MHA 516 University of Phoenix Consumer and Provider Costs Paper



The way America determines who is “poor” is a continuous debated issue that affects many. Healthcare disparities with health insurance coverage, related to poverty, have been a long-standing issue in the United States and is also a big concern among policymakers and health care professionals. The Proposed rule I would like to review is the 2022 Federal Poverty Level Standard. The Department of Health and Human Services (HHS) updates the poverty guidelines at least annually and by law these updates are applied to eligibility criteria for programs such as Medicaid and the Children’s Health Insurance Program (CHIP). These annual updates increase the Census Bureau’s current official poverty thresholds by the relevant percentage change in the Consumer Price Index for All Urban Consumers (CMS, 2022)

According to Lin, (2021) Most people who care about measuring poverty—academics, policymakers, nonprofit leaders, and the like—agree that the way the federal government currently determines who is at the poverty level and who is not doesn’t work. The so-called “poverty line” was determined in the mid-1960s by calculating the amount of money it costs to buy a basic basket of food and then multiplying that amount by three. Each year the line is updated to account for inflation.

Cultural sensitivities regarding Poverty Level Guidelines are far and wide. When you take a look at culture with respect to ethnicity, religion, geographical location, and social groups they all have a different way of life that may affect the household expenditure. Therefore, having a poverty guideline can not possibly meet the standards with all cultural appropriations and affiliations. However, trying to adjust the guidelines to meet the needs for all cultures may become challenging but not an all out fail. All aspects of culture should be considered with making decisions in the health care industry.



The proposed rule I will discuss is the “Coverage of Stand-alone Vaccine Counselling for Beneficiaries Eligible for EPSDT.” Some of the cultural sensitivities that need to be considered because of the rule are religious sensitivities. Certain religious groups decline treatment, and such groups cannot engage in vaccine counseling because they are likely to decline the vaccine. Social sensitivity is also essential, whereby it is important to consider that people from certain social groups and sexual orientations may take a different approach to vaccine counseling.

It is essential to consider all cultures in health care policies. The lack of culturally competent health care policies reduces patient participation. When the patients are unable to receive certain services because of their culture, this can lead to decreased patient safety. Some religions decline treatment; it is, therefore, essential to develop policies that work around traditional treatment plans (Brooks,2019). Policies should also consider people from all social groups and be provided with the same treatment options regardless of gender identity.

Some aspects of culture should be considered in the health care industry. Nurses should consider language barriers whereby some patients have specific preferred methods of communication, and it is, therefore, essential to arrange for an interpreter. It is also important to consider gender roles in certain cultures whereby women request less invasive treatments that make them comfortable (Henderson,2018). Different cultures also have different beliefs regarding their health care. For example, Caucasians have low pain tolerance and higher expectations of receiving the prescription, while people from a Hispanic background are less willing to take western medicines.



Hi Class,

As future healthcare leaders and administrators, we need to understand the topics of payer mix and population mix within the state and community we are working in and those of the organization we are employed at. The video titled How do public health care programs affect the way health care leaders manage organizations? shared great insight on the payer and population mixes. For example, in the United States, the payer mix can range from private insurance, private pay, and government programs such as Medicare (elderly) and Medicaid (low income). About population mix, it can vary from one organization to the other. The types of populations that receive care at an entity will affect payments for the services rendered. This in turn will allow healthcare leaders/administrators to provide pricing accordingly. (University of Phoenix, 2022).

As I have continued reading through the class novel I have learned more about the Hmong culture, Hmong refugees, the level of care they were receiving at MCMC, and government programs/publicly funded programs available to them. As Fadiman (1997) described in chapter 3, pages 24-25, MCMC accepted all patients, whether or not they could pay for services.

MCMC’s payer mix included the following:

-“Only twenty percent are privately insured, with most of the rest receiving aid from California’s Medi-Cal, Medicare, or Medically Indigent Adult programs, and a small (but to the hospital, costly) percentage neither insured nor covered by any federal or state program.”

-“The hospital receives reimbursements from the public programs, but many of those reimbursements have been lowered or restricted in recent years.”

MCMC’s population mix included the following:

-“Southeast Asian refugees began to move to Merced in large numbers.”

-“The city of Merced, which has a population of about 61,000, now has just over 12,000 Hmong.”

-“Hmong patients in almost every unit.”

-“The Hmong fail resoundingly to improve the payer mix-more than eighty percent are on Medi-Cal-but they have proved even more costly than other indigent patients because they require more time and attention.”

According to Dreger & Trembeck (2002), “More than 90 million Americans have limited literacy skills. Almost two million US residents cannot speak English, and millions more speak it poorly.” The Lee family was not able to communicate effectively with their care providers and vice versa. Based on the notes and/or documentation shared by the physicians, residents, nurses, and visiting nurses in chapter 5 one could see how the documentation lacked substance and emotional intelligence. The care team was very frustrated and took some of the encounters with the Lee family personally. “Patients who do not understand their plan of care do not comply with instructions and, therefore, suffer unnecessary complications. Health care providers who can communicate with their patients through multilingual, low literacy patient education materials and with the use of qualified interpreters markedly improve the quality of care for their patients and the resulting outcomes.” (Dreger & Trembeck, 2002).

While going through the chapters of the novel, I learned that the Lee family was welfare-dependent. They struggled to present their Medi-Cal card as they couldn’t even locate it at times. At one point, I had to stop to process everything that the Lee family was going through and the cultural and communication gaps that existed among the MCMC providers, care team, and the Lee family. In a sense, there was so much information overload for the family, let alone even understanding the intricacies of health insurance, coverage, and payment. In my humble opinion, I believe publicly funded health care programs do overrule cultural differences for the sake of providing a standard level of care. Once again, there is not a one size fits all approach. Within these healthcare programs, cultural differences and language barriers such as the ones experienced by the Lee family do have an impact on healthcare compliance. “The effect of health literacy on patient compliance is a recurrent theme in health literature. Patients who cannot read their prescriptions, medication labels, or written instructions for home care do not clearly understand their treatment regime; therefore, they do not follow it.” (Dreger & Trembeck, 2002). When the aforementioned occurs, serious consequences follow such as life-threatening complications.

Only one response was posted. Here is the other one


Do public funded health care programs overrule cultural differences for the sake of providing a standard level of care? My answer to this question is no, I do not believe that health care programs choose on how they decide to give care to patients based on their cultural differences. Culture is a big part of healthcare how and all cultures should receive equality care, race, gender, and ethnicity should not play a part on how to treat a patient in need. In some families, cultural differences can play a part in how they choose to proceed with the type of health care service. “All cultures have developed systems of beliefs to explain the cause of illness, how illness can be cured or treated, and who should be involved in the health care process. In other words, every culture has beliefs about health, disease, treatment, and health care providers”. (Lake Park, 2017)

After reading about the Lee family, their cultural differences and language barrier did have an impact on how they were receiving care from the doctors. The providers also felt like Lia’s family was neglecting her when they stopped giving her medications that was supposed to help with her epilepsy. Based on the family’s culture and beliefs, they didn’t feel like the meds were helping but hurting their daughter, which is why they stopped it. Cultural differences can have an impact on healthcare compliance if the healthcare facility has not established culture compliance within the organization. ” A culture of compliance promotes prevention, detection, and resolution of instances of conduct that do not conform to government laws, public and private payor healthcare program requirements, and ethical and business policies”. (Strategic management services LLC, 2018)