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					Unit 6 Presentation

     Presented by:
     Chris Bateman
     Kara Simmons
     Krystal Garlick
  Deanna Shallenberger
                    Medicare
• What is it?
   Federal Insurance program created by
    amendments to the S.S. Act.
• Who does it benefit?
   Persons 65 or older (before 2003, government report
    recommended 67 because system going bankrupt).
   Certain disabled persons younger than 65.
                2 parts of Medicare
• Part A – Hospital Insurance • Part B- Supplementary
                                      Medical Insurance
      Helps pay for…
                                       Helps pay for…
         • Inpatient hospital care
                                          • Doctors' services
         • Inpatient care in a
                                          • Outpatient hospital
           skilled nursing facility         services
         • Hospital care                  • Lab Services
                                          • Ambulance service
                                          • Durable medical
                                            equipment
                                          • & other medical services
                                            and supplies
More information at:
www.medicare.gov
                      Medicaid
• What is it?
   Cost-sharing plan between federal and state
    governments.
   Provides medical assistance for individuals and
    families with limited incomes and resources.
   52 million are eligible
     • People with jobs paying minimum wage who are below
       poverty but above cutoff are part of the 33 million +
       Americans who have no health insurance.
      Medicaid Qualifications
• How do you Qualify?
   Different state to state
   Can only qualify if more than one of the
    following statements are true.
        You have children and a limited income.
        You receive or are eligible for Supplemental Security
         Income (SSI).
        You’re a pregnant woman who meets income
         requirements. For ex: a family of 4 making $23,225 a year
         or less qualifies.
        Your family assets are less than $2,000.
        You receive adoption assistance or foster care assistance.
             Medicaid Services

•   Inpatient hospital services
•   Outpatient hospital services
•   Prenatal care
•   Vaccines for children
•   Physician services
•   Laboratory and x-ray services
•   And many more…look at www.freequotesusas.com
     Problems of Health Care

• Access, Quality, and Cost are major issues
 in any health care setting.

• Triangle analogy
                   Access
• Estimated 45 million uninsured or underinsured
  Americans.

• One in seven Americans don’t have even basic
  health insurance, which includes 8 million
  children.

• Massachusetts mandatory Health Care
          Right or Privilege?
• R.M. Sade quote:
 “ The concept of medical care as the patient’s
 right is immoral because it denies the most
 fundamental of all rights, that of a man to his own
 life and the freedom of action to support it.
 Medical care is neither a right nor a privilege: it is
 a service that is provided by doctors to others
 who wish to purchase it. It is the provision of this
 service that a doctor depends upon for his
 livelihood”.
                  Quality
• Institute of Medicine reported in 1999 that
  medical errors take from 44,000 to 98,000
  lives each year.
• Medical errors are the leading cause of
  preventable death in the United States.
• Burden on society is greater when fatal
  and nonfatal errors are combined.
Cost
            Cost continued

• Medical malpractice lawsuits drive the cost
  of health care up
• People in poverty lack a primary physician
  so they go to the emergency room
• Aging of the population
  HMO’s: Health Maintenance
       Organizations
• What do HMO’s offer?

• History

• Pro’s and Con’s
     Different Classifications

• IPA-Independent Practice Association

• Group Model

• Network Model

• Staff Model
                    PPO’s

• Stands for: Preferred Provider
 Organization

• Characteristics

• Pro’s and Con’s

				
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