Comprehensive Report on Medicare Service: Analysis and Recommendations

This report provides a comprehensive overview of the Medicare service, a federal health insurance program in the United States primarily for the elderly and individuals with disabilities. It details the service's function, administration, and client groups, highlighting its role in providing medical care and financial assistance. The report critically evaluates the effectiveness of the service, examining both its positive aspects, such as coverage for medications and setting medical standards, and its negative aspects, including high administrative costs and potential for fraud. Furthermore, it suggests various ways to improve the Medicare service, such as enhancing plan selection and balancing care services with costs. The report concludes with a summary of the key findings and recommendations for future development.

Running head: MEDICARE SERVICE
MEDICARE SERVICE
Name of the Student
Name of the University
Author note

1MEDICARE SERVICE
Table of Contents
Overview of the service...................................................................................................................2
Function.......................................................................................................................................2
Administration.............................................................................................................................2
The client groups of the Medicare services.................................................................................3
Critique of the service......................................................................................................................3
Effectiveness of the service in achieving the stated purpose.......................................................3
The positive and negative aspects of the service.........................................................................4
Ways to improve the Medicare services......................................................................................5
Conclusion.......................................................................................................................................6
Reference.........................................................................................................................................7

2MEDICARE SERVICE
Introduction
The Medicare service is a federal programme of health insurance which pays money for
the different hospitals and medical care for the people of The United States, mainly for the
people with physical disabilities and also for the older people (Alley et al., 2016). The
programme mainly consists of two main parts for nursing homes or hospitals and also for the
medical insurance and other two additional parts for the providing flexibility and for the
providing of drugs. Title XVIII of the social security act designated “health insurance for the
aged and the disabled” is a Medicare service (Harris-Kojetin et al., 2016)
Overview of the service
Function
This health insurance programme caters to the medical needs of the aged persons and
specially those who have retired from their service. This has been done for complementing the
retirement of the people after working for such a long period of time in a particular workplace.
This insurance policy also benefits the persons having physical disabilities (Schwartz et al.,
2015).
Administration
The hospital and nursing coverage of the patient are funded largely by the revenue from
the tax levied on the workers and the employers (Schwartz et al., 2015). The individuals who are
self-employed should pay the entire tax on the net earnings of the self-employed. The insurance
of the supplementary medicines and the prescription plan are totally funded by the premiums that
are paid by the enrolees of the Medicare service and the treasury revenue of the United States
(Rajaram et al., 2015). The hospital insurance, the insurance of the supplementary medicines and
the prescription plan use the trusts funds that are separate. The Medicare adverse plans use the
same trust funds that are used by the other plans of the services. Till now, the Medicare services
had spent a large amount of money which were mainly collected from the domestic products and
from the total US federal spending (Rajaram et al., 2015).
The centres for Medicare and Medicaid services (CMS) is one of the component of US
department of health and human services which mainly do the administration of Medicaid,

3MEDICARE SERVICE
Medicare and Child Health Insurance programme. The administration of the social security is
fully responsible to determine the eligibility of the Medicare and also solve all the problems
relating with the payments. The main Actuary of the CMS provides all the information related
with the accounts and also about the costs relating to the services of the services of the trustees of
the Medicare Board. The Relative Value Update committee consists of the physicians who are
associated with the American Medical Association (Alley et al., 2016).
The client groups of the Medicare services
The client groups of this Medicare services are the old people and the persons having
physical disabilities. Normally the old people feel very helpless after their retirement. Not only
the retired people, other old people who belong from poor families, also feel helpless because of
the lack of money. These people also need proper medical treatments from time to time, so for
them this Medicare service is very helpful. Similarly, the persons having physical disabilities are
also lagged behind from the healthy people. The Medicare services also help these persons by
providing with medical assistances (Kline et al., 2015).
Critique of the service
Effectiveness of the service in achieving the stated purpose
Yes, the Medicare service very effectively achieved the purpose stated by the service.
The Medicare service is completely a social insurance programme and thus vary a lot from the
other health insurance practices. Normally the other health care insurance programme provide
the healthcare policies for people of all age groups but this policy has been made for taking care
of the old aged people only. All the people of the community work very efficiently while
providing the care services. The physicians involved in the care giving services work very
efficient on providing their services (Meadows et al., 2015). The persons working in the
administrative area of the service also work very hard in achieving their success.
The positive and negative aspects of the service
The positive aspects of the Medicare services are:
 The service support the full coverage of the providing medicines to those people who do
not have much money to spend on their treatment and on medicines.

