Future Direction in Healthcare in America

Adults, 65 years old and older and people with disabilities are eligible for Medicare and Medicaid. Physician services and hospitalizations are covered by medicare. An additional supplemental program may be purchased to cover prescription drugs. Low income families and children may qualify for Medicaid and Children’s Health Insurance Program (CHIP). Medicaid has significantly lower copays and out of pocket expenses compared to private insurance. Unemployed individuals may qualify for Medicaid depending on the state.

Medicare and Medicaid are programs that have been developed to assist Americans in attainment of quality health care. Both programs were established in 1965 and are federally supported to provide health care coverage to vulnerable populations such as the elderly, the disabled, and people with low incomes. Both Medicare and Medicaid are federally mandated and determine coverage under each program; both are run by the Centers for Medicare & Medicaid Services, a federal agency ("What is Medicare? What is Medicaid?” 2008).

The Medicare and Medicaid federal programs were put in place as a way to help the less fortunate. Individuals with severe disabilities or over the age of 65 qualify for Medicare. This program helps them with health coverage, so the disabled and elderly who have Medicare do not have to worry about their medical bills and not going to the hospital when they are sick. Medicaid is a similar program, however, it only applies to low income families who cannot provide for their children. Similar to Medicare, this program covers any health related problems and takes away the worry and troubles that come with hospital bills.

One dominant economic feature of the healthcare industry is the growing need for both basic and specialized healthcare due to the continued aging of the “Baby Boomer” generation. This generation consists of over 79,000,000 individuals born in the US between 1946 and 1964. As this generation has aged, the need for healthcare has increased dramatically. Let us take a look at some statistics:

Medicaid and Medicare was created and called the Social Security Act of 1965 to provide coverage for medical treatment for qualified individuals and their families. Medicaid is a program that is jointly funded and managed by the federal and state governments that reimburse hospital and physician for providing care to qualified patients who cannot afford medical expense. To qualify for Medicaid he or she must be a United States or resident citizen which, includes low income adults and their children, people with certain disabilities and senior citizens. “Medicaid and Medicare is overlooked by the Center for Medicare and Medicaid,

Medicaid is a medical assistance program for low-income Americans. It is funded partially by the federal government and partially by the state and local governments. The federal government requires that certain services be provided and sets specific eligibility requirements. Medicaid covers the following benefits required by the federal government; early and periodic screening, diagnosis, and treatment services, rural health clinic services, family planning services, SNF and home health services for persons over 21 years old, physicians’ services, laboratory and x-ray services, outpatient hospital care, and inpatient hospital care. Because Medicaid is also partially run by the state and local government individual states sometimes cover services

Over the recent years, healthcare in the United States has drastically changed. The industry has experienced continuous growth, due to an array of events. The introduction and passing of Affordable Care Act, the increase of Baby Boomers (individuals born between 1946-1960) reaching the age of retirement, and potential passing of immigration inclusion laws has impacted and will continue to impact America’s healthcare landscape. Numerous factors associated with the political, economic, social, technological, environmental, and legal aspects are key indicators into the potential success of the industry.

The Medicaid program differs by state. There are dozens of ways to qualify for this state and federally funded health insurance program. There are Medicaid programs for the low-income, disabled, elderly, children, and long-term care. “Since its inception in 1965, the Medicaid program has evolved to become the largest single source of health coverage in the United States” (Crowley & Golden, 2014). From its beginnings the goal of single payer health care is on a slow roll for all citizens. Some

Medicaid is a government program that effects millions of people in the united states by providing health care. These individuals that receive these benefits include low-income adults, children, pregnant woman, the elderly, and people with disabilities (medicaid.gov). Because of the many different types of people that this program serves, it has the ability to effect many people across America. In the United States, each individual state administers and makes decision about their own medicaid program. There are certain services that the states are required to provide to a pateint with medicaid. A few, but not all, of these services are home health services, in and outpatient hospital services, X-ray services, family planning services,

The Medicaid program is a state and federally funded entitlement program that pays for medical services to qualified “low income adults, children, pregnant women, elderly adults and people with disabilities” (Medicaid, n.d.). Through Medicaid, health care coverage is made available to individuals and families who meet certain eligibility criteria. The purpose of Medicaid programs is to ensure that vital health care services are made available to those who otherwise do not have the financial means to obtain them. Medicaid programs are established and administered by individual states to “determine the type, amount, duration, and scope of services within broad federal guidelines” (Medicaid, n.d.). A list of mandatory and optional benefits can

