Abstract This paper discusses how Oregon's original Medicaid reform law provided for the centralized allocation of a broader array of health care services. It looks at how the policies applicable to the functioning of the Medicaidprogram in Oregon required a federal waiver for the state to deviate from federal laws governing the Medicaidprogram. It describes the Medicaid policy in Oregon and assesses Oregon's approach to the administration of the Medicaidprogram within the context of the overall effects of the approach on the state.
Outline
Introduction
Description of the Policy
Justification for Government Intervention
Assessing Efficiency and Equity
Evidence of the Benefits and Costs of the Policy to Oregon and Oregonians
Conclusion
From the Paper "The state's controversial plan to prioritize Medicaid-funded services initially was rejected by the United States Department of Health and Human Services (HHS) on the grounds the plan would violate the Americans with Disabilities Act (ADA). The federal government contended that the original law tended to value of the life of a person with a disability less than the value of the life of a person without a disability. Oregon changed the law and the reform measure was approved by HHS through a waiver process for the state, and the new law was implemented in Oregon (Sage, Hastings, and Berenson, 1994)."
Abstract In this article, the writer notes that Franklin D. Roosevelt's financially recuperative "New Deal" and the Sheppard-Towner Act of 1921 during the Great Depression helped the American public back on the road to health. The writer points out that the Social Security Act of 1935 was sadly Roosevelt's last efforts to establish universal financial and health security. The writer discusses that another try at providing universal health came in 1965 with Medicare/Medicaid, but by this time until the present, however, history, economics and politics would be complicit in impeding a utopian vision of "affordable health care for all." This paper describes each program in terms of eligibility criteria, funding approval process, appeal procedures and scope of devices and services funded.
Outline:
Medicaid Medicare Medicare vs. Medicaid
From the Paper "Franklin D. Roosevelt's financially recuperative "New Deal" and the Sheppard-Towner Act of 1921 during the Great Depression helped the American public back on the road to health. The Social Security Act of 1935 was sadly Roosevelt's (and all those who succeeded him) last efforts to establish universal financial and health security. Another try at providing universal health came in 1965 with Medicare/Medicaid; by this time until the present, however, history, economics and politics would be complicit in impeding a utopian vision of "affordable health care for all." This paper will describe each program in terms of eligibility criteria, funding approval process, appeal procedures and scope of devices and services funded.
"Medicaid is a federal program administered at the state level that aids individuals with low-income, insufficient or no health insurance. Health care needs are paid directly to care providers, in whole or partially subsidized."
Abstract The paper relates that the vast majority of home healthcare industry consumers consist of the sick and the elderly, with Medicare/Medicaidprograms comprising a significant percentage of the payment revenues. The paper looks at a specific competitor, the Heritage Homecare Agency located in Florida and discusses the results of a survey of home healthcare patients. The paper concludes that home healthcare is seen as one of the most promising alternative healthcare programs that might result in an overall cost reduction for healthcare services and delivery over the next several years.
Outline:
Executive Summary
Industry Analysis
Overview
Case Study
Home Healthcare Patient Survey
Conclusion
From the Paper "The home healthcare industry in the United States (U.S.) is receiving a great deal of interest recently because of the ever increasing costs of healthcare in general which is leading many healthcare constituents, both industry competitors and consumers, to seek alternatives. The home healthcare industry in the U.S. is valued at approximately $40b annually and has some 20k unique industry competitors that focus primarily on 2 target patient markets: the elderly and the sick (Buckley & Van Giezen, 2004). Furthermore, the industry itself is not dominated by a few large companies as many other segments of the healthcare industry are. In this sense, the home healthcare industry is highly fragmented in nature because the 50 largest companies hold less that 24% of the total market share (Geisler, Krabbendam & Schuring, 2003)."
Abstract The paper reveals that an increasing amount of fraudulent claims have been detected in the Medicare and Medicaidprograms, raising concerns among taxpayers, the elderly, government agencies and police authorities alike. The paper provides an overview of the fraud that occurs in the Medicare and Medicaidprograms and concludes with recommendations for the future of these programs. The paper maintains that if nothing is done, American citizens will be denied the health benefits for which they have worked all their lives.
Outline:
Introduction
Federal and State Statutes
Analysis and Recommendations
Conclusion
From the Paper "After working their entire lives, elderly people look forward to many relaxing years ahead with a little medical care and a few prescription drugs. However, the majority of this population do not have any way of paying for healthcare, and soon, neither will the government. This once unimaginable scene is very close to becoming a reality in just a few years time, an atrocity attributable to the high volume of abusers of the government-assistance programs. The national government insurance program that covers nearly 41 million seniors and disabled citizens, Medicare, has raised many substantial concerns concerning its' state of financial crisis. The National Center for policy Analysis (2001) has reported that fraud and abuse cost Medicare and Medicaid about $33 billion each year."
