Healthcare Systems Report: Medicare, Medicaid, and More

This report provides a comparative analysis of three key aspects of the healthcare system: managed care organizations, Medicare, and Medicaid. It explores the responsibilities of physicians in managed care, particularly concerning patient access and the ethical implications of gatekeeping. The report then delves into the financial burdens and potential alternatives for easing the strain on both Medicare and Medicaid resources, highlighting their roles in providing healthcare coverage to different segments of the population, including the elderly and low-income individuals. The analysis emphasizes the similarities in their aim to provide healthcare coverage and financial assistance, while also pointing out the differences in eligibility criteria and the impact of financial factors on access to care. The report concludes by summarizing the key similarities and dissimilarities, underscoring the importance of financial resources in healthcare and the need for effective management of these resources to ensure quality services and equitable access.

Running head: HEALTH CARE SYSTEMS
HEALTH CARE SYSTEMS
Assignment 5

HEALTH CARE SYSTEMS 1
Table of Contents
Introduction......................................................................................................................................2
Main context....................................................................................................................................2
Conclusion.......................................................................................................................................4
References........................................................................................................................................4

HEALTH CARE SYSTEMS 2
Introduction
The paper will help in explaining the differences and similarities between the three
questions provided. These questions are based on health care services, including financial
resources. One of the similarities is that the facilities are accessible by people having less
financial support or income.
Main context
The first question reveals the fact that there are different managed care organizations
whose primary motive is to focus on the responsibilities of the physicians for controlling the
patient's access towards the hospitalization as well as specialty care. The question reflects the
fact that gatekeeping is unethical as it introduces various financial factors for treating a patient.
On the other hand, people says that it helps in improving quality by promoting suitable levels of
care. This question is found to be different from the second question as the second question
reflects the explanation of Medicare which is defined as the area that is overlooked many times
and is considered as a financial burden. This question reflects to discuss the alternatives which
are required to ease the drain on Medicare resources. Moving to the third question, it has also
been found that it helps in reflecting the explanation of Medicaid as the shouldering an ever-
increasing burden of the cost for longer-term care mainly for the elder people having numerous
impact on the concerned state budgets across the nation (Chung et al., 2019). It also asked to
discuss the alternatives for easing the drain on Medicaid resources. By contrast, it is found that
Medicaid is a public assistance program which is meant for needy people of all age groups.

HEALTH CARE SYSTEMS 3
Moreover, Medicare is explained as a federal program which is supposed to provide
health coverage to all of the people having age 65+ or under 65 and have a disability (Layton,
Maestas, Prinz & Vabson, 2018). But Medicaid can be defined as both state and federal program,
which also provides health facility when people have very low income. The first question also
reflects the fact that managed care organizations provide responsibilities to the physicians for
controlling the access of the patients, which is different from the other two questions of Medicaid
and Medicare. This questions also give rise to the discussion of gatekeeping to be unethical
because of the introduction of the financial aspects for the treatment provided to the patient. One
of the crucial difference found between Medicaid and Medicare is that people are eligible for
Medicare if they are of 65 years or above 65 and retain specific illness, whereas Medicaid
reflects that the patient should have low income depending on its state (Coury et al., 2018). The
argument of gatekeeping is one of the crucial aspects which is not stated in the other two
questions, and it can be considered as one of the other dissimilarity. Also, it has been considered
as unethical, but there are no other aspects in the next two question regarding anything as
unethical.
The similarity between the three questions is that financial factors and financial resources
are involved in each of them. On the other hand, Medicaid and Medicare are seen to be more
similar since they help people to pay for their health care as well as medical expenses.
Considering the similarity aspects of all three questions, it is found that they all look to provide
health care coverage to people, including some part of the financial resources. The financial
resources are found to be necessary for the health services provided to the patients. One of the
other similarities is that these facilities are provided to those who employees who have lesser
income or are less financial active (Coury et al., 2018). On comparing the first and the third

HEALTH CARE SYSTEMS 4
question, it is found that finance is important for getting proper treatment whether the income is
low or very low.
Furthermore, if a patient is eligible for both Medicare and Medicaid, then the patient can
have both and the services will be provided respectively to the concerned patient. The first
question retains one more similarity with the other two as it refers to delivering and improving
the quality of services provided to the concerned patients. Also, the second and third questions
ask to discuss more alternatives for easing the Medicare and Medicare resources for the
concerned patients. Both these questions include offering superior healthcare services to patients
and requires very less income of people but the financial resources are mandatory and cannot be
ignored completely (Alley, Asomugha, Conway & Sanghavi, 2016).
Conclusion
The paper concludes the evaluation of similarities and dissimilarities between the three
provided questions that are based on the health care services offered to patients of ages above 65
or below 65 and have low income.

HEALTH CARE SYSTEMS 5
References
Alley, D. E., Asomugha, C. N., Conway, P. H., & Sanghavi, D. M. (2016). Accountable health
communities—addressing social needs through Medicare and Medicaid. N Engl J Med,
374(1), 8-11.
Chung, J. W., Dahlke, A. R., Barnard, C., DeLancey, J. O., Merkow, R. P., & Bilimoria, K. Y.
(2019). The Centers For Medicare And Medicaid Services Hospital Ratings: Pitfalls Of
Grading On A Single Curve. Health Affairs, 38(9), 1523-1529.
Coury, J. K., Schneider, J. L., Green, B. B., Baldwin, L. M., Petrik, A. F., Rivelli, J. S., ... &
Coronado, G. D. (2018). Two Medicaid health plans' models and motivations for
improving colorectal cancer screening rates. Translational behavioural medicine.
Layton, T. J., Maestas, N., Prinz, D., & Vabson, B. (2018). The Consequences of (Partial)
Privatization of Social Insurance for Individuals with Disabilities: Evidence from
Medicaid.