Question

US HEALTH POLICY- List the key variables with operating policies. Explain each variables.

Answer 1

U S HEALTH POLICY

The United States primarily has a third-party payer system of healthcare, which means that a health insurance plan (the third party) reimburses doctors for the bulk of the cost of healthcare services provided to patients. The nation used a mixed system of public and private insurance. The two major public programs are Medicaid, for low-income people and individuals with disabilities, and Medicare, for people 65 or older or younger people with certain disabilities or kidney disease. Most Americans, 48 percent, are enrolled in private health insurance through their employer. The remainder of insured people either purchase private insurance through the individual market or receive insurance through a different publicly-funded program, like the military's TRICARE.

Medicaid

The Medicaid program provides medical insurance to groups of low-income people and individuals with disabilities. It is the largest source of financing for the healthcare services they need. Medicaid is a nationwide program jointly funded by the federal government and the states. Medicaid eligibility, benefits, and administration are managed by the states within federal guidelines. A program related to Medicaid is the Children's Health Insurance Program (CHIP), which covers low-income children above the poverty line and is sometimes operated in conjunction with a state's Medicaid program. Medicaid is a separate program from Medicare, which provides health coverage for the elderly.

The federal Centers for Medicare and Medicaid Services (CMS) monitors state Medicaid programs and establishes requirements for service delivery, quality, funding, and eligibility standards. Medicaid does not provide healthcare directly. Instead, it pays hospitals, physicians, nursing homes, health plans, and other healthcare providers for covered services that they deliver to eligible patients.[3][4]

The Patient Protection and Affordable Care Act of 2010, also known as Obamacare, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138 percent of the federal poverty level, which amounted to $16,643 for individuals and $33,948 for a family of four in 2017.

Medicare

Medicare is the federal program that provides health insurance for people 65 or older, as well as certain younger people with disabilities and people with permanent kidney failure requiring dialysis or a transplant, sometimes called end-stage renal disease (ESRD), legally considered a disablity.

Former President Harry Truman received the first Medicare card.

Some individuals can be dual eligible for both Medicare and Medicaid. By 2011, nearly 10 million Medicare beneficiaries were also receiving Medicaid.

The Affordable Care Act of 2010 closed the "donut hole" of Medicare prescription drug coverage by covering part of the costs for beneficiary drug spending amounting between $2,250 and $5,100 per year.

TRICARE

Tricare formerly 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.[1] Tricare provides civilian health benefits for U.S Armed Forces military personnel, military retirees, and their dependents, including some members of the Reserve Component. Tricare is the civilian care component of the Military Health System, although historically it also included health care delivered in military medical treatment facilities.

The Tricare program is managed by the Defense Health Agency (DHA). Before 1 October 2013, it was managed by the Tricare Management Activity (TMA) under the authority of the Assistant Secretary of Defense (Health Affairs). On that date, TMA was disestablished and Tricare responsibility was transferred to the newly established DHA.[2]

The Department of Defense operates a health care delivery system served approximately 9.4 million beneficiaries in 2018. The Department of Defense's unified medical program represents $50.6 billion or 8% of total FY2019 U.S. military spending. With the exception of active duty service members (who are assigned to the TRICARE Prime option and pay no out-of-pocket costs for TRICARE coverage), Military Health System beneficiaries may have a choice of TRICARE plan options depending upon their status (e.g., active duty family member, retiree, reservist, child under age 26 ineligible for family coverage, Medicare-eligible, etc.) and geographic location.