This paper discusses the socialization of the American healthcare system by examining the current U.S. Medicare and Medicaidprograms, the socialized systems of Japan, Russia and Canada and the American HMO systems.
Abstract This paper explains that, currently, the majority of Americans has health insurance through their employer or through government funded programs such as Medicare, Medicaid and the Veteran's Administration; however, 16% of the population being uninsured, such as the unemployed, the underemployed and workers with preexisting medical conditions, will receive medical treatment only if their life is immediately at risk. The author points out that Medicaid and Medicare, a partial federal and state paid program, similar to socialized systems in other countries, suffer from a physician payment hierarchy, which creates a longer waiting times and lesser access to care for patients under Medicaid, and abuse on the part of patients and that the paradox with HMOs is the less healthcare they provided the more money the HMO stands to gain. The paper concludes that a fully socialized healthcare system to grant healthcare access to every citizen and to reign in the rising costs is ultimately the answer to all the problems facing the U.S. medical industry.
From the Paper "Attempts to establish fully socialized healthcare within the United States have been occurring for nearly a century. From Theodore Roosevelt to Bill Clinton, every time politicians have believed they were on the brink of passing such legislation, their efforts were thwarted by either opposing partisan groups or other lobbyists. Additionally, other simultaneously occurring geopolitical issues have often acted to stymie the passing of such laws. Today, the current state of exponentially escalating U.S. medical costs, which has left over 40 million lower income citizens without affordable access to healthcare, has acted to renew fervor on this debate."
Abstract This paper explains the type of program, services of each, eligibility requirements, rules of SSI, SSDI, Medicaid and Medicare. The author discusses Federal and State administration. of these welfare programs.
From the Paper "Supplemental Security Income SSI is an income assistance program administered by the federal government. SSI provides cash payments on a bimonthly basis to low income, aged or older blind and disabled persons. Disabled or blind children can also receive SSI. Cash payments are provided to ensure recipients receive the necessities of life including food, clothing and shelter. Although the basic SSI amount is the same nationwide, states may add money to the basic benefit. To qualify for SSI, a person must meet the government's stated definition."
Abstract This report looks at some of the issues facing hospitals and healthcare professionals in terms of the future of the Medicareprogram within the hospital or healthcare setting. Specifically, the report looks at change and dynamism in this environment with regard to Medicareprograms, in regards to perceived problems in the current system that limit the delivery of quality healthcare to all and not just some clients and what obstacles exist to successful marketing and consulting relationships in the healthcare environment. The paper also looks at the role of the researcher in this environment and presents tentative solutions to the problems mentioned. The report concludes with recommendations for future research on this vital topic, which also has been impacted by the new competitive healthcare environment so that has many hospitals and other healthcare facilities, such as nursing homes and home-care providers struggle to make ends meet in terms of financial performance.
Table of Contents:
Introduction
Literature Map
Synthesis
Integration of Operative Paradigm
Conclusion
From the Paper "Managed care is a system that has drawbacks and advantages, depending on one's perspective. Because it offers a wide variety of services in a cost-effective manner, many people support managed care as a balanced solution to healthcare. But on the other hand, other individuals state that managed care does not in fact improve on variety when it constrains some clients in their choice of providers, physicians, and facilities. There are many sides to the issue, and overall, "managed care organizations have a practical incentive to reward physicians and other health-care providers for being efficient-for making sure that appropriate care is provided but avoiding necessary or duplicative
services... they offer the prospect of better integration of care for multiple chronic conditions" (Atchley, p. 378)."
Abstract The paper relates that the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 has positively expanded the Centers for Medicare & Medicaid Services (CMS)' focus to preventing disease and assisting beneficiaries with managing their health. The paper further relates that smoking, obesity and the prevalence of sedentary lifestyles in the country are the leading causes of death. The paper then discusses how the Medicare Act improved the Medicareprogram to cover a number of services to prevent many such health problems, but points out that patients' actual utilization of what is offered is relatively low.
From the Paper "Over the next few years, the United States will be experiencing the first wave of the demographic shift as the oldest segment of the baby boomers, born between 1946 and 1964, begin to turn sixty-five. Population reports estimate the number of people the age of sixty-five will double from 36 million in 2003 to more than 72 million in 2030. In spite of the negative trends in lifestyle management, people seem to be living longer lives due to positive changes and advancements in medicine, public health, and nutrition throughout the latter part of the twentieth century (Lapin, 2006)."
Abstract The paper discusses the increasing costs of healthcare and healthcare insurance to the consumer in the current market. The paper looks at the various methods that patients are using to finance medical care. This includes Medicare and Medicaid, self-paying patients, patients relying on philanthropic sources and insurance that is integrated with managed care systems.
