Compare and contrast each of the three questions related to Managed Care Organizations, Medicare, and Medicaid with one another
Compare and contrast each of the three questions related to Managed Care Organizations, Medicare, and Medicaid with one another and explain how they were similar and different to each other.
- Managed care organizations emphasize physicians’ responsibilities to control patient access to expensive hospitalization and specialty care, a principle dubbed “gatekeeping.” Some argue that “gatekeeping” is unethical because it introduces financial factors into treatment decisions. Others say it improves quality by promoting the use of the most appropriate levels of care.
- Medicare is an area that often gets overlooked and is seen as a burden financially. Discuss alternatives to ease the drain on Medicare resources.
- Medicaid is shouldering an ever-increasing burden of cost for long-term care for the elderly, with enormous impacts on state budgets throughout the nation. Discuss alternatives to ease this drain on Medicaid resources.
Develop an APA-formatted essay discussing the three entities.
Describe what they are and how they differ. Include an introduction to let the reader know what will be found in the essay.
Create a table to provide comparison of the three entities. The table can be used as the body of the paper, or it can be added as an addendum after the Reference page. If you opt to add it as an addendum, refer to the table in the narrative in the body of the essay.
As in all essays, include a conclusion to provide a summary of the material. This assignment highlights your ability to do research and display information in a table format. Include citations, as appropriate, for information in the table. Refer to chapter 7 in the APA manual, specifically pages 223 -224 for information on tables using words for displaying information.
Required Source
- Sultz, H. A., & Young, K. A. (2017). Health care USA: Understanding its organization and delivery (9th ed.). Jones & Bartlett. Read Chapter 8.
The following specifications are required for this assignment:
- Length: 750 words
- Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment.
- References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least two (2) scholarly sources to support your claims.
- Format: Save your assignment as a Microsoft Word document (.doc or .docx).
- File Name: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.docx”)
Expert Answer and Explanation
Gate-Keeping, Medicaid, and Medicare Management
The increasing healthcare costs have always become one of the major barriers of accessing the right levels of healthcare in the US. Healthcare insurance comes in handy in reducing this burden, and ensuring that individuals receive subsidized healthcare services through the financial aid such as Medicare and Medicaid (Sohn & Timmermans, 2017).
The increased demand for healthcare services, especially among the aging populations, however, has led to a significant drain in Medicare and Medicaid resources, creating questions as to whether these insurance services would be able to serve in the coming years. Healthcare givers have also bought the idea of ‘gate-keeping,’ where they refer primary care patients to specialists who help them access better services based on their specific needs (Barnett et al., 2018).
These improvements in care, unfortunately have numerous financial implications on the patients. Whereas healthcare services in the US are said to be almost free, the idea of insurance and gatekeeping raises several cost concerns that should be addressed using relevant policies.
Gate-Keeping Effects on the Quality of Primary Care
Whenever healthcare givers perform gate-keeping activities on their patients, the immediate reactions of most patients is that they feel that these primary healthcare givers are either not willing to do their job, or are completely incapable and do not deserve it. This is because patients feel that their trust on the primary health providers is completely broken when they are referred to other specialists (Barnett et al., 2018). However, it should be understood that gate-keeping has led to improved first-contact coordination and utilization of care.
Primary health care providers can no longer take ‘too much than they can chew,’ and they leave the experts to solve the conditions of patients in the most professional way (Barnett et al., 2018). While gate-keeping results in areas with more scarcity of medical resources, it is one of the reasons why the costs of primary healthcare has increased considerably over the years.
Alternative to Medicare Resources Increased Usage
Social security and Medicare takes up to 40% of the budget, and plans to limit spending on Medicare seems almost impossible. Among one of the ways reducing the drain on resources of Medicaid is expanding bundled payments and promoting alternative models of payment. This is one of the ways in which efficiency and coordination can be improved in the entire Medicare program.
Another way to reduce this resource drain is reducing preventable admissions and the occurrence of unnecessary complications. In this program, the government could impose fines on facilities that do not give holistic care to patients, and hence contribute to patient medical errors, avoidable complications, and readmissions (Caswell & Goddeeris, 2020).
A reduction of payments to post-acute providers could also serve a long way in reducing the drain on Medicare resources. Other ways that can be utilized to improve the Medicare service provision through a control of the resource drain is reducing the prices of high-cost drugs and adding competitive bidding to the advantage of Medicare (Caswell & Goddeeris, 2020). With these techniques, Medicare would be sure to avoid most of the financial strains it encounters.
Saving the Resources of Medicaid
There are many ways in which the increasing drain on Medicaid resources can be controlled. One of these is the implementation of Medical Homes that are more patient-centered. Besides improving the ease of access of care, these homes serve as ways of boosting care giving activities, which eventually lowers the total quality of care.
Health homes, which are almost same as patient centered medical homes, target patients who have chronic conditions. At the federal level, heath home programs show significant decrease in the specific-service spending, and this relates to decrease in Medicaid spending. Another way to ease Medicaid spending is the application of accountable care organizations in healthcare, which informs different expectations for Medicaid and hence assists in planning (Perez, Benitez, & Seiber, 2018).
Medicaid should also tighten the financial eligibility rules for patients who are receiving long-term care. These rules could include limiting asset transfers, including retirement accounts as part of the patients’ countable assets, and increasing the efforts of state recovery (Perez, Benitez, & Seiber, 2018; Sohn & Timmermans, 2017). The government bodies associated with health insurance should also promote private long-term health insurance as this directly easens the burden on Medicaid.
Conclusion
Among the ways of improving health insurance include building on private insurance, which distributes the increased demand of healthcare insurance among government insurance services. For Medicaid to reduce the financial drain on its resources, it should implement policies such as tightening financial eligibility rules using things such as including in the countable assets of patients, the retirement accounts.
A strain on Medicare resources, on the other hand, can be reduced through things such as imposing fines on some of the healthcare facilities that do not give holistic care to patients. There is need for regulation of gate-keeping activities among primary care providers as too much of referrals to specialists outside the scope of primary care increases care costs, despite the increased outcomes.
References
Barnett, M. L., Song, Z., Bitton, A., Rose, S., & Landon, B. E. (2018). Gatekeeping and patterns of outpatient care post healthcare reform. Am J Manag Care, 24(10), e312-e8.
Caswell, K. J., & Goddeeris, J. H. (2020). Does Medicare Reduce Medical Debt? American Journal of Health Economics, 6(1), 72-103.
Perez, V., Benitez, J., & Seiber, E. (2018, May). Elasticity of Medicaid Access with Respect to State Financial Distress. In AEA Papers and Proceedings (Vol. 108, pp. 384-87).
Sohn, H., & Timmermans, S. (2017). Social Effects of Health Care Reform: Medicaid Expansion under the Affordable Care Act and Changes in Volunteering. Socius, 3, 2378023117700903.
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