Health care is among the most necessary and important needs in any given society. Many governments strive to implement programs or avail necessary resources required to help with the health care situations of its citizens. In the United States, two of such programs are Medicare and Medicaid. These programs are sponsored by the Government to help with the healthcare costs of its citizens. Medicare is a program for the elderly (65 years and above), while Medicaid is a health care program for low-income families ( Sparer, 1996 ). The elderly with low-income are eligible for both programs. A distinctive characteristic of the two programs is that Medicare is that Medicare program administered through the federal government, whereas Medicaid is administered through the State and federal program. Both programs are, however, funded by the government. Being a State affair, Medicaid programs usually have varying practices.
Taking a case study of the state of Kentucky with a population of 4.437 million, only about 20% of the entire State population are covered by the Medicare program, and 22% covered Medicaid. These percentages are among the highest in the U.S.
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Medicare
This program is available to U.S citizens regardless of income. The population that qualifies for Medicare should be:
i) Persons 65 years old and above
ii) Persons with certain disabilities below 65 years
iii) Persons with End-Stage Renal Disease
The benefits of the Medicare program are broken down into four categories: Part A covers hospital insurance, Part B covers medical insurance, Part C is concerned with Medicare advantage, and final, Part D deals with prescription drug coverage. Beneficiaries of this program are only allowed an access to one part, of the four.
Medicaid
The qualification for the Medicaid program depends on the size of the household. For a household size of:
One – Your income should be less than $16,394
Two – Your income should be less than $22,107
Three – Your income should be less than $27,820
Four – Your income should be less than $33,534
In addition to low incomes, beneficiaries should either be above 65 years, or below 19 years, or pregnant, or living with disability to qualify for this program. Eligibility is higher for children and pregnant women, in that order. Medicaid comes with a wider range of benefits and services compared to Medicare. These benefits include:
- Doctor visits
- Hospital stays
- Preventive care
- X-rays
- Maternal care
- Necessary medication
- Vision and dental care for children.
- Etc.
Management of the healthcare program payments is among the biggest challenges currently facing Hospital administrations. One of the challenges that come with Medicaid plan is controlling costs. During recessions, people lose their jobs which increase enrollment hence increment of expenses. The State, therefore, struggle to keep up with higher costs due to the increased number of beneficiaries, with their tax revenues declining. To counter this, States usually control costs by cutting payment rates to hospital workers. In light of all these, the nurse leaders are faced with the challenge of figuring out how to provide better pay for the nurses, and also how to hire more nurses with their limited resources ( Morrison & Monagle, 2009 ).
Another cause of concern for hospital administrators is the continuously increasing number of employees. Nurse leaders are faced with the challenge of finding a suitable system that allows them to provide health care services to the beneficiaries of these programs, while simultaneously upholding fiscal responsibilities. In addition to this challenge, the government has placed caps on the reimbursements received by Medicaid and Medicare patients, and nurse leaders ( Morrison & Monagle, 2009 ). This implies that the more Medicaid and Medicare patients a hospital attends to, the less money they take in.
References
Morrison, E. and Monagle, J. (2009). Health care ethics: critical issues for the 21st century . Seatle: Jones & Bartlett Learning.
Sparer, M. (1996). Medicaid and the limits of state health reform . New York: Temple University Press.
