...outsourced to private businesses. Like anything performed by any business, organization or government body, there are potential improvements that could be implemented. Here, I will discuss the stakeholders involved in the federal healthcare systems of Medicare and Medicaid, and how the strategies might be improved within outsourcing practices. Multiple groups hold interest in the strategies used by Medicare and Medicaid to provide healthcare to patients. Medicare contracts with private health insurance companies to provide specific benefits to people with Medicare. People eligible for Medicare include those over 65 years old, or those who are disabled. Medicaid is operated at the state government level, and generally covers disabled, and people over 65 years old with low income and minimal assets. In addition to the people covered under these systems, additional stakeholders include doctors, hospitals, insurance brokers and agents, and public policy-makers (legislators). An easily forgotten group of stakeholders within these systems are taxpayers not currently receiving direct benefits from these systems, but who are directly contributing funds which are used to fund Medicare and Medicaid expenditures. Those who are recipients of Medicare and Medicaid benefits want to receive the best possible care, with the least amount of cost to them personally. Meanwhile doctors and hospitals want to receive the highest possible amount of reimbursement for their services, facility use and time...
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...Rolunda Baker Medicare Crisis Medicare is another project of Lyndon Baines Johnson Great Society. Spending is obviously out of control. On June 5th the government announced that the Medicare Trust Fund would go broke if something isn’t done with the spending (nationaldebt). In 1965 when LBJ started Health and Medicare, the Total Federal Spending for the year was $101 Billion. By the year 2000 we will spend over 4 times than amount on Health and Medicare alone, and Medicare will equal the annual spending for Defense (CNN). Medicare was a program that was not acceptable gracefully by the Liberal/Socialists. You might keep this in mind when we get to the point where we have to choose what we CAN do versus what we would LIKE to do. According to CMS the government predict that if healthcare keeps going the in the current direction the cost of Medicare will have exceeded defense spending, unlike other Healthcare systems the US healthcare has been a problem for the government as well for it has added to the enormous debt the country already has. Another major problem of Medicare is that the government does not regulate Medicare enough (Medicare). Medicare affects all different aspects of different programs. For instance Medicare affects Social Security (national debt). Social Security has already exceeded Defense spending by almost double. Just like Medicare, Social Security is being abused. So many people abuse the system, by that i mean people take advantage of it. It is different...
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...Policy Process: The Affordable Care Act Dinah Riveron HCS/455 May 18, 2015 John Cutspec Policy Process: The Affordable Care Act The Patient Protection and Affordable Care Act signed by President Obama on March 23, 2010 as the means to enforce Health Insurance reform. Its main object is to make Health Insurance and Preventive care accessible and affordable to the American population. The Affordable Care Act The ACA major components include: Medicaid expansion, allowing states the opportunity to expand their existing Medicaid programs to include, (OPA, 1015) “individuals under 65 years of age with incomes up to 133% of the federal poverty level… (as well as) certain low-income adults without children” (Medicaid Expansion). Health Insurance Marketplace (HIM), available for access to individuals and small businesses enabling them to compare a variety of plans on the basis of price, quality and benefits and to choose the most affordable option according to their needs. The proposed three models are State Operated, State and Government Operated, and Federal Government Operated, for States that choose not to establish a program. Under the ACA, health services provided by all Insurance companies (participating or not on the HIM) are required to offer individuals and small businesses, affordable health Insurance plans that allow access to ten services identified as Essential Health Benefits (EHB). EHB services include, Ambulatory and Emergency services, Hospitalization...
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...medicine leading to reductions in infant and maternal mortality, infectious and parasitic diseases, occupational safety measures and improvements in nutrition and education. This occurrence is creating challenges for Americans of all ages as they deal with Social Security, health care, housing, employment and other national issues that are important to an aging population. The number of Americans living over the age of 65 has dramatically increased in the past years. People are beginning to live well past retirement and later stages of their lives because they have remained healthy and productive. Given the fact that America is aging, it is important to have resources available for American’s who will soon dip into retirement funds and Medicare. A good question to ask as America becomes populated by more and more elderly is, “How can the unique needs and desires of each person be appropriately assessed and addressed in a rapidly changing health care environment?” In 2011 “baby boomers” began to turn 65 which accounted for 14 percent of the U.S. population, that percentage will increase to 20 by the year 2030 (APA). The average life expectancy for men is now 73 years and for women it is 80 years. These baby boomers will have a significant impact on American society and will challenge the health care delivery and financing systems. As the life expectancy increases, the elderly will spend more than half of their adult life in retirement (Helsler, 2000), many will re-enter the workforce...
