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

ANS : First let us briefly understand what is Managed Care Organizations, Medicare, and Medicaid.

• 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.
• A managed care organization (MCO) is a health care provider or a group or organization of medical service providers who offers managed care health plans. It is a health organization that contracts with insurers or self-insured employers and finances and delivers health care using a specific provider network and specific services and products.

Hence the third statement made in the question is a mistake as it is Medicare that provides health insurance to elderly.

Here are some statements that would bring out the contrast and similarities in the above three questions -

• While Medicare is a federal program, Medicaid is a state and federal program and MCO is a health care provider or a group or organization of medical service providers
• Also if seen from the perspective of the client seeking the services from Medicare and Medicaid is affordable than MCO
• But if seen from the perspective of the government, burden on budget of state and federal government decreases if a client opt for MCO services. Hence here is the answer to ease drain on Medicaid and Medicare resources.
• 'Gatekeeping' as mentioned in the question have it's own pros an cons, which will ultimately depend on the physician. This concept is not present i case of Medicare and Medicaid.
• But no matter the differences the ultimate goal of all three program/organization is same, i.e., to provide a wide variety of quality and managed health care services to enrolled client to keep medical costs down by various means.