Inequalities in Medicare and Medicaid for the Elderly - Research Paper Example

?Inequalities in Medicare and Medicaid for the Elderly Executive summary The Medicare and the Medicaid programs drew a number of criticisms from scholars with many of them seeing the two programs as fostering inequity in the access to medical services for the elderly. 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. All these make the two projects unable to meet their objectives as they engage in promoting health in the majority population. The scholars argued that statewide reforms are necessary that begin with the identification of the problem areas in the programs and the enacting of legislations that will lead to health care parity among the population despite their diversity. Introduction The Medicare program is a type social insurance program initiated and administered by the United States federal government to provide health insurance to citizens aged above the age of 65 and other young people with disabilities and others with end stage renal disease. Medicaid on the other hand is also a federal program that guarantees access to health services to people of low incomes and resources. The two programs serve as a backbone to the health and wellbeing of Americans by ensuring that people have access to medical services round the clock. However, continued speculations exist with many people questioning the operations of the two programs and whether they are achieving their intended objectives. A number of inequalities continue to exist brought about by the inefficiency of these programs; it is only through critical identification of the shortcomings of these two programs that health reforms can be achieved. Inequalities in Medicare and Medicaid programs Fuchs (2000) argues that the attempt to reform the Medicare program reflects the pressure from a number of groups. The elderly are on the forefront complaining of the failures of the program in covering drugs, the budget balancers on the other hand fear escalating expenditures; the health care providers such as hospitals complain of inadequate reimbursement that forces them to skimp on services while the public on the other hand views the program as a barrier that prevents them from accessing essential health services. He thus identifies two problems with the program that he views them as standing in the way of reforms that lead to inequalities in healthcare. These include: providing for the overall financial needs of the elderly and developing a more equitable, efficient medical care system for Americans of all ages. He continues to argue that the political climate in the nation is unsupportive of this program and thus blocks progress in health care reforms both in the short run and in the long run. In doing this, they cause inequalities in the access to medical services as not all people get access to these services and most of the affected are the elderly and those in the low income bracket causing more harm than good to the community. He proposes a policy approach or framework that he sees as essential in getting reforms in progress to help reduce the inequality. Gorin (2001) identifies the issue of adding coverage for outpatient prescription drugs to Medicare and Medicaid as of great importance and one that having not been implemented is contributing to the inequity in the programs. At the initiation of the Medicare program prescription drugs were not considered as significant in the care of older patients. At this time also Medicare had the coverage that included these prescription drugs for outpatients. However, it recorded a significant decrease in the number of people who wanted prescription drugs leading to its scrapping. In recent years, the elderly people expenditure on prescription drugs has drastically increased necessitating intervention from the program. The drastic increase in expenditure is attributed to price increases, increased use, replacement of less expensive drugs with more expensive ones and advertising. Older patients pay for these drugs through employers, HMOs or Medigap policies. Others due to financial constraints are not able to pay for them and this accounts for the greatest population. Individuals who are covered by any of the above mentioned ways are better placed as out of pocket expenses are reduced. Gorin argues that Bush’s legislation on prescription drugs only excluded millions of beneficiaries ad caused skewed and uneven coverage. He thus concludes by saying that Medicare needs to add the prescription drugs and to enact broader policy initiatives which should address the increase in health care spending to help the elderly deal with health problems. Eichner & Vladeck (2005) also add their voices on this debate by saying that the Medicaid program has contributed to health care disparities in a number of ways but it has also been on the fore front in advocating for healthcare parity. Medicare and Medicaid contribute to health care inequality because most of the minorities face many out of pocket expenses which they are not able to afford as compared to their fellow whites. Secondly most of the whites or the majority population has supplemental insurance cover of which most of the minority populations are not beneficiaries. Most of the minority populations are not covered by their employers in form of employee retiree insurance and at the same time they cannot afford Medigap. Third there are a number of issues in the administration of the two programs that promote inequity and such include tacitly countenancing access, treatment and quality differentials or by not countering the possibilities of differentials. There are also a number of policies that continue to promote inequity and these include (1) regulations that allow participating physicians to select patients at will; (2) the local medical evaluation process under fee for service Medicare; and (3) the rules of eligibility in the Medicare savings program and Medicaid. The scholars conclude the research by asserting that Medicare and Medicaid need a comprehensive plan that considers data from the field in order to provide coverage to all and reduce disparities in health care. McClellan & Skinner (2000) argue that Medicare and Medicaid are programs that foster inequity in health because the people who actually pay for the service do not benefit from it. The wealthier people are seen to benefit from the program more than the people from low incomes. Medicare part A is paid by payroll taxes which has been increased several times to accommodate the ever increasing budget. Medicare part B is financed by federal revenues. The people who pay for Medicare actually do not begin to use that money until they are over the age of 65. This means that the payment is for generations that were born earlier than the tax payer. As expected, the people in the lower income categories often tend to be in worse health and thus Medicaid should be seen to come to their aid. The scholars argue that previous researches have shown that lifetime benefits have been shown to increase with income. The researchers conclude that the lower income earners struggle to pay for the Medicare and the Medicaid program and most of them do not benefit from it. The high income earners benefit more because they pay for premiums in the part B plan and are thus entitled to quality care as opposed to the low income earners. This causes disparity in health care. They propose a single plan that should be adopted to take care of the upper and the lower income earners to reduce the inequity arising from the benefits different groups get from the two programs. Stuber & Bradley (2005) conducted a study that was aimed at looking at the factors associated with knowledge about Medicaid eligibility rules and the perceived Medicaid enrollment barriers. They found out that those individuals that reported physical health problems were more likely to be misinformed. These groups of people who were likely to be misinformed about their right to the Medicaid program were mostly the minority groups that included the Hispanics. The other groups had very high chances of being informed about the Medicaid program and thus their out of pocket expenses were largely reduced. States with better policies ensured that people were informed about the program, however, not all knew about it. A number of barriers also existed that were perceived to increase the chances of illegibility and these include: mental health problems; people with less education and women. Thus only the people with education and of the majority population were more likely to know about the Medicaid program. The scholars view this as perpetuating inequality in the program and argue for statewide education as well as communication on the availability of the program (Stuber & Bradley, 2005). In conclusion, scholars have presented various views on why Medicare and Medicaid programs continue to foster inequity in the health sector. A number of reasons are provided for this and most argue that the inequalities are built around racial discrimination and rules that do not support access to the services. They agree to statewide reforms by looking at the problems with the programs and enacting policies that will ensure that people get equal access to the programs and the services they offer. References Eichner, J., & Vladeck, B. C. (2005). Medicare as a catalyst for reducing Health Disparities. Health Affairs, 24(2), 365-375. Fuchs, V. R. (2000). Medicare reform: The Larger Picture. Journal of Economic Perspectives, 14(2), 57-70. Gorin, S. H. (2001). Medicare and prescription drugs: prospects for reform. Health and Social Work, 26(2), 115-118. McClellan, M., & Skinner, J. (2000). Medicare reform: who pays and Who Benefits. Health Affairs, 48-62. Stuber, J., & Bradley, E. (2005). Barriers to Medicaid Enrollment: Who is at Risk? American Journal of Public Health, 95(2), 292-298. Read More