Government Funded Health Care Assistance Programs

GOVERNMENT FUNDED HEALTH CARE ASSISTANCE PROGRAMS

Introduction.

Government funded health care assistance programs are initiatives by a government of a certain country to provide financial assistance for payments and improvement of medical care on behalf of a certain group of people could be pregnant mothers, children, physically handicapped, mentally disabled or the aged and any other medically needy persons in the society meeting certain income requirements.

In the United States, Medicare is a social insurance program administered by the government providing health insurance coverage to people who meet a certain criteria. This was passed in the Social Security Act of 1965. The Medicare program is funded by payroll taxes.

Importance/ Benefits of Medicare.

In the United States, Medicare is divided into two parts: Hospital Insurance and Medical Insurance, it only on specific cases does it cover prescription drugs. (Sylvia, 1974)

Hospital Insurance

This covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees.

Government Funded Health Care Assistance Programs

Medical Insurance

Medical insurance helps pay for services and products not covered by hospital insurance, generally on an outpatient basis.

This covers physician, nursing services and any other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under medical insurance, if it is administered by the physician during an office visit.

Medical Insurance also helps with equipment including canes, walkers, wheelchairs, and other equipment.

Medicare Advantage plans

Medicare advantage plans came up after the passage of the Balanced Budget Act of 1997, where beneficiaries were given the option to receive Medicare benefits through private health insurance plans, instead of through the original Medicare plan. This has a standard benefit package that covers members so that they can receive from medical treatment from nearly any hospital or doctor in the country. Medicare Advantage members receive additional benefits compared to traditional Medicare members. Medicare Advantage health plans also encourage preventive care and wellness and closely coordinate patient care. (Carasso, 2004)

Prescription Drug plans

Government Funded Health Care Assistance Programs

Anyone with hospital and medical insurance is eligible for this. To receive this benefit, a person with Medicare must enroll in Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD).

Criticism and solutions of the Medicare plan

Socialism

Leaders in the United States proposed that the Medicare system would lead to socialism since it does no participate in the price mechanism of competition.

Financial challenges

Medicare is facing financial challenges and according to the 2008 annual report to Congress, the Medicare Board of Trustees reported lack of money by 2017, so far there is no specific strategy to keep the, Medicare program solvent (Mobley L,2005)

Quality of beneficiary services

The rate of accurate information provided by Medicare customer service representatives is low. The customer care representatives were subjected to training and quality assurance monitoring has improved.

Government Funded Health Care Assistance Programs

Hospital accreditation

Hospital is low on accreditation and attempts to provide accreditation in 2006 were denied. But currently, there are a number of American organizations possessing healthcare-related power for Medicare.

Physician residency

The cost of medical services is rising rapidly and many geographic areas face physician shortages. In response, teaching hospitals have resorted to alternative approaches to funding resident training, and this has lead to total growth in residency slots. (Johnson, 2008)

Government Funded Health Care Assistance Programs

Government Funded Health Care Assistance Programs

References

Carrie Johnson, (2008) Medical Fraud a Growing Problem: Medicare Pays Most Claims Without Review, The Washington Post.

C. Eugene Steuerle and Adam Carasso. (2004)The USA Today Lifetime Social Security and Medicare Benefits Calculator. Urban Institute.

Hellinger FJ, (1998) The effect of managed care on quality: a review of recent evidence, Archives Internal Medicine.

Mobley L, et al., (2005) Health Care Financing Review, Spring Publishers.

Sylvia A. (1974) The role of private intermediaries in Medicare administration is discussed in Law, Blue Cross: What Went Wrong? New Haven, Conn. Yale University Press.