Various Medical Health Services, Case Study Example

Abstract

Many of the various medical health services provide different services to their patients. In this paper, I will have a view on Medicare as one of the health service providers. In the discussion, I will give an understanding on the services provided by Medicare Part A, Part B, and Part D. I will also give an illustration of the costs of funding each program and the financial state/health of the entire Medicare program.

Discussion

Medicare is one of the senior citizen service providers in medical insurance for individuals who are aged sixty-five and over. It provides medical services to those who have no medical coverage with their employer during the period the senior was in the work force before retirement time. Just like any other social security funds, Medicare requires some payment while the person is working. This Medicare is based on a health maintenance organization whereby the government pays some private medical practises to patients covered by Medicare.

The Medicare package is split into three categories that are part A, B, and D. This enables the patients to have options when it comes to meeting their needs. A patient can either choose to have the original Medicare or the Medicare advantage plan. The original Medicare has the Medicare providing coverage of part A and part B. The patient has a choice of doctors, hospitals and any other service providers. On this category, the patient’s supplemental coverage pays the deductibles and coinsurance and they usually pay a monthly premium for part B. In the Medicare advantage, private insurance companies approved by the Medicare provide a plan for the coverage. The doctors, hospitals are normally planned, and a payment of another monthly premium is made apart from the premium paid for part B.

The first package, part A mostly covers the hospital care only, which includes inpatient care in the hospital- critical access hospitals, long term hospital care and rehabilitation facilities (Shaw, 2010). This part also offers services in hospice, inpatient care in skilled nursing facility, and home care services. For an individual to apply for part A health care services there are conditions he or she should have, this includes. If the individual is 65 years and above he or she have to meet the citizenship or redundancy requirements but, if less than 65 years, an individual should be paying the premium fee.

The second package is part B, covering the medical health care. This service includes the services offered by the doctor, home health services, outpatient services and any other services. It also covers the medically needed services to diagnose a patient’s condition, which meets the standard of medical services. In addition, it also caters for the preventive services to prevent any illness or detect an illness at an early stage if the treatment will work best.

The third package is part D, where the coverage for the prescribed medicine is done. To get this coverage, an individual has to get insured in an insurance company either in the following two ways (Shaw, 2010). It can be through Medicare prescription drug plan or Medicare advantage plans. For a patient to get accessed to this Medicare drug plans, he or she has to have the Medicare for part A or part B.

All the three packages have their own cost per patient. For part A, most patients normally do not pay for the services offered. This is because during the period, they are working the pay Medicare taxes called the premium fee part A. but if a patient was not working he or she will not be eligible for the premium, rather he or she will be forced to buy by using their own money. For part B, an individual will be required to pay a premium each month, which includes the standard, premium amount. With part C, the payment will depend on the medical plan chosen, and the drugs covered and the income of an individual.

According to the data given, the cost of funding each person’s program and the financial state/health of the entire Medicare program can be calculated as follows. The Medicare payments are in two categories, the prospective payment, and the physician payment. The payment of the patient will depend on the physician he will attend to her or him, but the prospective payment for each patient will remain constant for any treatment services offered. Considering the three types of physicians that is the participating physician, the non-participating physician who accepts assignment on a case-by-case basis, and a non-participating physician who does not accept assignment patient will do the payment as follows using the assumption for the medicare-approved fee for a procedure to be $1,000.

Total                                                   2320                                          722.5

The cost of funding each person’s program using the Medicare Approved Rate, will be calculated by adding the expenses incurred by Medicare, and the patient himself and then multiplied the sum by the payment rate. $ (2320 +722.5) $5,847.42=$17,790,755.35. Total figure a Medicare will use to fund a program for one individual whose Medicare-approved fee for one procedure is $1,000.

According to the recent reports, the United States government through the trustees who are overseeing the program, they reported that the Medicare trust fund would get depleted by 2024, compared to the earlier projection of 2029. This is due to a downgrading of the expectation of the economic growth in the government.

References

Shaw, S. (2010). Senior citizen journal, Medicare Home Health Services for seniors-Social Security & Medicare Feb 28th, 2010.

Home Health Compare, retried on 26^th may 2011 from, http://www.medicare.gov/HomeHealthCompare/search.aspx?AspxAutoDetectCooki Support