Day 5: US Health Care And Medicade/Medicare Flashcards
What has US healthcare traditionally been provided by? And what issues can be from this?
Its from the private sector
*What happens for people who don’t work or are children / retired
**also what if work does provide some kind of insurance to employees
What is the case for “private (free-market) run” healthcare system?
Some people say that when health care is run by the government it will slow everything and take away competition with will lead to worse care over all
**think about the VA or the DMV and how it always seem frustrating with long waits
**VA still needs private sectors incase there is to long of wait times pts can go to private care
What is the simple “KEY” summary of Medicaid?
STATE governments help people living in poverty to have access to medical care
What is a simple “KEY” summary of Medicare?
FEDERAL government helps the elderly to have access to medical care
What is a simple “KEY” summary of Medicare Part D?
FEDERAL government helps the elderly pay for out-patient prescription dugs
What is a simple “key” summary of the ACA?
Created to help people not covered by Medicaid or Medicare to have access to medical care
What are the government responsibilities when it comes to MEDICAID?
Its a joint FEDERAL and STATE program
The federal government sets eligibility standards that define the minimum Medicaid services that must be provided by state governments
Fed also pays the majority of the expenses
State government :
Administers the program
Complies with the fed requirement
**Determines if it wants to offer more than the minimum Medicaid services required by the fed government
Who is eligible to get Medicaid and how do they determine it, it hard for people to enroll into Medicaid?
Mostly used for low income people : Most of Medicaid is children
It’s Means tested: its tied to a persons income, the FED government defines the poverty level
Can be hard to enroll due to the amt of paperwork that is required and needing to prove you are in the level needed
Does Medicaid vary with the economy?
Yes, when the economy is weak, expect more individuals to enroll in Medicaid, but if the economy is strong, expect fewer to enroll in Medicaid
How is Medicaid financed?
FEDERAL AND STATE governments finance it (tax dollars)
The fed government provides money to the states
What’s a problem with the federal funding “match” program?
It discourages states from reducing spending
**if a state government reduces spending, it will then loses the matching federal spending that they would have gotten.
What is a problem with nursing home patients and Medicaid?
In order to get funding for nursing home a patient must prove that they don’t have any money. They will typically transfer their funds to someone else and then be able to take advantage of Medicaid nursing home
**nursing home is a very large expense for Medicaid
What are examples of Required and Optional Services?
Required: Physician services In-patient and out-patient services Labs and X-ray Vaccines for children
Optional Services:
RX DRUGS! (A lot of times they will be covered by some states can put in no coverage or a copay to control costs)
Dental
Physical therapy
How is the reimbursement rates to health care providers with Medicaid?
It’s an issue because state governments control costs by reducing reimbursement
They say Drs should not expect to get rich off of these services
This is an issue because some doctors will not accept Medicaid patients because they don’t get reimbursed enough to justify helping the patient
What are the Government Responsibilities for Medicare?
FEDERAL government program
The fed government administers the program
Determines eligibility thro Social Security
Also sets the policies for the program
STATE GOVERNMENTS ARE NOT INVOLVED!
