The Main Issues of Medicare

Introduction

The main two issues with Medicare are manifested in the fact that it is vulnerable and adjusted for an ever-growing older population. This means that there will be an increased number of people with chronic conditions, which require inpatient services, outpatient options, and prescription drugs or medications. As an advanced practice nurse, it will be a challenge to properly treat and oversee older patients with special needs of health support and medical supervision.

The issues of Medicare

The first issue is that Medicare Part A and B include outpatient and inpatient services, but do not cover medication costs. It is because the latter option is assigned to Part D, and it offers prescription drug benefits alongside pharmacies on retail. Medicare part A includes inpatient care in a skilled nursing facility (SNF), home health care, and inpatient hospital care. To be eligible for premium-free Part A, an individual must be insured based on his or her earnings or those of a spouse, parent, or child.

Part B includes physician services, ambulance, and hospital outpatient services. The reason is that Part B is a non-obligatory program, which demands the monthly payment on premium. Therefore, individuals who do not wish the given coverage might reject the procedure of enrollment. However, it also might give penalties if these people choose Part B after selecting the other options (“MLN web-based training,” 2019).

Therefore, there is a problem of people who require the benefits of both options but cannot afford it due to the population-wide aging. Older people gradually lose competence and capability in the job market, which will lead to an inability to afford premium options, such as a Medicare Advantage plan.

Aging is a step-by-step process, and at first, the proportion of children increases due to a decrease in child mortality, and then, the proportion of the able-bodied population grows, but the birth rate declines. The number of older adults is estimated to double within the next decade (Cotton et al., 2016). Fertility is lowering either due to birth control or due to consumption among the adult population. At the last stage of the country’s aging, the proportion of the elderly population grows. The period with a high proportion of the working-age population has a decisive influence on the development of the economies of countries.

The process of demographic aging is irreversible, and the state can stimulate an increase in the birth rate. One of the consequences of aging is the presence in the labor market of a large number of different age groups. Physical abilities differ among age groups, and work experience is significant in the field of mental labor, whereas physical strength does not play a decisive role. Therefore, the main competition may arise for vacancies in the field of professions related to mental activity. Although objectively, due to age, even with experience, not all people due to health conditions can continue to successfully experience heavy loads, as in young years, even when practicing not physical but mental work. Different age groups of the population have different opportunities in terms of their participation in labor activities.

The second major issue is manifested in the fact that there is a tendency for an increase of people with chronic conditions, which are not related to aging. Examples are diabetes, obesity-related issues, and metabolic problems. Part C is Medicare Advantage, or MA plan includes both A and B. Part D is a prescription drug benefit, and retail pharmacies may enroll in Medicare to provide covered Part B services as a supplier. Pharmacies decide whether to contract with specific MA Plans or Medicare Prescription Drug Plans.

Medigap policies are additional privacy policies that can help to pay certain health care expenses that Original Medicare doesn’t provide. Beneficiaries who choose a Medicare Advantage plan mostly do not require and may not be able to buy a Medigap policy (“MLN web-based training,” 2019). The goal of preventive health care nurses is to improve patient health through evidence-based medicine recommendations while encouraging people to receive preventative services such as screening, counseling, and participation in a disease management program.

Through public health education, nurses can inspire a group of people to lead a healthy lifestyle and, ultimately, a long, quality life. Improving basic health indicators for chronic noncommunicable diseases, achieving patients at a target level, and supporting self-management of diseases largely depends on the participation of nurses. The participation of nurses in the medical care process is the most economically effective.

However, it should be noted that their actions in terms of medical care are limited. Obstacles to the full coverage of advanced practice registered nurse practices can adversely affect public health. The expansion of the powers of a nurse will lead to a decrease in the frequency of hospitalizations and will effectively affect the quality and cost of medical care. At the same time, it will positively affect patient satisfaction, clinical outcomes, and patient quality of life.

Preventive care

The main activity of nurses is to participate in preventive measures aimed at improving the health status of patients. Preventive care covers a wide range of methods. Nurses are actively involved in their implementation in medical organizations. Primary prevention is the measures and measures taken to provide people with the knowledge to prevent the occurrence of a particular disease. At this stage of prevention, nurses play the role of educators who provide information and consult with patients. Prevention programs, ranging from immunization to the use of seat belts, are aimed at avoiding the suffering and illness of patients, as well as avoiding any costs associated with treatment.

Secondary prevention – a form of early detection of diseases, identifies individuals with a high level of risk or preclinical diseases through screening and regular monitoring to prevent the occurrence of diseases. The nurse interacts with patients to reduce and manage controlled risks, advises on changing the lifestyle of patients, and applies methods for early detection of the disease at the initial stages when treatment can be more effective.

Regular examinations by a nurse are the most common secondary prevention method and can significantly reduce the development of certain diseases. Tertiary prevention – involves the treatment of existing diseases in patients. At this stage, the nurse draws up a care plan and makes additional changes to change the lifestyle. This type of prevention covers measures to prevent possible complications.

Conclusion

In conclusion, the issues regarding the Medicare program revolve around the topic of the growing older population and an increase of people with chronic conditions. Older people will become less suited for the job market, which will hinder their earnings and retirement-related finances. However, they will need the benefits of both the traditional options of Medicare, which includes Part A and B, as well as the Medicare Advantage plan for medications. In addition, patients with chronic diseases will have a wide range of necessities, which is not fully covered by static and inflexible Medicare options.

References

Cotton, P., Newhouse, J. P., Volpp, K. G., Fendrick, A. M., Oesterle, S. L., Oungpasuk, P., … Sebelius, K. (2016). Medicare Advantage: Issues, insights, and implications for the future. Population Health Management, 19(S3), S1-S8.

MLN web-based training. (2019). Web.