Medicare and Medicaid insurances were created in 1965 by the Social Security Amendments, which defines their purpose (Rajaram & Bilimoria, 2015, p. 420). Medicare is geared towards making healthcare more accessible to elders (over 65 years old) and the disabled. Medicaid works with the low-income population (Rocco, Gellad, & Donohue, 2015). Both, therefore, share the purpose of making healthcare more accessible for the disadvantaged population and eventually improving the health of the nation.
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However, there are certain limitations and barriers that limit access to the plans. In particular, McDoom, Koppelman, and Drainoni (2012) mention low reimbursement rates, limited understanding and knowledge of the patients’ needs exhibited by the provider, communication issues (in particular, linguistic ones and those related to mutual understanding), and the insurance barriers (its limitations). As stated by Bhalla (2010), the developers of the relevant plans and models tend to ignore different socioeconomic conditions of the population, and there may be discriminatory differences between regions. All of these aspects limit the availability of healthcare despite the initial purpose of Medicare and Medicaid.
Traditional Medicare consists of two parts neither of which has the limit on the out-of-pocket expenses. Medicare part A covers “inpatient hospitalizations, short-term stays in skilled nursing facilities, some home health care, and hospice care,” and part B is concerned with “outpatient services, including doctor’s appointments, medical equipment, laboratory tests, and preventive care such as vaccinations and cancer screenings” (Rajaram & Bilimoria, 2015, p. 420). It is noteworthy that Medicare is only concerned with the necessary home care, and daily activities (eating, for example), are not included. Since the population is aging, it is expected that the number of beneficiaries of Medicare will increase dramatically in the near future (AARP Public Policy Institute, 2009). At the same time, the program has its limitations, and its solution is of supreme importance.
Bhalla (2010) describes two hypothetical patients with the same diagnosis but different socioeconomic circumstances. The more affluent of them (who has proper drug coverage, lives with his wife, and speaks English fluently) is less likely to be readmitted, which means that the socioeconomic circumstances predict the outcomes and the needs of the patients. This aspect, however, is overlooked by the readmission measurement model described by the author, which means that the use of readmission rates for healthcare models need to be used more carefully. In other words, the model described by Bhalla (2010) has at least two limitations: it does not take into account the socioeconomic and regional variables, which makes it unfit for its purpose (measuring the effectiveness of hospitals). Such is an example of the issues that need to be resolved to improve our healthcare policies.
The specific strategies for the solutions can be outlined as follows. The issues of the reimbursement rates, insurance limits, and socioeconomically-friendly models are very complex and need to be addressed at the governmental level. Davis, Schoen, and Guterman (2013) insist that the improvement of these aspects is a possibility, and they require research and the creation of new opportunities. Some of the barriers, however, can be addressed at a less general level. For example, according to McDoom et al. (2012), the issue of communication is an ongoing one, and it appears that the staff of every particular facility can contribute to its solution. For example, additional courses for the staff could help them improve their relevant skills. Similarly, the problem of provider education could be attended if their actions were monitored by professionals.
Like any other complex, comprehensive measure, the improvement of the accessibility of Medicare and Medicaid requires multiple solutions. In general, they need the development of enhanced policies (for instance, those related to the providers monitoring) and new models (a socioeconomically-friendly one), but each individual member of the healthcare community can contribute as well (for example, nurses can improve their communication skills). The common effort is bound to advance Medicare and Medicaid.
AARP Public Policy Institute. (2009). The Medicare beneficiary population. Web.
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Bhalla, R. (2010). Could Medicare readmission policy exacerbate health care system inequity? Annals of Internal Medicine, 152(2), 114. Web.
Davis, K., Schoen, C., & Guterman, S. (2013). Medicare essential: An option to promote better care and curb spending growth. Health Affairs, 32(5), 900-9. Web.
McDoom, M., Koppelman, E., & Drainoni, M. (2012). Barriers to accessible health care for medicaid eligible people with disabilities: A Comparative Analysis. Journal Of Disability Policy Studies, 25(3), 154-163. Web.
Rajaram, R., & Bilimoria, K. Y. (2015). Medicare. Journal of the American Medical Association, 314(4), 420. Web.
Rocco, P., Gellad, W. F., & Donohue, J. M. (2015). Modernizing Medicaid Managed Care: Can States Meet the Data Challenges? Journal of the American Medical Association, 314(15), 1559-1560. Web.