees. None of them have private insurance or Medicaid -- nor do they have primary care doctors. They rely on a small local urgent care center or the emergency room at the nearest hospital which is in the next county.  All of this may be changing. Stephanie has been invited into a small business consortium where many small businesses are coming together to negotiate collective terms of agreement to buy insurance at a reduced rate from Blue Cross Blue Shield.  It would most likely be a managed care plan - either a PPO or an HMO.  Stephanie is trying to consider all the pros and cons in order to make her decision.

By Day 3 of Week 7

Post your initial response to the case study :

• Identify "the role of the social determinants of health in the case study" and explain "the role of public health in addressing these".
• Explain "how the quality of the health service is an issue within this case study"?
• Describe the quality improvement mechanisms that could be leveraged.

Answer 1

As per the questions the points to be noted in the case study of Ms.Stephanie are:

• Small retail business, less income from business
• Employees : 4, 2 part time, all under vulnerable group ie oldage
• Treatment option: Small local urgent care centre/ emergency hospital in next county

Here the option of choice before Ms. stephanie on buying insurance from BLUE CROSS BLUE SHIELD are 2 : either PPO( prefered provider organization) or HMO plans( Health maintenance organization).According to the case study , the employees may have to depend on emergency care outside the county and are belonging to vulnerable community, so it is preferd to opt for PPO over HMO plan due to its better option for choosing their health care provider out of network coverage ( FLEXIBILITY) and easy to use option apart from the heavy monthly premium. still you have to pay less for services under PPO plan, due to pooling of people in PPO network.

Social determinants refer to the wide range of environmental factors in which people are born, lived, work and spend their leisure timewhich determine their quality of life outcomeand its specially accountable for vulnearable population specially oldage groups. Education, environmental status and income level had to be considered while providing health care. Health ministry have to focus on ensuring the social needs and social related behaviours, carry out research to identify the social determinants of health in the community and based on that have to plan for the health care facility and health promotion strategies in that community.So social determinants have a viatl role in determinants of health.

Quality of health care facility is very low in areas of people living with a low standard of living,as the they have a low socio-ecnomic status. They face it difficult to meet the health care needs in a super speciality hospital so they approach the PHCs and clinics for basic health care needs. In this case study the employees donot have a primary doctor as they cannot afford the cost and they approach a urgent care facility nearby or emergency care in next county due to their low income status from their work place , absence of medicare and due to their vulnerable age. so a medicare option helpp them to approach a better health care facility for their health care need.

The Quality improvement mechanism that can be leveraged are :(PDSA)

Initially we have to decide on,

• What we are trying to accomplish?
• How to determine a change is an improvement?
• What changes can we make that will result in an improvement?

In the case study, We try to accomplish an improvement in the health status of the employees by initiationg a PPO plan health insurance policy which will provide the employees with a better outreach of the best health health care facility .

We could determine the change, by assessing the improvement in health and by better output at the workplace during working hours

The change that result in an Improvement is, implementation of PPO insurance facility under blue cross blue shield, which provide a motivation for other retail business owners too, to care for their employees and their by a join community participation for improving the health status of their community people by better access to the best hospital , irrespective of low income status. As PPO insurance provide them better option for choosing their health care provider out of network coverage.