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End stage renal disease case study
End stage renal disease case study
End stage renal disease case study
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Medicare and Medicaid are for those who are unable to pay for private health insurance. They were created in 1965 by Lyndon Johnson to meet individual health care needs. Medicare covers those who are 65 or older or who have certain disabilities. It also covers individuals with End-Stage Renal Disease (ESRD) who need dialysis or a kidney transplant. There are four parts of Medicare. They are Part A which covers hospital stays, hospice care, skilled nursing facility care, and home health care. Part B covers doctor services, outpatient care, durable medical equipment, and some preventative services. Part C includes all benefits and services covered under Parts A and B and usually includes Medicare prescription drug coverage (Part D) as part of
According to Medicare’s WebPage Medicare is a Health Insurance Program for people 65 years of age and older, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant). Medicare has two parts, Part A which is for basically hospital insurance. Most people do not have to pay for Part A. In addition it has a Part B, which is basically medical insurance. Most people pay a small monthly fee for Part B. Medicare first went into effect in 1966 and was originally administered by the Social Security Administration. In 1977 the control of it was switched over to the newly formed Health Care Financing Administration. Beginning in July 1973 Medicare was extended to persons under the age of 65 with certain disabling conditions. In 1988 Congress passed legislation to expand the program to cover health care costs of catastrophic illnesses.
Ranked third by U.S. News and World Report on the list of “Best Health Care Jobs of 2017”, the Physician Assistant career has a 96 percent job-satisfaction rate, and represents one of the fastest growing jobs in the nation. Created as a position to relieve the job shortage of primary care physicians, Physician Assistants first came to be in the mid-1960s. Since then, the number of PAs in practice has just about doubled with every decade helping to improve health care not just nationally, but on a global level as well. Physician Assistants are licensed to practice medicine, prescribe medication, treat chronic illnesses, and assist in surgery in all 50 states under supervision of a physician. Although some medical practitioners perceive the role
The bill created a Job Corps similar to the New Deal Civilian Conservation Corps; a domestic peace corps; a system for vocational training. The bill also funded community action programs and extended loans to small businessmen and farmers. This helped people to get jobs with good wages.Then came the Medicare Act of 1965 which help people to get better health coverage. “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years” (1) In 1964 more than 44 percent senior had no health coverage or insurance. Senior citizens were dragged down to poverty as they were not able to pay the medical bills. But after the Medicare Act of 1965 which provide everyone with the medical coverage of all people age 65 and above this issue was almost solved. Along with the Medicare, the Johnson Administration established the Medicaid program to provide healthcare to the poor. Different from Medicare, this Federal-state partnership is largely determined in form and construct by each individual state. In the first three years of the program, nearly 20 million beneficiaries were enrolled
Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities and people of any age with End-Stage Renal Disease. There are four subcategories of Medicare. Part A is for hospital stays or, with certain restrictions, at-home care for a limited number of days. Part B is more like regular medical insurance. It covers ambulatory care and physician fees. There is a deductible and are sometimes co-pays as well. Part C is presented as an alternative to parts A and B. It is where private insurance companies can contract with the federal government to offer Medicare benefits through their own policies. It can offer benefits not covered under original Medicare, although there might be a premium charged. Part D is the prescription plan for enrollees. (Centers for Medicare and Medicaid Services, 2010)
There are four components to the Medicare program, part A, B, C and D. Part A of Medicare covers in patient hospital services; patients have a financial responsibility to cover a deductible that is equivalent to 1 day of hospitalization, thereafter cost is covered at 100 percent for a maximum of 60 days. This also includes nursing facilities, home and hospice care. Part B covers outpatient surgery and physician office visits. This is an elective component of Medicare in that there is a premium associated with this plan that is paid for directly through social security payments. Part C is know as Medicare Advantage and is a supplemental policy that is purchased directly from employers; one may be denied for health reasons depending one when the plan is acquired. Part D is prescription drug coverage that is eligible to all individuals that qualify for Medicare. Beneficiaries of the Medicare choose which prescription plan they want and pay a corresponding monthly premium.
In 1965 President Johnson signed both Medicare and Medicaid programs into law (Nile, 2011). According to Medical news today, “Medicare is a social insurance program that serves more than 44 million enrollees as of 2008” (MediLexicon International Ltd, 2011, para2). It cost about $432 billion or 3.2% of GDP, as of 2007(par2).Medicare is broken down into parts, Part A is hospital Insurance Part B is medical Insurance, and Part D is Medicare prescription drug coverage (medicare.gov). Like we previously stated Medicare is a health insurance for people who are 65 and older, people under 65 with certain disabilities, and people of any age with End- Stage Renal Disease. Medicaid is a joint federal-state program of medical assistance for low income persons (Benefit.gov). It is administered by the Illinois Department of Human Services (DHS) and Illinois Department of Public Aid (IDPA). Medicaid serves about 40 million people as of 2007; it cost $330 billion, or 2.4% of GDP, in 2007.(par.2) “In Illinois you may be eligible for Medicaid if you are a child, pre...
