Medicare Psychotherapy

All healthcare systems, regardless of funding mechanisms, ration the limited resources of health care to some degree (Petrou & Wolstenholme, 2000). Even setting limits on patient choice is a form of rationing that takes place in almost all countries’ health systems (Lauridsen, Norup & Rossel, 2007). In the United States, health care is rationed according to free market principles while other countries employ other means such as long wait times for non-acute conditions or delays in the

The rationing of Healthcare in the United States exist in many different forms. According to the medical dictionary (2002), “Healthcare rationing is the limitation of access to or the equitable distribution of medical services, through various gatekeeper control.” Healthcare rationing takes place when a treatment is denied by a healthcare provider or insurance company. Patients that have access to private health insurance is rationed based on the prices of the services in which they receive and also their ability to pay. Insurance companies pre-screen applicants that are applying for health insurance for pre-existing medical conditions and at this time a decision is made to either decline the applicant or apply a higher price for additional medical coverage. Individuals that receive state insurance such as Medicaid is restricted by the applicants’ income and assets limits as well as other federal and state edibility regulations. According to Shi & Singh (2015), “ Although uninsurance among adults has increased, lack of health insurance coverage among children declined from 13.2% in 2009 to 6.5% in 2011 (CDC 2011a), mainly because of the success of the CHIP program.”

The purpose of this paper is to thoroughly examine the similarities and differences of Medicare and Medicaid managed care plans by comparing and contrasting its strengths, weaknesses, incentives, commitment to access, and risks to the consumer. Medicaid and Medicare are both health insurance programs financed and administered by government entities and are both equivalent in terms of the number of beneficiaries and total expenditures (McCarthy, Schafermeyer, & Plake, 2011). These healthcare programs differ in terms of how they are funded and governed and who they cover. Medicare is an important source of coverage for 65 or older adults, for people under 65 with disabilities, and for people of all ages with End-Stage Renal Disease in the United States. It provides health insurance protection and enables access to medical care for 54 million beneficiaries.

One of this health care’s programs objective is to limit the number of uninsured (Shi & Singh, 2015). This controversial healthcare plan incorporates a privately funded insurance which is paid for through employment and solely by the patient and a publicly funded insurance by the government. Medicare is provided for senior citizens 65 and older, and Medicaid is provided for low income citizens. The federal government and state government both partake in the funding of Medicaid. Although insurance is provided to the low income through Medicaid, the United States continues to suffer from cost escalation spending 17.1 percent of GDP on healthcare in 2013, a 50 percent more than the second nation (Commonwealth, n.d.) The high cost and limited coverage continues to spark up the conversation for a

Fifty years ago, Lyndon B. Johnson signed the Medicare program into law. “It has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses.” (Hamel, Blumenthal, Davis, & Guterman, 2015, p. 479). With the encouragement of George W. Bush, congress passed the Medicare Modernization Act of 2003 (MMA). The MMA extended Medicare to include prescription-drug coverage, known as Medicare Part D. In 2013, Medicare covered the health care expenses for 52.3 million Americans, costing $583 billon. Originally, Medicare had difficulty controlling costs; physicians and hospitals were

This exercise point out some very important factors with regard to health care cost.  nursing homes and other health care delivery systems are faced with significant shortfalls in reimbursement for various reasons.  Medicare reimbursement often does not cover the full extent of treatment of individuals.  McPike (2008) notes that, “The insurance and hospital industries released a study today showing that underpayment by Medicare and Medicaid costs consumers and employers $88 billion more a year for health care as providers attempt to make up the difference.” Today with continue cutbacks in medicare reimbursement this number is significantly higher.  In an attempt to reclaim these losses, both self pay and privately insured patients are charge

The essential target of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was to furnish seniors in the United States with moderate scope for their physician endorsed solutions through the new Medicare Part D professionally prescribed medication advantage. After the MMA was implemented—however before Part D was actualized—there was a disagreement about the cost of the program. In March 2004, the Medicare Chief Actuary affirmed before the House Ways and Means Committee of United States Congress that he was requested by the (Centers for Medicare and Medicaid Services) CMS Administrator to smother his assessments of the ten-year cost of the program, which were considerably more noteworthy than unique Congressional Budget

