Introduction
Medicaid and Medicare systems were first introduced in the 1960s as medical insurance plans for those who could not afford to pay the medical expenses themselves. Medicaid covers people who live in poverty and have severely limited resources. Medicare is a plan covering elderly people, younger people with disabilities, end-stage renal disease, and amyotrophic lateral sclerosis. According to research, the funding seems to be the biggest limiting factor for both managed healthcare plans (Kellermann & Weinick, 2012). The problem is aggravated by various programs limiting reimbursements. Another, less frequently mentioned barrier to entry, seems to be the lack of knowledge of the entitled person. That factor mostly affects former foster care youth (Rubin, 2016).
Medicare Description
Medicare includes two main parts. Part A covers hospitalization, skilled nursing care, and hospice stays. Part B is for the outpatient care, clinician visits, and preventive services. Part A is free for those beneficiaries who have worked for over 40 quarters and paid taxes while Part B requires a monthly payment. 93% of the Medicare participants enroll in both programs. Generally, Medicare covers about 50% of the medical expenses of the patient.
“Medicare Readmission” Article Assessment
The article “Could Medicare Readmission Policy Exacerbate Healthcare System Inequity?” presents a case of flawed policies limiting access to healthcare programs. It deals with the suggestion to limit payments for the hospitals with high patient readmission rates. However, that policy does not take into consideration several patient-level limitations. In a case of two patients with a similar diagnosis, it is important to consider their socioeconomic conditions. If one of them can afford to consistently pay the premiums for his Medicare plan, lives in a safer neighborhood and can visit his appointments more regularly, he obviously is much less likely to need readmission than his less well-off counterpart. The policy also ignores the cases in which the repeated hospitalization is not in fact readmission but is related to the completely different circumstances. Addressing preventable hospital readmissions can be a great way to decrease the expenses and promote cooperation between medical institutions (Bhalla & Kalkut, 2010). The article demonstrates how important it is to take into consideration the status of the community the hospital serves, as well as, several other factors before developing the policies regarding Medicare or Medicaid. Rash decisions can lead to vulnerable communities having even less access to the much-needed healthcare. Moreover, such policies negatively affect the quality of services rendered by the hospitals (Joynt & Jha, 2012).
Possible Solutions
The research indicates that penalizing the hospitals can have disastrous consequences for the quality and availability of the managed healthcare plans. While rewarding medical institutions for positive results seems like an obvious solution, the constant drive to cut the expenses on Medicare and Medicaid makes such a solution unrealistic. In the current situation, where the government is unwilling to spend more on such systems, the most logical advice would be to at least treat the hospital assessment more carefully. It is crucial to take into consideration what community the institution serves and the actual reasons for high readmission rates or poor performance. Without accounting for those factors, new Medicare and Medicaid regulations threaten to further limit the access to healthcare for the needy.
Conclusion
The issue of funding is the most limiting factor for the accessibility of Medicaid and Medicare. Unwillingness to spend money on these systems leads to more and more restrictive legislation. In this situation, it is important to ensure that the laws are reasonable and do not cause the healthcare plans to become defunct.
References
Bhalla, R. & Kalkut, G. (2010). Could Medicare Readmission Policy Exacerbate Healthcare System Inequity? Annals of Internal Medicine, 152, 114-117.
Joynt, K., & Jha, A. (2012). Thirty-Day Readmissions — Truth and Consequences. New England Journal Of Medicine, 366(15), 1366-1369.
Kellermann, A., & Weinick, R. (2012). Emergency Departments, Medicaid Costs, and Access to Primary Care — Understanding the Link. New England Journal Of Medicine, 366(23), 2141-2143.
Rubin, R. (2016). Improving Medicaid Access for Former Foster Youth. JAMA, 315(10), 970.