One of the greatest changes in healthcare in the past ten years has been the rise of managed care, much to the displeasure of many patients and physicians alike. Managed care arose out of concern about spiraling healthcare costs and was designed to encourage physicians to give patients treatments that were cost-effective out of their own financial interests. "The consumer strategy was directed at imposing some barriers to use by levying various forms of co-insurance. The most common approaches used either deductibles (where the consumer paid the first portion of the bill a technique familiar in other types of insurance) or co-payments (where the consumer paid a portion of the bill and the insurance company the rest) or a combination of both' (Kane et al 1994). Managed care has given health insurance companies an increasingly significant voice in how treatment is administered and allocated. Managed care has proliferated in the past decade despite considerable criticism of the practice of 'nickel and diming' patients as well as the considerable bureaucratic red tape it is has generated. Also, research indicates that healthy, well-insured patients tend to over-consume care without meaningful co-pays but poorer, sicker patients can be deterred even by moderate co-payments and suffer negative health consequences (Kane et al 1994). However, managed care has not gone away and is a reality that all healthcare

Rising healthcare costs in the United States have made healthcare less affordable over time, creating a major public health issue for individuals without insurance. In a Health Affairs study about patient accessibility to care, the differences between adults with and without coverage has broadened from 2000 to 2010.1 The Obama Administration recognized this as an issue, and in 2010 signed into law the Affordable Care Act to make health insurance available and ultimately affordable to all US citizens, regardless of socioeconomic status.9 For 2016, it is projected that seven out of ten Americans who were renewing a health insurance plan received insurance for $75 or less per month, and eight out of ten received insurance for $100 or less.9 Now in an election year, universal health care in the United States is at a critical juncture for reevaluation. Should our nation continue on its noble path forward to improving its citizen’s health care accessibility, remain stagnant, or repeal and undoubtedly abandon the last six years of progress? Although there may be some limitations, the moral obligation to society, the increased health and well-being of individuals, and the overall economic benefits to our nation that will come with universal healthcare are justifications that make this healthcare model a clear option to consider.

The healthcare industry in America spend $1.878 trillion in health care, comprising 16% of the gross domestic product and amount to $6,280 per capita thereby out pricing the GDP due to the rapid development of medical technology resulting in treatment of disease, rising expectation about value of health care services, government financing, growth of elderly population and lack of competitive market (Williams & Torrens, 2008). Therefore, US workers will have to take a greater responsibility for their own health and retirement, however 30 percent had no savings and around 1/3 of the retirees will be reliant on government for health coverage (Longevity, 2011). The funding for health care compromises of 54% from private health insurance, 46% from federal, state or local and government (Williams & Torrens, 2008). Although there have been several attempts to curb the cost of health care over the years (HMO, PPO, P4P, etc) a model that dramatically reduces expenses and slows the rapid growth of health coverage cost has not be developed. In 2004, Medicare/Medicaid contributed to 56% of hospital reimbursement and 59% of Medicaid funding is contributed from by the federal general treasury with the states averaging 41% of the contribution resulting in $309 billion in Medicare health services while Medicaid spent $213.5 billion in 2002 (Williams & Torrens, 2008). The US will have to change the model of private, state and federal funding to support the growing number of individuals over 65 that require health coverage. The Patient Protection and Affordable Care Act is to help provide government funding exceeding $100 million in grants to develop 150 community health centers to meet the growing demand for health services and the system was enacted to ensure all Americans had health coverage, however the funding for long

The future and direction of health care has been the topic of discussion amongst politician and U.S citizens today. There are several challenges surrounding the future and strategic direction in which health care should be heading. Accreditation, quality of health care and organization’s compliance; access to health care, maintaining a skilled workforce, information technology and pay for performance are some of the challenges that currently presenting itself in healthcare today. If health care is not dealt with appropriately it will have a significant effect an impact on the strategic direction in the future and direction of care.

Medicaid is defined as "Federally assisted and state-administered program to pay for medical services on behalf of certain certain groups of low-income individuals." (p.210) The individuals are not covered by social security. It provides medical and long term term care coverage for people with disabilities and assistance with health and long-term care expenses for low-income seniors as well. Medicare is defined as "Nationwide health insurance program authorized under title 18 of the Social Security Act that provides benefits to people age 65 and older. (p.210) Medicare does also apple to people with chronic illnesses and catastrophic no matter their age. Both are expected to grow because of the aging population and the Affordable Care Act.