View on Medicare and Medicaid joining forces
It is essential to start by asking ourselves the definition of efficiency on cost, quality, as well as a quality improvement? This is mainly viewed to as cost per unit output in consideration of health care where value must be measured. In order to have an efficient Medicaid program, I believe that the program should have better results for a given spending level. It should also be assessed by conducting a spending comparison together with the results from the Medicaid program. HMOs is well known for having a restrictive type of health insurance. The subscriber’s choice to doctors is restricted together with networks in their hospitals (Carrasquillo et al., 2001). HMOs joining forces will assist if there are given choices of two to three HMOs being chosen form. Selection will aid Medicaid, and Medicare patients have an option of selecting their provider. Most of the states have contracted with private insurers to help in enrolling recipients from Medicaid in managed care plans: expenses are reduced as the governments try to coordinate care. HMO delivers compacted healthcare coverage that Medicaid plans have been motivated from; in return, the care is improved, whereas the majority of HMOs Medicaid lack comprehensive results on the performance reported. Taxpayers are left out with no objective since it is compared access in return. I would recommend for the initialization of planning and execution of thorough reporting so as consumers and taxpayers are paid better. There is a belief that physicians are less participating when the HMO program for Medicaid beneficiaries becomes mandatory. It is clear to all that there is a similarity between traditional HMO Medicare to the Medicare achieved care present previously.
Impact of Medicaid HMOs on Expenditure and Health Results
In the 90s, there was a shift in employer-provided insurance on health from the traditional fee for services plans to managed care plans-91%of the total employees covered in 1999 were registered in a managed care plan. Both the Medicare and Medicaid programs were accounting for five hundred billion per year spending together with seventy-five million in beneficiaries also shifted out to implement the managed care. Today, a third of both programs beneficiaries are registered in the managed care plan.
The shift to managed care was mainly motivated by these public programs that reduced the growth and level expenditure. Mark Duggan has examined the impact of HMOs Medicaid on health care results and expenditure. He clarifies that spendings can be lower in managed care without altering the quality. Nevertheless, it is possible for the managed care resulting in spending increase or fall in quality. The government can be charged by insures huge mark-up due to costs in case the bidding process tend not to be competitive. Providers may also fail to deliver critical services (Grabowski et al., 2017). Measuring the impact and effect of HMO participation can be a challenging task: This is because managed care plans enrollment is mostly voluntary.
Additionally, those enrolling may potentially differ in unobservable means from those not registered. Duggan escapes from this problem by utilization nineteen California counties mandates that needed a half of Medicaid beneficiaries to enrol HMO IN 1993. Participation in HMO is mainly based on whether the counties adopt a mandate.
By use of 300, 000 welfare recipients data, Duggan discovers that the average mandate impact is increasing spendings by twelve per cent. The increase may be as a result of higher payments to all providers and higher costs in administration. He also finds out that growth in spendings depends on the pre-mandate level of HMO penetration. Lack of increase in spendings to counties having a massive pre-mandate penetration may imply that the counties were paying HMO before and above costs.
In reference to the health outcomes, managed care plan results to a thirty% reduction in avoidable children hospitalization. Former results have been suggested to be as a result of treatment pattern changes rather than improved healthcare. A switch to a managed care plan may fail to decrease the mortality rate of infants or situations of reduced birth weight infants. Dugan concludes by stating that mandates which required Medicaid beneficiaries to shift to HMO failed to improve the efficiency of the Medicaid program (McBride et al.,2020). This is because they resulted in substantial expenditure increase with no illustratable improvements in quality.
References
Carrasquillo, O., Lantigua, R. A., & Shea, S. (2001). Preventive services among Medicare beneficiaries with supplemental coverage versus HMO enrollees, Medicaid recipients, and elders with no additional content. Medical Care, 616-626.
Grabowski, D. C., Joyce, N. R., McGuire, T. G., & Frank, R. G. (2017). Passive enrollment of dual-eligible beneficiaries into Medicare and Medicaid managed care has not met expectations. Health Affairs, 36(5), 846-854.
McBride, K., Bacong, A. M., Reynoso, A., Benjamin, A. E., Wallace, S. P., & Kietzman, K. G. (2020). Healthcare decision-making among dual-eligible immigrants: implications from a study of an integrated Medicare-Medicaid Demonstration Program in California. Journal of immigrant and minority health, 22(3), 494-502.