SIM410 Assignment 4

SIM410 Assignment 4. Purpose and importance of Medicare and Medicaid programs

Medicare in addition to Medicaid are legislative programs providing health and medical services to particular group of individuals.  Medicaid is a health care program for individuals below a certain income level. Medicare is a health care program paid by the individuals themselves. Medicare program is designed to pay for the senior population that is 65 years and above when health costs are higher than their income. It also serves some individuals below the age of 65 years who have medical conditions or disability. Medicare guaranteed that hospitals and doctors could provide care without a significant loss. It also revolutionized the way families were able to deal with old age. This improved care as it made end of life decisions much more humane and gave older individuals for instance Americans a significant degree of security and independence. It evolved to include the disabled as well.

Medicaid developed to meet the needs of those who are poor and unable to obtain other forms of insurance. It is primarily needs based. Given the inability of our model of primarily employer provided health insurance to cover significant parts of the population it provided a significant public good (Maeda, 2014). Medicaid is a significant benefit to doctors too. The poor have much more complicated illnesses that are expensive and time consuming to treat, often due to an absence of preventive care. By taking the recipient out of a purely charity model the doctor and hospital can focus on getting the patient better. In the case of children the lifelong benefits of Medicaid might even pay for themselves. Medicaid is by the state money and the federal…SIM410 Assignment 4…

SIM410 Assignment 4

Before Medicare people were often left in a terrible position without the ability to obtain and pay for medical care when they were most likely to need it. This was after they passed the time in their life when they were able to maintain a regular income, notably retirement. Older people were made dependent on struggling younger members of their families. Medicare and Medicaid programs portray a very significant purpose to the health care sector and the society.  These programs deliver health insurance for the disabled, low-income earners and seniors. Medicaid and Medicare aid individuals find healthcare when they are not in a position to afford it.

Healthcare coverage options

Health insurance is a form of insurance coverage that caters for the cost of insured individuals’ health in addition to surgical costs. Plan type directs a person’s approach in receiving the treatment they require and amount of money they need to pay on that particular day. Depending on the type of health insurance coverage, either the insured pays the charges from pocket and receives compensation, or the insurer makes payments straight to the health specialist (Green & Rowell, 2015). Healthcare providers are funded by either government insurers or insurance via a scheme of reimbursement. Reimbursement systems offer incentives to healthcare professionals…SIM410 Assignment 4….

Health coverage are programs that aids in paying for medical outlays. Medicaid programs have resulted in lots of new options for healthcare coverage. Health insurance marketplace is a way to purchase health cover. It permits one to equate the charges plus benefits of dissimilar policies. Health Insurance Marketplace is administered by the federal government.  Entities can obtain commercial insurance coverage through the Exchange.  Assistance with the cost of these plans is available depending on your income, family size, and the plan selected. Examples of healthcare coverage options that facilitate or limit access include emergency care, medication coverage, and lab diagnosis among others.

For instance, primary care physician office visits, are the daily healthcare provided by a health care specialist. The provider organizes other high-quality care that the patient may require. Preventive services are offered by the Medicare program. Preventive care is care one receives to detect medical conditions, prevent illness, and keep one in good health. Medicare Part B covers many preventive services, such as screenings, vaccines, and counseling. Surgery is another healthcare coverage option provided by the plans.

SIM410 Assignment 4

Role of Diagnosis Related Groups and charity care within healthcare facilities

Diagnosis Related Group is a classification system for patients that regulates potential compensation to health centers and boosts cost restraint initiatives. Diagnosis Related Group payment insures charges related through an in-patient stay from admission to discharge time. DRG allows health care centers administrators determine required resources in treating a specific group of people and also predict the treatment cost. Diagnosis Related Group takes into account the number of patients admitted in the hospital for acute care. Each DRG has a payment allocated to it that permits the hospital to define the amount it can charge for service delivery. The DRG system builds greater opportunity for health amenities to advantage financially from keeping correct records….SIM410 Assignment 4….

Charity care involves the provision of free or reduced prices to patients earning low income. Charity care allows uninsured individuals receive both inpatient and outpatient care at a decreased cost. Charity care is only authorized to individuals who meet certain asset as well as income measures. The hospital benefits community in form of charity care. The total community value available to acquire the specific requirements of a certain community is not accounted for by the charity care. Health systems and hospitals deliver great value to their resident societies apart from the provision of high quality care.

Individuals who are uninsured suffer from vital health outcomes because of not having coverage. Substandard health care quality, high death probability in addition to lower degrees of preventive care are linked to one being uninsured. Several uninsured individuals avoid pursuing medical care lest they are encountered with an emergency. In most cases they delay seeking care up to the time their warning signs turn out to be unbearable. Therefore, the vulnerable populaces are less probable of obtaining diagnosis during the early phases of an ailment.  They are more likely to suffer from difficulties due to the serious health conditions. Multiple charity programs target the outreach of uninsured populations toward improving their health.


Green, M. A., & Rowell, J. A. C. (2015). Understanding health insurance: A guide to billing and reimbursement.

Maeda, A. (2014). Universal health coverage for inclusive and sustainable development. Washington, D.C: World Bank Group.


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