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...DeVry University Managed Care & Health Insur Professor: Keri Bahar Week 7 – Webliography Contribution Reforming Medicare in the age of Deficit Reduction Date: 04/16/2014 Webliography Contribution Entry / Reference 1: Urban Institute (2013). Can Medicare Be Preserved While Reducing the Deficit? Timely Analysis of Immediate Health Policy Issues. Retrieved from: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf404766/subassets/rwjf404766_1 This reference help the current healthcare insurance and managed healthcare issues to reach the right set of policy to make changes that could correct long-standing gaps in financial protections that Medicare beneficiaries face, promote greater efficiency within payment systems, and generate the additional revenues necessary to pay for the impending surge in the number of beneficiaries. Entry / Reference 2: Steckenride, Janie, Parrott, Tonya (1998). New Directions in Old-Age Policies. The Health Care Policies and Older Americans. Retrieved from: http://books.google.ae/books?id=rwR4rpIrvW0C&pg=PA19&lpg=PA19&dq=Reforming+Medicare+in+the+age+of+Deficit+Reduction&source=bl&ots=ZtGKc36-o3&sig=00b8wDb48nxaR4uqWAHTms1slBU&hl=en&sa=X&ei=SKgJU77mK8eb0QW-44C4AQ&ved=0CDUQ6AEwAjgU#v=onepage&q=Reforming%20Med&f=false This reference help the current healthcare insurance and managed healthcare issues to explores the changed political environment in the United States and what...
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...Centers for Medicare and Medicaid Services Centers for Medicare and Medicaid Services Centers for Medicare and Medicaid, once called the Healthcare Financing Administration was signed into law on July 30, 1965 by President Johnson. The Medicare and Medicaid programs were created under the social security act to provide health insurance to people with disabilities, low income families, people 65 or older, or people with terminally ill disease. Medicare was once the responsibility of Social security administration, and Medicaid was once the responsibility of the Social and Rehabilitative Service Administration until in 1977 the Healthcare financing Administration was created administer both services. What led the production of these two health insurances was the belief in the 1940s that everyone is entitled to health insurance no matter what, but since then health care cost has risen drastically. Many health care providers are reluctant to offer services or the appropriate services to people with this type of insurance because only a set amount is covered and not all expenses are paid for. In America Medicaid and Medicare provide health insurance to millions of people every day, and it would be devastating if they failed and were no more, throughout this essay I will show shocking statics and facts on both of these health services and how they work. It is important for Americans to be knowledgeable on what our country’s health runs on and how financially Medicare and Medicaid...
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...Carla, a Registered Nurse, with twenty years of experience, from the Operating Room. She has seen many changes occur in healthcare during his career. This paper will discuss some of the values he finds most important for creating an equal healthcare system. In order to establish an equal healthcare system, coverage needs to be affordable, with equal opportunities for everyone, and American’s need to feel they have the freedom of choice for the type of coverage they want. Healthcare coverage first of all, needs to be affordable. Employers should pay all or most of the healthcare premiums to cover their employees. The coverage should be competitive and at the same time the employee should have the right to choose if they want to be covered or seek private insurance. Mandatory physical exams and blood work should be discussed in detail at employee forums and human resources should not just assume all employees know their coverage rights. Physician’s office staff should be well educated in insurance literacy to let their patients know what their coverage rights are. This will keep the patient from getting a surprisingly high statement in the mail. Those who are eligible for Medicare should not have deductibles. If they are on Medicare then they obviously fall below some standard and therefore do not have the money to pay for medical coverage. Carla states, “Medicare should not be eliminated unless the federal government is going to hand out free healthcare coverage...
