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Health Care Financing Essay

1262 words - 6 pages

| |Market- Based Approach |Government- Financed Approach |
| |(Private Insurance, self-insured employers, Managed Care |(Medicare, Medicaid, State Children’s Health Insurance Program [SCHIP]) |
| |Organizations) | |
|Access for who: |Private insurance provides access to employees whose employer,|Medicare is for individuals 65 years or older. Medicaid are for families |
| ...view middle of the document...

|transplants, medical equipment and supplies, rural health clinic services, |
| | |and limited preventative services (Shi & Singh, 2008). Medicaid provides |
| | |coverage for hospital inpatient care, hospital outpatient services, |
| | |physician services, laboratory and X-ray services, nursing facility |
| | |services, home health services, prenatal care, family planning services and|
| | |supplies, health clinic services, preventative, diagnostic, and treatment |
| | |services, nurse-midwife services, and pediatric and family nurse |
| | |practitioner services (Shi & Singh, 2008). SCHIP covers the services for: |
| | |inpatient and outpatient hospital visits, physicians, surgeries, medical |
| | |visits, lab and X-rays, well-baby and well-child care, and dental (Shi & |
| | |Singh, 2008). |
|Payment for services: |Services are paid for through premiums usually paid monthly |The Medicaid program will assist to pay for expenses and services Medicare |
| |where employee share in the cost through payroll deductions |does not cover when an individual qualifies for Medicare. Medicaid pays |
| |(Shi & Singh, 2008). Individuals also have out-of-pocket costs|first, then Medicare will cover the remaining balance (coinsurances and |
| |consisting of a deductible and co-payment. |copayments) (American Federation of Teachers). |
|Reimbursement: |The healthcare professional files a claim with the payer to |“Medicare reimbursements apply only to charges directly related to medical |
| |become reimbursed. The insured will then pay the difference |care. Medicare reimbursement rates are set by federal legislation, and |
| |between the actual charges and the payments received from the |govern how much a provider or supplier will receive from Medicare for |
| ...

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