This is a social insurance program offered by the government of United States to individuals above the age of 65 years and who meet other required conditions to provide health insurance coverage to them. Some of the exceptions of people included in the system less than 65 years include people with disabilities and those with permanent kidney failure or amyotrophic lateral sclerosis (Biggs, 2005). It usually operates as one of the single payer health care system in the country.
The system assists the members in the expenditures of health care although it doesn’t cater for the entire medical expenditure for the majority of long-term care. To ensure that the program get moving and active to assist the people in the country, the organization have been able to get support from various sources. Some of the areas in which they get their donations include; taxes paid in by the workers in the country and that from their own workers.
It is also supported by monthly premiums subtracted from social security checks in the country (Reischauer, Butler, National Academy of Social Insurance Conference & Lave, 1998, pp 44). Due to its involvement in many areas in the country, it has sub divided the program into four major parts of which each section tend to deal with a certain group of people with their own way of doing things. They have then made their sections in such away that, one can not attain the standards of a higher section without going through that which is beneath it.
These include the hospital insurance, the medical insurance, Medicare advantage plans and the prescription drug coverage (Anonymous, 2008). The paper will look at each of the section slightly and then develop on one of the areas at Medicare program in United States. 2. 0 Literature Review This is a commonwealth supported health insurance plan that supplies at no cost or subsidize health care services to United States population. It offers free hospital services for community sick people in public hospitals by means of the agreements they sign with their clients in different region in the country (Biggs, 2005).
They usually have their own way of operation in such away that, they tend to offer free hospital services to community health centers to the citizens who have accepted to be treated as public patients. With this, the patients do not incur the cost of accommodation while at the hospital and they also do not pay for the services offered to them. Other than the people at the public hospitals, the program also offers free services to the qualified individuals who pay medical costs in respect of professional services delivered by standardized qualified medical professionals.
In this, the individual ahs to be bale to register with the group for them to assist him or her in facing the health services cost at any hospital. With these, the program has come up with four major categories in which their member has to register with depending with his or her requirement. As much as the parts meet different needs of an individual, it has been clear that the parts are interrelated with one another in such a way that, one has to register with the minor part for her to be eligible to register with the upper part of Medicare for their services.
They are usually in term of part A to part D. 2. 1 Section or Areas of Medicare Part A is the hospital insurance, it assist the patient in the payment for their inpatient care while at hospital and trained nursing facility, some of the residence health care and the hospice concern. Part B is the medical insurance of which one has to be registered with part A, it tend to offer other services that were not covered in part A plan of the program.
In part C the Medicare advantage plans, the individual with both part A & B is eligible to get the services, and it usually concerns itself with the advantages that the patient may get while associating her with the program. In part D the Prescription drug coverage plan, it tends to concern itself with the payment for the drugs prescribed by the doctors to the patients. With these, the paper will tend to concentrate on Part A plan to look on the ways in which it deals with its duties and the ways that it can implement fro better services fro the patients at different locations in the country.
In so doing, it will be bale to look at some of the issues such as the process changes, the policy changes, software implementation and the training that the participants together with the beneficiaries have to undergo to enhance the performance of the plan within the program. At later stage of the discussion, it will come up with recommendations to the program of which it is expected to have a positive impact to the section on the study. 2. 1 Hospital Insurance
Having the knowledge that part A Hospital Insurance is the core plan of the program, it is then clear that, with its improvement, it will have a great influence on the whole system of Medicare. Thus the paper will look at this area of Medicare, in terms of; the way in which they carry out their operations and how they can change it to better the performances to the patients associating with them. 2. 1. 1 Eligibility Process This section of the program tends to concern itself with the provision of health services to the people who have attain the age of 65 in the country.
It is believed to be applicable to the person, he has to be a citizen in the country or be a permanent resident of United States. For one to be eligible to get these free services he or she has to certify some of the requirement such as; one has to be over the age of 65 years and eligible to receive social security benefit, retirement benefits and whether you are reliant parent having worked more years in government offices that pays the Medicare taxes and or if under the age of 65 years, one can be eligible to the insurance if he certify some of the following conditions;
1. You are permitted to social security disability advantage for 2years 2. You get a disability retirement fund from the railroad retirement board and attain given standards 3. One has amyotrophic lateral disease 4. Having worked more years in government offices that were paying the Medicare taxes and you attain the necessities of the Social Security disability program 5. You are a relative to someone who had worked in government offices that were paying the Medicare taxes and you attain the necessities of the Social Security disability program 6.
You have lasting kidney malfunction and you receive continuation dialysis or a kidney transplant and having one of the above qualifications. These are some of the criteria that the management of the program does use to scrutinize the individual that will benefit from their services. Having attained the people that they want to deal with, the plan has to fulfill the expectations of the patients. 2. 1. 2 Policies within the Plan To ensure that the plan run on smoothly within the organization, it has come up with some of its policies that governs then on how to perform their duties to the patients at their disposal.
