Medicare and Medicaid are two most popular policies used in the health care scenarios in the Unites States. Medicare is a national social insurance program initiated by the U.S. government that guarantees access to health insurance for Americans aged 65 and older, as well as young people with disabilities, irrespective of their income (McEachern, 2008). This policy serves a large number of elderly, poor, and low-income people many of who would be unable to afford health care otherwise. Medicaid, in its turn, is the United States health program for people and their families with low income and resources (McEachern, 2008). It is a means-tested program that is jointly funded by the state governments and managed by the US. People engaged in Medicaid are either U.S. nationals or legal permanent residents; they include low-income adults and children, as well as people with definite disabilities. The main distinction between these two programs is that Medicare was designed for old people mostly, whereas Medicaid can be used only by families with low income and insufficient resources. Though Medicare and Medicaid emerged at one and the same time, they have been growing and developing differently due to certain social, economic, and political factors that influenced their overall success and effectiveness.
Background: Insurance Referral and Provider Referral
The Players – Official and Unofficial
In the field of healthcare, people are dependent on references and always look for the best treatment. There exist two main types of referral: insurance referral and provider referral. It is often the case that certain insurance companies take care about the patient’s medical treatment. When there is some intermediary insurance firm involved in financing the references, it is called the insurance referrals; these are not always beneficial for the patients (“Insurance Referral Resources,” 2012). In most of the cases, insurance referrals can be regarded as unofficial players, because they are not directly involved in the healthcare official scenarios. Sometimes they have bonds with their own hospitals; in this case, they come under the official records of a healthcare organization. Medicare facilities and pharmaceutical companies are some of the official counterparts that are expected to be beneficial for the patients. They can be useful, but it is often that they do not solve the problem effectively. In the latter case, the patient suffers and the insurance company benefits.
In contrast, provider referral services take more care about the patients’ treatment than of the benefits of their own. Physician or provider referral services can be regarded as official players because they are more responsible when it comes to giving proper treatment to the patient. Generally, provider referral services give the patients full access to the name of a physician, his/her specialty, office telephone number, address and, if possible, even a website. Physician referral services may be volunteer organizations, companies that profit indirectly by the referral, companies that are paid by the physician or, more rarely, companies that are paid a fee by a prospective patient. These services are usually provided in conjunction with other patient-related …