Over the years, the cost of healthcare expenditure has continued to rise exponentially, particularly on health services and goods like pharmaceuticals, services provided by medical practitioners, and also hospital care, and related activities in healthcare, which includes administration and research. The states and federal governments are working around the clock to ensure that they maintain they maintain the quality of healthcare and services while ensuring that the cost is significantly reduced, alleviating the burden on citizens. It has been projected that the cost and expenditure of healthcare is expected to rise due to the changes in lifestyle and also government policies. According to a report that was released by Medicare Trustee Report, the medical hospital insurance has been projected to be depleted by 2026 (Cubanski, Neuman, & Freed, 2019) . It is imperative to understand the dynamics that are currently surrounding Managed Care Organizations, Medicare, and Medicaid in response to increasing expenditure on healthcare services in the country.
Table 1
Facts, Comparing and Contrasting Between MCOs, Medicare, and Medicaid
| Managed Care organizations | Medicare | Medicaid | |
| Definition | These are organizations that have been designed to reduce utilization through concurrent utilization review, preauthorization, or intended to reduce cost, for example through claims review, and ensuring that there is less expensive alternatives during hospitalization | This is a federal health insurance program which funds medical care and hospital for senior citizens in the country | Medicaid is a national and state-funded insurance program that helps to pay medical costs to citizens that have fewer incomes and also resources. It mainly funds families with physical disabilities, people with mental disabilities, and families with elderly and children. |
| Funded By | the program is mainly funded by a certain amount of fee per person per month | the program is funded by Social Security Administration, meaning it is paid by taxpayers through the Federal Insurance Contribution Act | Funded by federal and state governments. The federal government ensures that each state government receives a share of program expenditure (Federal Medical Assistance Percentage) |
| Administered by | The program is mainly operated by for-profit organizations and providers in the country | The program is governed by the Center for Medicare and Medicaid Services which is a division of the Department of Health and Human Services | The program is administered by the Center for Medicare and Medicaid Services which partners with different state governments, Children’s Health Insurance Program, and insurance portability standards |
| Coverage/type | The coverage type is health maintenance organization which ensures people pay for care within the available network | the program has covered over 44 million people in the country or around 15% of the total population. The care is divided into 4 significant parts part A; which covers inpatient, hospital insurance, home health and hospice among other care Part B; covers outpatient Part C; private health covering both Parts A and B Part D; for prescription coverage | As of 2019, the program has total coverage of around 72.4 million citizens in the country. the coverage includes doctor visits, nursing homes, and other medical expenses |
| Advantages | Ensures collaboration between specialists and generalists Provides low insurance care through a network of providers creation which is extensive Provision of cheaper prescriptions Provision of accredited cares | Medical and prescription medicine coverage Dental, hearing, and vision coverage Additional health perks Cheap medication per month | Provides health insurance for low-income families, covering costs associated with long-term and medical care, Inpatient and outpatient, pregnancy, and home-based programs |
| Disadvantages | Limited to only those that have an insurance provider and is a bit expensive Provides “gatekeeping” or tightly controlled utilization of resources People often advocate for themselves | The insurance is costly to administer per year. In many instances, the insurance coverage have created downsides with physicians practicing fraud | Medicaid does not give room for medical practitioners to charge patients when they miss the appointment Does not provide long term care to low-income families |
| Alternatives and Recommendations | Come up with strategies that would ensure there is inhibit cost during cost-shifting The government should ensure that some providers are accredited to eliminate skimming | It should provide there is reduced payments to post-acute providers to accommodate more people Come up with diverse payment options and programs | Expand the overage plan to accommodate more low-income individuals and families It would be vital also to provide cover to small businesses and affordable schooling |
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Conclusion
With healthcare expenditure in the country is expected to rise exponentially in few years to come because of changing lifestyle and government policies, it would be imperative to come up with coverage programs that ensure the quality of health would remain competitive. Through improving the three central insurance policies, i.e., Managed Coverage Organizations, Medicare, and Medicaid, the state and national governments would ensure that Americans are able to afford healthcare services and expenses through having programs that they are able to pay within an articulated time frame. Private health insurance would be vital, particularly helping people to be able to gain control of their health and also enabling people to evade Medicare levy surcharge, particularly among people with high income (Sommers, 2017) . As such, coming up with a system that allows a combination of both private and public insurance would primarily improve the quality and affordability of care in the country.
References
Cubanski, J., Neuman, T., & Freed, M. (2019, August 20). The Facts on Medicare Spending and Financing . Retrieved April 05, 2020, from Medicare: https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/
Sommers, B. D. (2017). Health insurance coverage and health—what the recent evidence tells us. N Engl J Med, 377 (6), 586-593.