This tries to help the hospital to manage the number of people that they deal with at a given time and also helps them to manage their funds. The insurance is only offered to the individual with his or her stay in the hospital fro at least 3days. The home visit offered to the patient has to be of the same problem that the patient was cured for while at the hospital. The insurance needed for skilled nursing facility fro an individual in a maximum of 100 days for an identified sickness, any more days than that, the patient caters fro the cost of services offered to him or her (Bodenheimer, & Grumbach, 1998, pp 262). 2. 1. 3 Training Offered
Fro one to be eligible to offer some services to the patients at the plan, he or she is required to have obtained some of training basing on the section that he deal with. In most case, people involve themselves with the social education in which they will need while attending to the elderly people within the country at their homes. This is viewed that the individual has to be efficient in dealing with the old person as they have many complications in life (Lowy, 1980, pp 91). The workers have to be trained to gain the knowledge on technology so as to familiarize themselves with the new style and mode of dealing with things in the society.
This also helps them to increase the speed at which they attend to their patient at the hospital and to be aware of emergency needed by one of their patient at home (Shi, 2004, pp 131). 2. 2 Recommendations for better Performances within the Plan Basing on the mode to select the people eligible to the free service, the organization has to be able to adjust on the conditions that they have stipulated on the eligible people. This will tend to accommodate a large group of individual in the society and thus enhance the level of health in the country.
Basing on the mode of financial collection to support the plan, the organization has to change their long term strategies to that of short term. This has been to the fact that, they some time base their long term budge on number of patient of which it then comes to overpass it leading them to face negative effect on their services. Thus, with the short term plan, the organization, will be able to plan for a given period of time with given amount of cast of which in case of any shortage in money, it will be much easier to adjust their budge to suit it that when the budge it for the whole year (Anonymous, 2001).
The high change in technology has also led to the increase in the expenditure experienced at the organization. This has been to the idea that the workers has to be trained to familiarize themselves with the system and to get better knowledge on how to offer the best services to the patients (Jonathan, 2000). In order for the organization to change this, the paper recommends that, it has to recruit the workers who already have the technology knowledge so as to cut down on the training cost experienced at the organizations.
Other than, improving the mode of recruitment policy, the management has to check on the type of the training that they offer to their workers. They have to avail a specific institute in which they be obtaining their workers from. This mostly concerns the individuals dealing with social works. It has been noticed that, some of the old people do complain of not being taken care of well by the social workers sent to them at their homes. Regarding to the mode of assessment of their workers, the management has to come up with a better way to assess the type of work that their employees perform at their respective locations.
Other than waiting to get a call from the worker to prompt them visit the patient, they have to come up with a strategy that they can use to be going round the cycle to visit their patients at their respective homes. This will give the patient more confidence in their work and service offered to them (Stanhope, & Lancaster, 2004, pp 115). The patients at the public hospitals have to be looked at well despite the fact that they do not pay any cost fro their well being at the hospital.
To facilitate this, the management has to identify every specialist to handle a given number of patients. Conclusion In conclusion we can then say that, with the implementation of the recommendation towards the hospital insurance at the Medicare discussed above, it is then clear that the performance standard at Medicare at large will improved at great deal as this is the core areas of the program of which houses all the basic requirements to run the program in the country. Reference
Anonymous (2008) Medicare SSA Publication No 05-10043, May 2008 ICN 460000: Retrieved 13th March 2009 from http://www. ssa. gov/pubs/10043. html Anonymous (2001) Medicare Hospital Insurance Solvency, Looks Superior only Short- Term – Health Care Financing Review July, 1st 2001 Retrieved 13th March 2009 from http://www. allbusiness. com/finance/3585342-1. html Biggs, A. (2005) Medicare Background Brief Issue 9 may 2003 Retrieved 13th March 13, 2009 from http://www. aph. gov.
au/library/INTGUIDE/SP/medicare. htm Carroll, C. R. & Schaller, W. E. (1976) Health Quackery & the Consumer pp 341University of Michigan Saunders Grumbach, K. & Bodenheimer, T. (1998) Understanding Health Policy Clinical Approach pp 262 2nd Ed University of Michigan Appleton & Lange Jonathan, G. (2000) Technology Costs may Drain Medicare- Medicare Hospital Insurance Trust- Modern Healthcare Retrieved 13th March 2009 from http://www. highbeam. com/doc/1G1-67722769. html Lancaster, J. & Stanhope, M.
(2004) Community & Public Health Nursing 6thEd pp 115 Elsevier Health Sciences Lowy, L. (1980) Social Policies and Programs on Aging what is and what should be in the Later Years pp 91 University of Virginia Lexington Books Reischauer, R. D. , Butler, S. , National Academy of Social Insurance Conference & Lave, J. R. (1998) Medicare Preparing for the Challenges of the 21st century pp 44 Brookings Institution Press Shi, L. (2004) Essentials of the United States Health Care System pp 131 Jones & Bartlett Publishers