The U.S has many payer systems which many believe it to be its downfall among other countries. This may be because many view it more as an economic business and not an overall wellness plan. The United States’ main public program of funding is Medicare, which once followed a standard form of payment. It is now envisioned as a futuristic model that encompasses the payments of providers. Medicare is a national social insurance program that is run by the government since 1966. Also unlike Great Britain system, the program provides health care to Americans over 65 years of age for those who have paid their work dues in the system. Medicare has also extended its reach to those Americans who may be veterans or disabled. Another huge form of payment to providers is through Managed care which can be beneficial to physicians in the fee for service and capitation aspect. While this form of payment is similar to Great Britain’s programs, their execution of it remains vastly different. Managed Care is a type of healthcare system with health care plans that has restrictions on its selection of facilities and health care providers at a reduced cost for the patient. Rather than come to a conclusion about better ways to negotiate with payers, U.S providers continue to rage war against

The concept is built on trade-offs meaning that one aspect cannot be affected without affecting the other two. The most common view of this problem is that each aspect is in direct competition with the others. Analyzing Medicare in relation to The Iron Triangle, consumers who participate in the healthcare system through Medicare must still pay deductibles, fees and other costs not covered by the program. Additionally, enrollees who choose non-hospital coverage or Part B will have to pay a premium. In 1993, up to 11% of Medicare participants were also enrolled in Medicaid programs which pay expenses for the poor who may qualify for the benefits. Approximately 75% of Medicare enrollees have some form of health insurance coverage (Gok & Rubin p.1520). Younger participants don’t seem to fare as well within Medicare since the program focuses predominantly on people 65 and over. Too often, the role that Medicare plays in the younger population with disabilities is overlooked. A Kaiser Family Foundation survey drawn from administrative data provided by Centers for Medicare and Medicaid Services (CMS) found that non-elderly disabled beneficiaries reported problems with healthcare access and cost. Opinions have varied on the success and failures of Medicare in relation to overall access and cost. “According to (CMM) Centers for Medicare and Medicaid Services, total healthcare expenditures exceeded $2.1 trillion or more than $7000 for every American man, woman, and child” (Kuttner p.549). Total healthcare spending in 2006 was 16% of the GDP and was projected to reach 20% by 2013. The phenomenon known as “medical inflation” is believed to have contributed to rising costs of healthcare. An aging population, technology advancement, litigation, defensive medicine and insurance coverage that favors high taxes. The most common

Medicare assists people when they could have severe health abnormalities in their life time but are deficient in meeting the treatment expenditure.

From recent studies suggests that Medicare provides health insurance to 48 million Americans. Medicare also plays a significant role in determining the price for most medical treatments and services provided in the U.S. They set what is considered a “fair price” for services renders from routine check-ups to heart transplants. If the calculations were correct, some doctors spend more than 24 hours on average performing medical procedures. With is over-calculation the U.S. healthcare costs are sky rocketing. Medicare updates

The expansion of Medicare to cover and include all individuals below 65 years of age thus allowing for a single payer form of insurance in the United States. The paper will explore the financial possibilities of Medicare expansion to all individuals, which includes the required amount of money to do so as well as the long-term financial benefits. The paper will also explore the ethical benefits of a universal single payer healthcare system as well as comparisons between countries that have current single payer healthcare

Thoughtfulness regarding the points of interest of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) has generally centered around the new medication advantage and, to a lesser degree, to new installments and principles for private arrangement investment in Medicare. Less saw is a procurement in the law that made another measure of budgetary strength of the Medicare project to be incorporated in the yearly report of the Boards of Trustees of the Medicare Trust Funds. The new monetary measure built up by the MMA evaluates how a lot of Medicare spending is financed by broad incomes (basically made up of pay duties). At the point when general incomes surpass 45 percent of aggregate Medicare spending, general incomes

This worldwide phenomenon has been brought into focus by various health care reforms and other system-level developments (Farrar, Ryan, Ross, and Ludbrook, 2000). Meaning there are more claims on resources than there are resources available, some form of priority setting must occur. This making resources are scarce and there is a need, regardless of how many resources are available in total, to make choices about what to fund and what not to fund.

One of the problems of Medicare itself is that it doesn't cover the costs of prescription drugs for its members; this has led to one of the major reasons that the program is in danger. A great deal of personal healthcare relies on the use of drugs, and since the program doesn't cover these costs, the individual must bear them. According to the AARP, in 1999 out-of-pocket costs for prescription drugs were estimated to be $450 per person each year (AARP). Obviously, members have joined the program to defray their medical costs, but these figures indicate that they still have large costs to pay. The other problem faced by the Medicare program is that it is also suffering from a lack of funds. According to Governor George W. Bush, the financial health of Medicare is in serious jeopardy and might face deficit as soon as 2010 (Bush). As a result of these major problems, one might wonder why the plan isn't scrapped for another program; well according to polls done by the Public Agenda, an Internet public policy site, American citizens are strongly in favor of Medicare, and would rather see the problems ironed out (Public Agenda). Therefore it is necessary to come up with a solution, so that the Medicare program remains intact.