What are the basic programs offered through Medicare?

What are the basic programs offered through Medicare?

After reading Chapter 14 and reviewing information at https://www.cms.gov, respond to the following questions:

How does Medicare work?
What are the basic programs offered through Medicare?
How does Medicaid work?
What are the basic services offered through Medicaid?

Make sure you spell check, proofread, and include in-text citations and a reference listing if you use words that are not your own.

Chapter 14: The Health Care System of the United States

Chapter Summary

The focus of this chapter is to trace the health care system in United States. The health care system in the United States has been less than effective. America

spends more than other countries, yet has more than 47 million people without health insurance.

The cost of health care has been provided by a variety of sources such as employers, individuals and families, and the government. The greatest brunt of payments has

come from third-party payers over time. Medicaid and Medicare have made the federal government the largest payer of health care services.

Health care costs are escalating. There are several factors that have created this rise, such as new medical technologies, people living longer and needing more care

for chronic and acute illnesses, medical wastes, and medical entrepreneurialism. Because of concern over rising costs, and in an effort to contain said costs, the

country shifted to managed care.

Managed care programs attempt to cut costs while providing cost-effective care by securing lower provider reimbursements, regulating patient care, and rewarding

physicians for keeping their patients healthy. There are several types of managed care organizations such as HMOs, PPOs, and a combination of health insurance and

health care delivery in a single package.

The United States passed significant health care legislation in 2010. This legislation should bring health insurance to an additional 32 million people over the next

several years.

Chapter Outline

I. Introduction
II. Rating the U.S. Health Care System
A. Based on Systematic Analysis
B. Based on Consumer Attitudes
III. The U.S. Health Care System
A. The Foundation of the Health Care System
B. The Development of Private Health Insurance
C. The Development of a Nonprofit Health Insurance Alternative
D. The Entry of Public (Government-Sponsored) Health Insurance
1. Medicare
2. Medicaid
3. Children’s Health Insurance Program (CHIP)
E. Incentives to Overuse Services
1. Provision of Unnecessary Services
F. Cost Containment
G. The Development of Managed Care
1. Managed Care
2. Types of Managed Care Organizations
a) Health maintenance organizations (HMOs)
b) Preferred provider organizations (PPOs)
c) Point-of-service (POS)
IV. The Financing of Health Care in the United States
A. How Much Money Does the United States Spend on Health Care?
a) National health expenditures (NHE)
b) Personal health expenditures (PHE)
B. Who Receives the Dollars Spent on Personal Health?
1. Hospital care
2. Physician services
3. Drugs and other medical nondurables
4. Nursing home care and home health care
5. Dental care
C. Who Spends the Dollars for Personal Health Care?
D. Private Sources
1. Employers
2. Individuals and Families
E. Public Sources (Government)
V. Explanations for the High Cost of American Medicine
A. The Aging of the Population
B. The High Cost of New Medical Technologies
1. Defensive Medicine
2. Physician Self-Referral
C. Medical Entrepreneurialism
1. The Medical-Industrial Complex
2. Corporate Profit
3. High Administrative Costs
4. Exorbitant CEO Salaries and Compensation Packages
5. Medical Fraud
VI. America’s Uninsured Population
A. Who are the Uninsured?
B. The Role of the Employment-Based Health Insurance System
1. Individuals who are unemployed
2. Individuals after retirement but before Medicare
3. Individuals during any transition period from one job to another
4. Individuals working part-time
5. Individuals who work for small businesses
6. Individuals who cannot afford the employee share of employer-provided health insurance
7. Individuals who are in this country illegally
C. The Consequences of Being Uninsured


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