Health Care Financing

Health Care Financing

The broad issues here are how to control the rising costs of health care, who should pay for it, and what is the most cost-effective way to provide long-term care for older people?

Although they have been helpful in many ways, Medicare and Medicaid (Title XIX) became amandements to the Social Security Act. Medicare was designed to provide health-care coverage to those older people eligible for Sosial Security. Medicaid was meant to help persons of any age who could not pay for private health insurance, as well as those older people whose Medicare benefits had been exhausted. Medicaid is administered jointly by federal and state governments. The Veteran`s Administration is one source of funding. There are deficiences in both systems, and fraud and abuse have been widespread. Furthermore, rising health-care costs have made Medicare and Medicaid inadequate. Confusion and misconceptions generated by the procedures of these systems are enormous and too numerous to discuss here, since each person is affected in a different way. However, one popular misconception is that Medicare and Medicaid pay for all nursing home expenses. Medicare payment for nursing home expenses is limited, and families may be responsible for some nursing home costs under medicaid.

Inadequacies in the programs account for some of these adverse developments and they raise the issue of whether or not Medicare and Medicaid should be continued. Many advocates of the elderly population believe a national health insurance program for all people is the only answer. These specific concerns and facts are related to the issues of health care financing :

1. Lack of coverage for preventive care.

2. The impoverishment of one spouse while another is an a nursing home – must a couple who have been married 50 years get a divorce so that the spouse who is at home can retain his or her monthly income? Alzheimer`s disease, in particular, is making old people poor.

3. The number of elderly people with chronic health problems that could deplete their financial resources.

4. About 10% of all AIDS victims are over 50 years of age. Will this mean the establishment of extended care facilities with special services?

On June 8, 1988, a catastrophic health insurance bill was passed by the U.S. Senate that will provide more financial protection for the already 29 milion elderly people on Medicare. The beneficiaries of services will pay the additional costs. Highlights of this bill include :

1. Full coverage of all hospital bills after an annual deductible which after 1989 may be $564.

2. Full and appropriate payment of doctor bills after a $1,370 deductible.

3. A 50% payment of outpatient drug costs after a $600 annual deductible, beginning in 1991.

Increased home health care coverage for elderly people is still an issues of much debate.

Older persons must be educated as to the extent of medical benefits under federal, state, and private programs. They should have access yo information about partnerships between physicians and coalitions of aging groups in which the physician accepts the Medicare assignment for a specific service rendered. The nurse`s role is to know who can provide expert answers to questions about health care financing, and to stay aware of new and pending legislation.

Reference :

Farrell J : Nursing Care of the Older Person, J.B. Lippincott Company, Philadelphia, 1990.