MEDICAID

Medicaid

Medicaid

The financing of health care in the United States is part public, part private; part national health insurance through Medicare, Medicaid, and several other government—sponsored programs; part employer sponsored; and increasingly individually purchased through private-pay insurance plans and out-of-pocket payments from consumers. It's a complex system that, for all the wealth it consumes and creates in the United States, still has left almost 20% of the population with no coverage and many more with far too little coverage. Under the health reform legislation of 2010, many of the uninsured will receive health care coverage through an expanded Medicaid program or under the requirement that everyone purchase insurance. For those who do not meet the poverty guidelines for the expanded Medicaid coverage, an insurance exchange will be available through which they are expected to be able to find affordable coverage (Birk, 2010).

This process is right as the assistance towards the aged people make the future of adults better and the laws that are prevailing, make the process legal and accepted by the majority. Even with expansion in insurance coverage, public policy will still place hospitals in the role of default insurer for that portion of the population, including illegal immigrants, who are not covered. Under the Emergency Medical Treatment and Active Labor Act, hospitals are required to accept the uninsured in their emergency rooms and to provide essential diagnostic and treatment services required to stabilize those patients without consideration of their ability to pay. This generates a very expensive cost-shifting phenomenon in which costs charged to private-paying patients and insurers are increased by amounts not collected from the uninsured and underinsured (Buell, 2010).

The first place to start our discussion of health care financial management is to grasp how much the cost of health care is in the United States and what is driving the rapid rate of increase in costs. At the end of 2006, the U.S. tab for health care (hospitals, physicians, pharmaceuticals, nursing home care, and so on) was %2.3 trillion or 16% of gross domestic product (GDP). This represented a 6.9% increase from the previous year and a cost per person of %7,026. By 2016, health care expenditures are expected to reach %4.2 trillion or 20% of GDP. As a result of health reform legislation of 2010, the Congressional Budget Office predicts that the rate of increase in health care expenditures will decrease (Dye, 2006).

Many external and internal factors drive this rate of expenditure, including technological advancements, growth in the population, changing reimbursement systems, an atmosphere of plenty in the face of the destitution of many, the numbers of uninsured among the U.S. population, incentives for costly services, a history of third-party payment that separates the consumer from the cost of care, an expanding workforce of specialists, and other factors. None of these factors functions in isolation from the other. They lend themselves to the creation of a volatile financial environment. Together they create a complicated and tightly woven web of forces driving up the cost of medical ...