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Medicare Versus Medicaid

← Comparison of Health Care Systems: United States and Japan

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Medicare Versus Medicaid

Introduction

Created in 1965, Medicare and Medicaid are government-funded medical programs established to meet individual healthcare needs of the elderly and low-income Americans. Due to the inability of these groups to purchase private insurance, the government put in place these social insurance programs to relieve the financial burden of medical care by sharing the cost among affluent and low-income Americans. Though Medicare and Medicaid provide medical insurance services, they differ in terms of coverage and scope of payments and have advantages and disadvantages in equal measure.

SWOT Analysis

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Strength

Medicaid is a federal program serving low-income Americans in every state. Since it is an assistance program, patients do not have to cover medical expenses, though at times, a little co-payment is required. The positive side of Medicaid is that it provides a package covering inpatient and outpatient care in addition to physician and other medical services (McFarland & Collins, 2011). In the event of the long-term care, Medicaid covers nursing home care for eligible patients as defined by each state. Furthermore, Medicaid provides for individual and supervisory care regardless of the need for skilled care. More so, it pays for patients who are receiving medical care in order to cope with impairment resulting from chronic diseases.

In contrast, Medicare is a federal program that provides coverage to Americans of 65 years old and above and citizens ofany age afflicted by the severe disability or being permanently morbid (Bubolz, Emerson, & Skinner, 2012). Being a federal program, Medicare policies are uniform throughout the United States. Another advantage of Medicare is that its plans are not claimed on a monthly basis. In other words, Medicare plans are $0 per month, while the maximum out or pocket coverage is $6700 per year (Bubolz, Emerson, & Skinner, 2012). This gives patients ample time to receive treatment without worrying about expenses on drugs as it also offers drug coverage. Unlike Medicaid, Medicare caters for the elderly population who may require gym services; it also includes gym discounts in its coverage. Furthermore, Medicare is flexible in that patients are allowed to switch to another plan in the event of open enrolment.  

Weakness

The negative side of Medicaid is that patients have a limited choice of medical facilities resulting in patients receiving services in low quality medical establishments thus being eventually unsatisfied. Similarly, long-term medical care is limited due to insufficient funding. This leaves patients who need long-term care at the crossroads thus being forced to look for the alternative ways to access treatment. As for Medicare, it also has its share of weaknesses. For instance, patients are required to participate in co-payment as well as pay insurance fees, which exerts pressure on citizens with financial problems (Bubolz, Emerson, & Skinner, 2012). It is challenging to choose a preferred plan because all the choices are almost similar.    

Opportunities

Medicaid has exploited the fact that many Americans have low incomes thus by them contributing a little amount, they in turn receive medical insurance. This has enabled many citizens to access medical care; if it was not for Medicaid, they could not afford to pay for it. Similarly, Medicare considered that elderly people as well as the disabled are prone to illnesses and thus developed a plan to cater for their medical care at the same time making some profits. The point is that since the people contributing to the medical insurance do not fall sick at the same time, some money can be invested.

Threats

With the emergence of numerous private medical insurance providers, Medicaid faces the risk of losing customers because some private insurers are more efficient and offer patients the chances to access medical services in a wide range of facilities of their own choice as opposed to Medicaid provisions. The same scenario applies to Medicaid as private insurance providers offer services not offered by Medicare (Konetzka, Karon, & Potter, 2012).

Conclusion

In essence, both Medicaid and Medicare relieve citizens of medical bills despite the numerous challenges they face. However, in face of private competitors, they ought to do more in order to retain customers. By using SWOT analysis to evaluate their services, they have the opportunity to review their strategies and address areas of weaknesses as they aim at providing better services to American citizens.

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