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...the health care industry is also facing economic constraints and states, in a frenzy to save money and federal programs, have been forced to slash budgets and cut services in the Medicaid sector. Not all healthcare services will remain at the clinic, but it is important that eliminations do not affect the majority healthcare needs of the Medicaid and Medicare population. These changes are in benefit flexibility, cost sharing, enrollment expansions and caps, privatization, and program financing. Enrollment Expansion and Caps With the economic struggles faced in the banking and automotive industries, millions of Americans found themselves unemployed. With unemployment come a lack of financial resources and an inability to afford some of life’s necessities, including private sector health insurance. Medicaid With slow job growth and lack of reserve finances, many Americans applied for and began receiving Medicaid, a federally and state funded insurance geared to help pay health care expenses for people and families with low income (Dumas, Hall, & Garrett, 2008). They could receive them, due to; many of these recent changes were brought about not through legislation but through waivers of federal requirements. Medicaid waivers allow the federal government, as a long-standing statutory authority, to permit states to alter...
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...Assignment 3: World War II through the 1970s Evita McKinley Professor Hammons HIS 105 February 26, 2012 During World War II through the 1970s, there were many major historical turning points. October 24, 1945 the United Nations was established. It was the second multipurpose international organization created in the 20th century (Encyclopedia Britannica). The United States, United Kingdom and the Soviet Union took direction in designing, structure and decision making of the new organization. With a worldwide membership and scope, the purpose of the United Nations was to maintain security and peace among countries, as well as working on developing friendly relations. According to the United Nations Charter, it aims: “to save succeeding generations from the scourge of war,…to reaffirm faith in fundamental human rights,…to establish conditions under which justice and respect for the obligations arising from treaties and other sources of international law can be maintained, and to promote social progress and better standards of life in larger freedom.” The North Atlantic Treaty Organization, also known as NATO, was established by military alliance on April 4, 1949. Its quest was to develop a counterweight to Soviet armies. Original NATO members were Belgium, Canada, Denmark, France, Iceland, Italy, Luxembourg, the Netherlands, Norway, Portugal, the United Kingdom and the United States [ (The History Channel) ]. The heart of NATO is expressed in Article 5 of North...
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...Dealing with Fraud Liquid Professor Beharry Health Care Policy, Law, and Ethics March 18, 2013 Abstract This paper will evaluate how the Healthcare Qui Tam affects health care organizations while providing (4) examples of Qui Tam cases that exist in a variety of health care organizations. Other responsibilities discussed, are devising a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals; the ability to recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth. The know how to devise a plan to protect patient information that complies with all necessary laws. Evaluate how the Healthcare Qui Tam affects health care organizations. The Healthcare Qui Tam affects health care organizations in that well over more than 450 hospitals across the country were the subject of Medicare fraud investigations. Whether or not Medicare violations are found, the costs of responding to an investigation can be significant. Westchester Medical Center of New York, being investigated for possible health care fraud and violations of anti-kickback laws, received a subpoena for extensive records in some thirty-seven categories going back to 1997. Millions of dollars may be spent in legal fees and other costs associated with the investigation (e.g., hiring or reassigning staff to assist with compiling...
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...Timeline: History of Health Reform in the U.S. VIEW: Early 1900's 1930 – 1934 1935 – 1939 1940 - 1945 1945 - 1949 1950 - 1954 1955 - 1959 1960 – 1964 1965 – 1969 1970 - 1974 1975 – 1979 1980 - 1984 1985 - 1989 1990 – 1994 1995 - 1999 2000 – 2004 2005 – 2009 2010 1912 Teddy Roosevelt and his Progressive party endorse social insurance as part of their platform, including health insurance. 1912 National Convention of Insurance Commissioners develops first model of state law for regulating health insurance. 1915 The American Association for Labor Legislation 1912 Teddy Roosevelt and his Progressive party endorse social insurance as part of their platform, including health insurance. 1912 National Convention of Insurance Commissioners develops first model of state law for regulating health insurance. 1915 The American Association for Labor Legislation Early 1900's 1921 Women reformers persuade Congress to pass the Sheppard-Towner Act, which provided matching funds to states for prenatal and child health centers. Act expires in 1929 and is not reauthorized. (AALL) publishes a draft bill for compulsory health insurance and promotes campaigns in several states. A few states show interest, but fail to enact as U.S. enters into World War I. The idea draws initial support from the AMA, but by 1920 AMA reverses their position. 1927 Committee on the Costs of Medical Care forms to study the economic organization of medical care. Group is comprised of economists...
