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It is a program being implemented by the Centers for Medicare & Medicaid Services.
Medicare is divided into four parts. The first part is the Hospital insurance (Part A). This helps to pay for inpatient care in a hospital or skilled nursing facility, (after hospital stay), home health care and hospice care (Social Security Online, 2010). Medicare insurance (Part B) covers doctors’ services and other medical services and supplies which are not covered by hospital insurance (Social Security Online, 2010). Medicare Advantage (Part C) can be availed of in many areas. Those under Medicare Parts A and B can opt to receive all their health care services through the provider organizations under Part C (Social Security Online, 2010). Finally, drug coverage (Part D) assists in the payment of medications for which doctors prescribe for the treatment of their ailments (Social Security Online, 2010).
Medicare is different from Medicaid. Medicaid is a program which provides aid for those who cannot afford medical services. Different states have different rules on eligibility and coverage; and in some cases, these programs do overlap and some individuals may qualify for coverage under both programs (Social Security Online, 2010).
This Medicare program is significant for public health because it helps ensure that all people receive quality health care and are entitled to improved outcomes (DeWalt, Oberlander, Carey, and Roper, 2006). Some studies also point out that Medicare programs help control the cost of health care as it improves health outcomes of the people covered. It also helps prevent illnesses and reduce waiting times with doctors; and through the coordinated efforts of the Medicare programs, many states are able to encourage practices which “improve the timelessness of care and also…reduce the rate of no-shows to clinic appointments” (DeWalt, Oberlander, Carey, and
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The Medicare and Medicaid programs have been applied in the US in securing medical cover for patients. These programs are good and have been very influential in ensuring the health of people who cannot afford medical care. The US programs are however structured in a way that cuts on the scope of those who are considered eligible for the program.
The paper is being carried out to give the subpopulations in the Hierarchical condition category and Centers for Medicare & Medicaid Services model and their adjustments. The implementation of the Hierarchical condition category and Centers for Medicare & Medicaid Services models in the payment of the risk adjustment consented to medical costs predictions for the Medicare advantage enrollees.
The Medicare Value Based Purchasing Program or commonly known as”pay for performance” programs have been drawn up in an effort to amend flaws and attend poor performance issues in the Medicare statute. The widespread enforcement of Value Based Purchasing Programs has not yet been possible because the implementation involves drastic changes in the Medicare statue to be undertaken.
These agencies receive approval from the Centers for Medicare and Medicaid Services (CMS) to enable CMS provide support, such as funding, to healthcare companies (Curley & Vitale, 2012). Accreditation agencies ensure that the set standards for providing clinical and pharmacy services coincide with the practices in health institutions.
A number of factors were identified by various scholars as contributing to the inequalities and these include: unsupportive political environment that prevents enacting of relevant legislations; difficulty in providing cover for prescription drugs; administrative policies that favor the majority and oppress the minority and societal factors such as lack of access to education that cause providers to misinform the beneficiaries.
While the two programs differ greatly, they are run by a Department of Health and Human Services division; the Centers for Medicaid and Medicare Services. Medicaid is a program for social protection, or social safety, which serves approximately forty million people at a cost of roughly $330 million in 2012.
dministers and also the works in corporation with national governments to administer the children’s Health insurance program (Allgov.com, 2014), Medicaid as well as the standards of the health insurance portability. Apart from these programs (Allgov.com, 2014), Centers for
rrently, there are more than 48 million beneficiaries aged above 65 years and more than 8 million persons with disabilities aged below 65 years (Mason et al., 2013). Medicare is available for basic health services, subsidized drug prescription and short-term hospital care, etc.