On December 8, 2003, President Bush signed into law the Medicare Prescription Drug Improvement and Modernization Act of 2003 (Pub. L. 108-173). This landmark legislation provides seniors and individuals with disabilities with a prescription drug benefit, more choices, and better benefits under Medicare. It produced the largest overhaul of Medicare in the public health program's 38-year history. The MMA was signed by President George W. Bush on December 8, 2003, after passing in Congress by a close margin. One month later, the ten-year cost estimate was boosted to $534 billion, up more than $100 billion over the figure presented by the Bush administration during Congressional debate. The inaccurate figure helped secure support from fiscally conservative Republicans. It was reported that an administration official, Thomas A. Scully, had concealed the higher estimate and threatened to fire Medicare Chief Actuary Richard Foster if he revealed it. By early 2005, the White House Budget had increased the 10-year estimate to $1.2 trillion.
Tricare previously known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) is a health care program of the United States Department of Defense Military Health System (tricare.mil). Tricare gives non-military personnel medical advantages to military work force, military retirees, and their wards, including a few individuals from the Reserve Component. Tricare is the regular citizen care segment of the Military Health System, although verifiably it additionally included medicinal services conveyed in the military therapeutic treatment offices. Tricare, the military's medical coverage plan, covers everybody; including active-duty members, retirees, and their families. Be that as it may, retirees and their dependents
Medicare is the nation’s largest health insurance program. Generally, you are eligible for Medicare if you or your spouse worked for at least ten years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. Medicare-covered services include hospital insurance, inpatient hospital care, skilled nursing facility care, home health care, hospice care, and medical insurance (Medicare U.S.) With such an encompassing effect on the health insurance field, Medicare provides a haven for older individuals, and end-stage renal disease (ESRD) patients who require the best medical care for whatever possible reason. The only problem with this scenario is that doctors are turning many older patients away because they have Medicare. Why do doctors turn away Medicare patients? Is there a reason why certain doctors turn away certain patients?
Medicare was designed for beneficiaries sixty five years and older and enrollees who are permanently disabled and are unable to work. Medicare benefits are applied for at the Social Security office, where proof of eligibility is required. Medicaid however is health care benefits for those who are low income and do not have insurance through their job (Medicare.gov, 2008).
Blue Cross and Blue Shield (BCBS) headquarters are located in chicago, illinois. It was founded in 1929. It has a federation of 36 separate united states health insurance organizations providing healthcare to more than 106 million americans.
Medicare is a federal health insurance program for people, who are age sixty five or older, or people that have End Stage Renal Disease and permanent disabilities. There are four different entities of Medicare to include; Medicare Part A which is the Hospital Benefit that covers inpatient hospital services, hospice treatment, skilled nursing facilities and other home health services. Medicare Part B that covers the Professional component of the physicians' services, preventive services and medical supplies then there is Medicare Part C which is considered a Medicare Advantage Plans that is offered by a private company that has a contract with Medicare to provide the patient with both Part A and Part B benefits. A Medicare Advantage Plans consist of Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Private Fee for Special Needs Plans, Service Plans, and Medicare Medical Savings Account Plans.
1. What is the Centers for Medicare and Medicaid Services (CMS)? What is their function? Discuss this in detail.
Medicare is a federally governed insurance program, primarily serving Americans over the age of 65, younger disabled meeting specific disability criteria, and dialysis patients having permanent kidney failure. Medicare is linked to Social Security, is not income based, and is available to every American meeting the requirements of the program. Those entitled to Medicare can select Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) paying co-insurance and deductibles or opt to add Part C (Medicare Advantage Plans) paying a monthly premium and co-payments normally less than the out-of-pocket expenses for Original Medicare.
Health care entities need to stay within the global health care trend. The latest trend become pertinent to decision making regarding to health care workforce, financial relating to cost and quality of care as emerging trend of health care IT and claim processing system circulating among hospital and health care facilities (White, 2015). The greatest challenge for most health care organization is finding the right pace for adapting to or embracing new health care trends. The five specific trends in healthcare services, areas of wellness/health promotion, acute care, ambulatory care, long term care, and rehabilitation.