Medical insurance, part

Medicare A Federally administered health insurance program covering the cost of services for people 65 years of age or older, receiving Social Security Disability Insurance payments for at least two years, or with end-stage renal disease. Medicare consists of two separate but coordinated programs-hospital insurance (Part A) and supplementary medical insurance (Part B). Health insurance protection is available to insured persons without regard to income. 

Part B Medical insurance (Part B) that helps pay for doctors services and many other medical services and supplies that are not covered by hospital insurance... 

Historically, a lack of public insurance programs created obstacles to health care services. For those who could not afford to pay for private insurance, the costs associated with health care were larger than most could afford. After lengthy debate, the U.S. Congress passed legislation in 1965 that established Medicare and Medicaid. Medicare covers over 95% of the elderly in the United States as well as many individuals who are disabled. Coverage for the disabled began in 1973 and is divided in two parts 1) hospital insurance and 2) supplementary medical insurance. The total disbursement for Medicare in 1997 was 213,575 billion, and there were 36,460,143 enrollees, of which 32,164,416 were elderly. 

In health and mental health, social workers often serve as part of an interdisciplinary team and spend the most quality time with their clients. In all likelihood the social worker will be one of the first team members to become aware of regimen problems, possible side effects, or medication reactions. Social workers need to understand the antidepressant medications their clients are taking and assist with compliance issues, pharmacy shopping, side-effect profiles, and medication insurance coverage, as well as providing education information and support. 

Medicare a nationwide, federally-administered health insurance program which covers the costs of hospitalization, medical care, and some related services for eligible persons. Medicare has two parts Part A covers inpatient costs. Medicare pays for pharmaceuticals provided in hospitals, but not for those provided in outpatient settings. Also called Supplementary Medical Insurance Program. Part B covers outpatient costs for Medicare patients. 

Medicare Part B which provides medical insurance for physician s services, outpatient services, some mental health services, durable medical equipment, some preventive services, and home health visits not covered under Part A. 

Medical Programs. Large chemical plants have at least one hill-time physician who is at the plant five days a week and on call at all other times. Smaller plants either have part-time physicians or take injured employees to a nearby hospital or clinic by arrangement with the company compensation-insurance carrier. When part-time physicians or outside medical services are used, there is Httle opportunity for medical personnel to become familiar with plant operations or to assist in improving the health aspects of plant work. Therefore, it is essential that chemical-ha2ards manuals and procedures, which highlight symptoms and methods of treatment, be developed. A hill-time industrial physician should devote a substantial amount of time to becoming familiar with the plant, its processes, and the materials employed. Such education enables the physician to be better prepared to treat injuries and illnesses and to advise on preventive measures. 

In those jurisdictions where a formal workers compensation system is in effect, the compensation health records provide the most definitive information available because the medical, social, and work history of each employee who applies for workers compensation is investigated in comprehensive detail and is made available in large part to management. Currently, relatively few illnesses, as compared to injuries, are considered for workers compensation claims. However, if a cluster can be found with the same type of complaint, that information can be invaluable. Similar information can be obtained from private insurance companies who provide employee coverage in place of workers compensation. 

Patient data collection is an extremely critical component of a value-added service. The information collected provides pharmacists with important baseline and monitoring parameters for patients. The amount and type of information needed from the patient or other health care providers may differ depending on the service, but nonetheless, this information is the foundation on which the other components of the service are built. Forms can be developed to help pharmacists collect this information (see Figs. 25-2 through 25-4). In addition, some consideration should be given to how this information will be stored (e.g., paper charts or electronic patient database). The information that should be collected from the patient includes demographic information, medical history, family history, and medication history. Since some of the information may need to be collected from other providers and health care institutions, an authorization to release medical information should be signed by the patient and kept as part of the chart (see Fig. 25-5). Lastly, pharmacists should ensure that their site is in compliance with the Health Insurance Portability and Accountability Act (HIPPA) and reinforce to their patients that the information they provide is confidential and secure at the pharmacy. 

Medicare is an entitlement program and serves all eligible beneficiaries regardless of income or medical history Like Social Securify, Medicare is based on a system of social insurance. Medicare is composed of two programs. Medicare Part A covers inpatient care in hospitals and skilled nursing facilities. It also covers hospice care and some home health care. Part A is financed by a 1.45% payroll fax paid by bofh employees and employers (2.9% for self-employed persons). Currenf employers and employees pay for the health care of current Medicare beneficiaries, wifh the expectation that when they reach age 65 they will receive the same benefits. In the U.S., when people turn 65 years of age, they are automatically eligible for Medicare s Parf A, and they do not have to pay for the hospital insurance if they, or a spouse, paid Medicare taxes when they were working. 

Medicare Part B is a voluntary form of insurance, and beneficiaries choose whether to enroll in this part of Medicare. Parf B is financed parfly by a premium charged to the beneficiary ( 54/mo in 2002) and fypically is deducted from the beneficiary s Social Security check. The rest of Parf B funding comes from general federal fax revenues. Medicare Parf B helps cover physicians services, outpatienf hospifal care, and some ofher medical services not covered under Part A. Nearly 95% of Medicare beneficiaries choose to enroll in Part B because the federal government pays for 75% of the premium cost. Medicaid pays the Part B premium for low-income elderly. 

Certain insurers have a preferred ophthalmic medication formulary. These select drugs typically represent the result of a negotiated price between a pharmaceutical company and an insurance provider. These costsaving measures are an integral part of the health care industry and serve to keep costs manageable for the... 

The Medicare systems in China are as follows government-paid medical service for state functionaries and university/college students labor insurance medical service for employees of industrial, communication and other enterprises and various forms adopted on a voluntary basis for rural populations. Under the reforms of the healthcare system proposed by the Ministry of Public Health, co-payments were introduced in 10 provinces and cities for employees of state-owned institutions and enterprises to pay for part of their treatment, including drugs (IFPMA Compendium, 1994). Approval of drugs can be revoked after two years if no part of manufacture occurs in China (usually packaging). 

Most patients are used to providing this type of information for their doctor s office visits, but may question the pharmacist s need to inquire. The pharmacist should explain that updated information will assist in providing better care for the patient. For example, when a patient s insurance does not cover the medication the patient was prescribed upon hospital discharge, the cost may prevent the patient from taking the medication. Obtaining insurance information prior to patient discharge as part of the history can prevent this type of problem. 

Formulating the pharmaceutical care plan is a very important part of the outpatient neurological pharmacists duties. Special care must be taken to remove barriers to the patient obtaining the required medications. This may involve facilitating refill requests, obtaining insurance or health maintenance organization approvals for nonformu-... 

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