Medicare's Future: What You Need to Know

Brasfield, J. M. (2015). Medicare's future: policy ideas and the coming reform debate . Journal of health and human services administration, 462-517. 

This article aims at exploring the primary policy ideas which have emerged in the Medicare program in the United States. Medicare is one of the most extensive and expensive programs in the health sector; hence it requires consistency over time. The program has been a primary piece of funding the American health system with the elderly people using the program to pay for their medication expenses after their retirement. The author defines a policy idea as a set of integrated proposals implemented to handle an issue that has invaded a policy agenda. Plans need to be created to respond to the effects developed by threat emerging in a policy agenda. Medicare program has faced threats hence policy network, and health policy advocacy coalition advocated and nurtured social insurance strategy as the policy idea of financing health care through Medicare program. 

Implementation of Medicare program was the first legislative stage in the introduction of individual universal and national health insurance in American which ensured improvement in the financing of health care in the country. The article has indicated various policy ideas have been implemented to handle different threats which are facing Medicare program. A primary policy paradigm where social insurance system is expanded to have national health insurance which will cater for the elderly ensuring passage of Medicare program. A policy idea of sustainability concept has been implemented to handle the threat of sustainability which was affecting the program. The threat of sustainability raised the question of whether the program will acceptably achieve its substantive goals. The concept of sustainability was developed in integration of actuarial projections of the program’s future. Another policy idea in the Medicare program is cost containment approach which aims at identifying various strategies of reducing Medicare costs. Procedures used included restrictions in supply, global budgeting, consolidation of the system, payment administration, utilization of private insurance programs and creating all-payer rate setting. These ideas have ensured reduction of threats facing Medicare hence improving health care across the country. However, the Medicare policy ideas affects the Medicare advantage because individuals are needed to pay coinsurance and copays fees for the program. It is difficult to compare the policy plans of Medicare program as they are not alike and they are have no provided nationwide health coverage making the program less advantageous. 

Feder, J., Hadley, J., & Zuckerman, S. (1987). How did Medicare's prospective payment system affect hospitals? New England Journal of Medicine, 317(14), 867-873. 

The study in this article aims at exploring the impacts of the prospective payment system in hospitals which use them. It shows the degree of fiscal pressure exerted in hospitals by the prospective payment system and how these health facilities respond to this pressure. The authors used emailed surveys to collect their study data where the survey questions were emailed to hospitals using a prospective payment system and those which are not using the system. The authors needed to determine if there are a sign of performance variations of health facilities using the prospective payment system and those which use TEFRA for payments and the hospitals experiencing financial pressure due to use of proposed payment system. 

The impacts of prospective payment system were determined through comparing health facilities benefitting from this system with those using the TEFRA system for payment with the variations of the two program motive for cost containment. The study has indicated that health facilities using a prospective payment system reduces the increase of Medicare costs and high reduction in the use of Medicare than in the other health facilities. Prospective payment system offers considerable motives for decreasing healthcare costs as the program pays healthcare facilities predetermined and fixed amounts per health case. The system also permits profits in hospitals through the use of the Medicare program; hence it is essential for healthcare facilities compared to the TEFRA payment system. However, prospective payment system negatively impacts hospitals because the systems is regulated by the government and it can easily be changed and this can fail to be done in the appropriate manner making the changes of the system unpredictable. This greatly affects costs of the Medicare programs as there may be fluctuation of the costs.