Question

What role do Medicare and Medicaid play in this determination—are hospitals paid enough by these governmental payers?

Answer 1

The medicaid and medicare are two type of health insurance programmmes controlled by government. They are operated and funded by different parts of the government and primarily serve differentgroups.

Medicaid is a public insurance program that provides health coverage to poor peoples including low income families, individuals and people with disabilities. Federal government and states are funded jointly.Medicare is also an insurance program it mostly helpful in people over 65 age whatever their income, younger disabled people, and dialysis patient. Medicare and Medicaid are the nations major health care programs. This insurance collect and check the data produces research reports and works to avoid instance of fraud and abuse within the health care system. The agency aim to provide a health care system with better care, access to coverage and improved health. Medicare consists of 4 parts A, B, C, and D. part A including inpatient hospital, skilled nursing, hospice, and home services. Part B include physician, laboratory, outpatient, preventive care, and other services. Part C is the combination of A and B. Part D provides coverage for drugs and prescription medications.

The state health insurance assistance program works to inform who are eligible for medicare. The medicaid benefits are different the issuing state . Some benefits include in every program

1.lab and X-ray services

2. Inpatient and outpatient hospital services

3. Family planning services such as birth control and nurse midwife services

4. Health screening and applicable medical treatment for children

5. Nursing facility services for adult

6. Surgical dental services for adults

Reimbursement are payments doctors and hospitals receive for providing services to patients. Medicare reimbursement come from a federal trust fund. Most of the money for this finds comes from payroll taxes. Medicaid is similar, but many of the specifics vary by state including reimbursement rates. Government reimbursement leavels have an impact on private sector spending in an additional way. Because reimbursement from government programs like medicaid and medicare are lower than the average cost of serving those patients, providers charge privately insuared patients higher rates in order to recoup their costs. This increase in private sector prices to adjust for government payment levels is called cost shifting and it is controversial concept. Reimbursement from government programs are and have been lower than the average cost of patient care. The government reimbursement rates comes in the form off access to doctors. If doctors know that they will be paid less as a result of treating medicaid patients, they might not prioritize said patients. Slower medicaid reimbursement times were associated with lower physician participation in medicaid. The federal governments role as the dominant health care payer also has a variety of powerful effects on the reimbursement to health providers