What are the basic programs offered through Medicare?
September 16, 2022
What are the basic programs offered through Medicare?After reading Chapter 14 and reviewing information at https://www.cms.gov, respond to the following questions:How does Medicare work?What are the basic programs offered through Medicare?How does Medicaid work?What are the basic services offered through Medicaid?Make sure you spell check, proofread, and include in-text citations and a reference listing if you use words that are not your own.Chapter 14: The Health Care System of the United StatesChapter SummaryThe focus of this chapter is to trace the health care system in United States. The health care system in the United States has been less than effective. Americaspends more than other countries, yet has more than 47 million people without health insurance.The cost of health care has been provided by a variety of sources such as employers, individuals and families, and the government. The greatest brunt of payments hascome from third-party payers over time. Medicaid and Medicare have made the federal government the largest payer of health care services.Health care costs are escalating. There are several factors that have created this rise, such as new medical technologies, people living longer and needing more carefor chronic and acute illnesses, medical wastes, and medical entrepreneurialism. Because of concern over rising costs, and in an effort to contain said costs, thecountry shifted to managed care.Managed care programs attempt to cut costs while providing cost-effective care by securing lower provider reimbursements, regulating patient care, and rewardingphysicians for keeping their patients healthy. There are several types of managed care organizations such as HMOs, PPOs, and a combination of health insurance andhealth care delivery in a single package.The United States passed significant health care legislation in 2010. This legislation should bring health insurance to an additional 32 million people over the nextseveral years.Chapter OutlineI. IntroductionII. Rating the U.S. Health Care SystemA. Based on Systematic AnalysisB. Based on Consumer AttitudesIII. The U.S. Health Care SystemA. The Foundation of the Health Care SystemB. The Development of Private Health InsuranceC. The Development of a Nonprofit Health Insurance AlternativeD. The Entry of Public (Government-Sponsored) Health Insurance1. Medicare2. Medicaid3. ChildrenÂ’s Health Insurance Program (CHIP)E. Incentives to Overuse Services1. Provision of Unnecessary ServicesF. Cost ContainmentG. The Development of Managed Care1. Managed Care2. Types of Managed Care Organizationsa) Health maintenance organizations (HMOs)b) Preferred provider organizations (PPOs)c) Point-of-service (POS)IV. The Financing of Health Care in the United StatesA. How Much Money Does the United States Spend on Health Care?a) National health expenditures (NHE)b) Personal health expenditures (PHE)B. Who Receives the Dollars Spent on Personal Health?1. Hospital care2. Physician services3. Drugs and other medical nondurables4. Nursing home care and home health care5. Dental careC. Who Spends the Dollars for Personal Health Care?D. Private Sources1. Employers2. Individuals and FamiliesE. Public Sources (Government)V. Explanations for the High Cost of American MedicineA. The Aging of the PopulationB. The High Cost of New Medical Technologies1. Defensive Medicine2. Physician Self-ReferralC. Medical Entrepreneurialism1. The Medical-Industrial Complex2. Corporate Profit3. High Administrative Costs4. Exorbitant CEO Salaries and Compensation Packages5. Medical FraudVI. AmericaÂ’s Uninsured PopulationA. Who are the Uninsured?B. The Role of the Employment-Based Health Insurance System1. Individuals who are unemployed2. Individuals after retirement but before Medicare3. Individuals during any transition period from one job to another4. Individuals working part-time5. Individuals who work for small businesses6. Individuals who cannot afford the employee share of employer-provided health insurance7. Individuals who are in this country illegallyC. The Consequences of Being Uninsured
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