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...On March 23rd 2010, President Barack Obama signed the Patient Protection and Affordable Care Act into effect. This legislation was created to reform the American healthcare system, protect patients, and to provide insurance for more people in our country that could not previously afford or receive it. Since the Affordable Care Act has been passed, it has created uproar in our country. Many people in our Country do not want to be forced to purchase a healthcare plan created by the government, others don’t want to pay the increased taxes that have been enacted to help fund the new healthcare act. However, when it comes down to it, our healthcare system needed some change. The insurance companies had too much power; they could refuse to cover someone based on the most miniscule pre-existing condition. For the U.S. being the wealthiest country in the world, our healthcare was nowhere near the top in the world. There was a huge amount of fraud and waste going on in medical facilities across the nation, which was leading to increased unnecessary costs and overall inefficiency. The Affordable Care Act wont fix all of these problems right away or maybe even years down the road, but at least it is a step in the right direction and is putting methods into action to fix our healthcare system. The following policies are my three favorite policies of the Patient Protection and Affordable Care Act. One of my favorite policies of the Affordable Care Act is that it will prevent insurance companies...
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...Finance 4510 Exam Two Directions: Pick 10 questions and do a very good job of answering the questions. Essay Questions, not short answer. Reference each question, where you found your answers. Run a spell and grammar check. Discuss the uses of Life Insurance and explain how you would determine how much life insurance a family would need. Discuss the use of Disability Income Insurance and explain how you would determine how much disability insurance an individual would need. Name a category of individuals who might benefit from Disability Income Insurance. Explain why this category might need Disability Insurance. Discuss the use of Property and Causality Insurance and how this is used by a family or individual. Property and casualty insurance is insurance that protects against property losses to one’s business, home or car and against legal liability that may result from injury or damage to the property of others. This type of insurance can protect a person or a business with an interest in the insured physical property against losses. Auto Insurance policies typically cover you and your spouse, relatives who live in your home and other licensed drivers to whom you give permission to drive your car. The policy provides coverage for both bodily injury and property damage liability as well as physical damage to your vehicle. Auto insurance typically covers personal injury, medical payments, uninsured motorist, underinsured motorist, auto rental, emergency road assistance...
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...discussing what is Medicare, and what type of impact the Medicare Legislation will have upon it , what changes the Affordable Care Act made to the Medicare program, and last but lest what I feel need to change to the Medicare program that will extended the life program past the year of 2026. Medicare is known as the “national social insurance program, administrated by the United States Federal Government” (Medicare.gov, 2012). Medicare give health insurance to people ages sixty-five (65) years of age and older that have work and paid in to system, and younger people that have a medical and physical disabilities (Medicare.gov, 2012). Medicare when it first started only had two parts that was part A and part B (Longest, 2010). Medicare part A was the Hospital Insurance, better known as HI and it covers hospital visits, home health nurses, nursing homes, and hospice care, and part B which is known as Supplementary Medical Insurance or SMI covers doctor visit, home health services, and other medical services, And then the BBA, better known as Balance Budget Act in 1997 added on a third part which is known a Medicare part C, known as the Medicare Advantage Program pays for most prescription drugs. And there is Medicare Part D which was added by the MMA that pays for the prescription drugs that is not covered by Parts A&B. The Medicare Legislation will have a tremendously impact on the Medicare Program. The Medicare legislation I predict will change the Medicare program for the...
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...Is Medicare Sustainable? Brian Arguello Grand Canyon University: HCA 530 Introduction to Health Care Finance June 8, 2016 Is Medicare Sustainable? Medicare has been the primary health care provider for people over the age of 65 or disabled Americans for over 40 years. The program is in constant change because of new medical technology, advanced delivery systems, and rising costs. Despite the program being in continual transformation, many believe that Medicare is in need of major reform. The obvious question to be asked is, what is the future of Medicare and is the program sustainable? Assessing Medicare’s financial status is straight forward. Looking at Medicare parts A, B, and D individually, one can actuate whether the claims for each part can be paid, making the financial status an actuarial issue. Keep in mind that sustainability and financing are different. A program may be sufficiently funded but not sustainable, making the question of sustainability difficult to assess. According to Foster and Clemens (2009), “Sustainability for Medicare is a judgement about whether the program, as currently constructed, will meet the demands of all affected parties today and in the future” (p. 85). It is important to assess the program on its abilities to meet the needs of the patients and healthcare organizations but cost and future costs are the biggest concerns for all involved parties. The sustainability is of interest to both for-profit and not-for-profit healthcare...
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