4MEDICARE SERVICE
 The costs of the Medicare services is very little. The part A is mainly considered to be
free but they have to pay very little amount of money for getting the services of part B
(Jensen, et al., 2015).
 The next most important advantage is that this service has brought many innovations in
the prescriptions. The market of the drug companies have increased a lot after the
Medicare services has started. When the pharmaceutical companies found that this
service is creating a great market value then the companies also started preparing drugs
especially for the elder people.
 The most important positive aspects of the Medicare service is that the service has
resulted in the increment of medical standards. This service has set policies for the
enrolment policies in the hospital. As time passed, the Government has become involved
in looking after these standards and also looks after the public reporting on issues like the
infection rates in the hospital and the readmission rates of the hospital. All these forces
allow the hospital to work more efficiently than the hospitals were doing previously
(Wunsch et al., 2016).
The negative aspects of this service are
 The most important disadvantage is that the Medicare costs a large amount for the
administration, presently it is running about of 15% of the overall budget. The
percentage will not decrease in the near future and it will get increased in the near
future.
 The second disadvantage is that actually to improve the health of the poor people,
more money is required, so obviously this will cost a large amount of money.
 Another major disadvantage is that the hospital stay actually cost a large amount of
money. Thus automatically the burden on the hospitals increases.
 The Medicare services attract the fraudulent doctors who have completed their
medical degree in unethical ways (Wang et al., 2016).
Ways to improve the Medicare services
The Medicare services can be improved by following the given methods:

5MEDICARE SERVICE
 The Medicare service must be improved in such a way that it helps people to choose the
correct Medicare plan for themselves.
 The designing of the medicinal plans must need proper thinking so that it can maintain a
balance between the providing of the care service and the costs involved (Unroe et al.,
2015).
Conclusion
After completing the report about the Medicare services, it can be concluded that apart
from having many disadvantages this service has been very successful in providing cure services
to the old people and the people having physical disabilities. In future also if the service
overcome the negatives of the service then it can provide the services in much better way.

6MEDICARE SERVICE
Reference
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.
Harris-Kojetin, L., Sengupta, M., Park-Lee, E., Valverde, R., Caffrey, C., Rome, V., & Lendon,
J. (2016). Long-term care providers and services users in the United States: data from the
National Study of Long-Term Care Providers, 2013-2014. Vital & health statistics.
Series 3, Analytical and epidemiological studies, (38), x-xii.
Jensen, G. A., Salloum, R. G., Hu, J., Ferdows, N. B., & Tarraf, W. (2015). A slow start: Use of
preventive services among seniors following the Affordable Care Act's enhancement of
Medicare benefits in the US. Preventive medicine, 76, 37-42.
Kline, R. M., Bazell, C., Smith, E., Schumacher, H., Rajkumar, R., & Conway, P. H. (2015).
Centers for Medicare and Medicaid Services: using an episode-based payment model to
improve oncology care. Journal of oncology practice, 11(2), 114-116.
Meadows, G. N., Enticott, J. C., Inder, B., Russell, G. M., & Gurr, R. (2015). Better access to
mental health care and the failure of the Medicare principle of universality. Medical
Journal of Australia, 202(4), 190-194.
Rajaram, R., Chung, J. W., Kinnier, C. V., Barnard, C., Mohanty, S., Pavey, E. S., ... &
Bilimoria, K. Y. (2015). Hospital characteristics associated with penalties in the Centers
for Medicare & Medicaid Services hospital-acquired condition reduction
program. Jama, 314(4), 375-383.

7MEDICARE SERVICE
Schwartz, A. L., Chernew, M. E., Landon, B. E., & McWilliams, J. M. (2015). Changes in low-
value services in year 1 of the medicare pioneer accountable care organization
program. JAMA internal medicine, 175(11), 1815-1825.
Unroe, K. T., Nazir, A., Holtz, L. R., Maurer, H., Miller, E., Hickman, S. E., ... & Sachs, G. A.
(2015). The optimizing patient transfers, impacting medical quality, and improving
symptoms: transforming institutional care approach: preliminary data from the
implementation of a centers for Medicare and Medicaid services nursing facility
demonstration project. Journal of the American Geriatrics Society, 63(1), 165-169.
Wang, D. E., Tsugawa, Y., Figueroa, J. F., & Jha, A. K. (2016). Association between the Centers
for Medicare and Medicaid Services hospital star rating and patient outcomes. JAMA
internal medicine, 176(6), 848-850.
Wunsch, H., Gershengorn, H. B., Cooke, C. R., Guerra, C., Angus, D. C., Rowe, J. W., & Li, G.
(2016). Use of intensive care services for Medicare beneficiaries undergoing major
surgical procedures. Anesthesiology: The Journal of the American Society of
Anesthesiologists, 124(4), 899-907.