Question

Compare and contrast each of the three questions related to Managed Care Organizations, Medicare, and Medicaid with one another and explain how they were similar and different to each other. Managed care organizations emphasize physicians' responsibilities to control patient access to expensive hospitalization and specialty care, a principle dubbed "gatekeeping." Some argue that "gatekeeping" is unethical because it introduces financial factors into treatment decisions. Others say it improves quality by promoting the use of the most appropriate levels of care. Medicare is an area that often gets overlooked and is seen as a burden financially. Discuss alternatives to ease the drain on Medicare resources. Medicaid is shouldering an ever-increasing burden of cost for long-term care for the elderly, with enormous impacts on state budgets throughout the nation. Discuss alternatives to ease this drain on Medicaid resources.

Answer 1

Managed care organization:- It is an organization which deals with or based on practices managed care principles. the main aim of MCO is to provide cost effective prices and proper medical care to the individual or society with the help of health plan. on the behalf of patients hospitals, doctors and other medical professionals are work together to provide facilities by health care organization.

MCO include a care branches to provide saftey and efficacy to the society with:

Physician, Integrated Delivery Organizations, Physician Practice Management Companies, Group Purchasing Organization, Physician-Hospital Organization management .

Gatekeeping : used in relation to health insurance, the term gatekeeper describes the person in charge of a patient's treatment. Anyone who receives health insurance coverage in the form of a managed care plan, specifically a health maintenance organization (HMO) plan.

Primary Care Physicians also called as Gatekeepers. Because the primary care doctor regulates where the patient can be referred, primary care has the ability to reduce unnecessary doctor visits, and thus, prevents unnecessary expensive visits to specialists.

Medicare :- Medicare is the government program that provides health care (health insurance)

Medicare is a federal health insurance program that provides benefits to seniors and those with disabilities and certain illnesses. Medicare has several parts. Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). Part A covers hospitals, nursing facilities, and home health services.

Medicade :- Medicade is a medical assistance program for low income adults.It covers a wide range of medical services, like doctor visit, hospital care , mental health services as well as rehabilitation services.

Difference between : Medicare and medicad

Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income.

Medicaid is a state and federal program that provides health coverage if you have a very low income. They will work together to provide you with health coverage and lower your costs

Medicaid resources:-  HIV Health Improvement Affinity Group, Diabetes Prevention and Management Affinity Group, Antipsychotic Drug Use in Children (ADC) Affinity Group.

The resourses is provided by the Centers for Medicare & Medicaid Services (CMS) to ease in care effectivness and cost effective rationals to the society.