From the Paper "Healthcare costs and payment are increasingly problematic across the U.S. market because of increasing costs and increasing rates of uninsured patients. Within the healthcare apparatus there are some aspects which affect the cost of healthcare greatly such as staffing requirements, workload activities, as well as a host of variables, all of which affect affordability which have led to costs increasing as much as 12% by recent estimates (Medical, 2007). These variables consist of shift percentages, skill mix percentages, education and training costs, and a host of other miscellaneous expenses related to healthcare delivery (Geisler, Krabbendam & Schuring, 2003)."
Abstract Many social welfare programs incorrectly assume that all families share their incomes fairly. The need for a welfare state was absolute. The federal government pays the food stamps. Job Opportunities and Basic Skills. The JOBS program is funded through a cost sharing arrangement between Federal and state funds that varies by state. The Medicaidprogram is used by states to provide health care to low-income families with children, the elderly poor and disabled. The federal government pays the full cost of the minimum income level.
Abstract This research paper discusses what has been done in recent years and what can be done in the future to make long term care better for the elderly who are no longer able to care for themselves. It looks at the impact of cost, quality and access of Medicare, Medicaid and new technology in nursing homes. The paper defines what nursing homes are, and how they operate.
From the Paper "The number of elderly who are living longer is on the rise because of new methods of treatments, new medications and use of medical technology to improve their life span. On any given day, nursing homes, or as many are now called, "long-term care facilities", are caring for about one in twenty Americans over the age of 65. Almost half of all Americans turning 65 this year will be admitted into a nursing home at least once. It is projected that in 2020, 40 percent of Americans will die in nursing homes. As the numbers increase in utilization of nursing homes, there is increasing concern about cost, quality and access- concerns that need to get attention."
Abstract This paper takes a look at the Vanderbilt Medical Center, one of the State of Tennessee's largest employers, in tandem with its parent organization, Vanderbilt University. Two directors within the Vanderbilt Medical Center were interviewed in relation to their responsibilities, the level of their influence and input into the organization, as well as their general purview of the organization's operations. Comparing the two interviews, the paper concludes that there seems to be a wide disparity in the degree of organizational involvement between these two departmental managers.
Outline:
Organization Overview
Director of Record Services
Director of Medicare/Medicaid Billing
Conclusions
From the Paper "Vanderbilt Medical Center is budgeting for capital expenses across the spectrum of its operations. In that light, my sense was that not only was Mr. Alvarez apparently given access to the center's top management but he was also a trusted member of its informal advisory committee regarding fiscal policy and management. While his direct departmental responsibilities and tasks were not related to overall center budgeting processes, his input regarding the Medicare/Medicaid payments and services was considered critical to the Vanderbilt Medical Center's ongoing financial viability."
Abstract The paper focuses on the Sidonia Psychiatric Care Center, an acute inpatient care facility for adults, adolescents and children. The paper discusses how the facility had to adjust from a largely insured patient population, to a largely Medicare, Medicaid and uninsured population. The paper describes the difficulty in running Sidonia with such high running costs. The paper warns that while the debate continues daily about what to do about the uninsured in America, hospitals, especially specialty care like Sidonia, are getting closer to closing their doors to inpatient care altogether.
Outline:
Ten Years Ago
Today
Staffing
The Future
From the Paper "Sidonia Psychiatric Care Center is licensed for 110 beds, but utilize only 100 of those beds. They are an acute inpatient care facility for adults, adolescents, and children. This includes a dual diagnosis ward for adult drug and alcohol patients whose primary diagnosis is a psychiatric diagnosis, but whose secondary diagnosis is one of drug and alcohol abuse and addiction. Sidonia has been in operation for more than 20 years, since the middle 1980s, which is the halfway point between the emergence of managed care and overhaul of existing group plans, which evolved into today's managed care programs and the representative group benefit plans, which are vastly different than those of the 1980s."
Abstract The paper provides statistics on the United States' growing healthcare expenditures including those of Medicare, Medicaid, prescription drug spending, nursing home spending and home health spending. The paper reveals that since these expenditures increase year by year, it is obvious that population's state of health is only getting worse. The paper asserts that increasing health care expenditures and funding will not solve the problem, rather the government and population should increase their investment in prevention.
From the Paper "United States' healthcare expenditures in 2005 reached $2 trillion total, and $6,697 per person. Healthcare expenditures increased 6.9% from 2004, accounting for the third consecutive year of deceleration. In the previous years, percentage increase values were the following: 7.2% in 2004, 8.1% in 2003, and 9.1% in 2002. These total healthcare expenditures growth that seems to be following a descending direction are due to lower growth in prescription drugs expenditures (CMS, 2007).
"Also, healthcare expenditures account for 16% of GDP, after a 0.1% increase. This increase is due to the 6.3 economic growth rate. This is a significant value for the country's economic development."
Tags:Medicare, Medicaid, prescription, drugs, nursing, home
