Economics of End Stage Renal Disease Term Paper

Pages: 3 (886 words)  ·  Bibliography Sources: 0  ·  File: .docx  ·  Level: Master's  ·  Topic: Healthcare

Economics of End-Stage Renal Disease

Major Reimbursement Mechanisms

health care delivery system has made vast changes throughout the history of its system of managed care. The majority of reimbursement spending is facilitated by the federal government and by the states via Medicare and Medicaid. These programs provide for some of the Long-Term Care services received by the geriatric population. The government programs of Medicare and Medicaid cover approximately 60% of LTC spending with private out-of-pocket payment providing approximately 33% (no reimbursement), and private health insurance coverage < 5% of LTC spending (Kovner, Knickman, Jonas).

In 2005, state operated Medicaid programs provided coverage for 44% of all nursing home expenditures (Catlin, Cowan, Heffler, Washington & National Expenditure Accounts Team, 2007). (Kovner, Knickman, Jonas) Individuals may qualify for Supplemental Security Income program benefits if they spend down their assets and qualify for Medicaid. Medicaid will then cover nursing home care for disabled individuals 65 and above within income limits 3x's the $623 monthly limit (Kovner, Knickman, Jonas)

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Home health care under Medicaid coverage is mandatory under federal guidelines if ordered by a physician for individuals deemed eligible to receive skilled nursing services (Kovner, Knickman, Jonas). Reimbursement under Medicaid for these services is 100% of cost when receiving the covered from social security. Medicaid does reimburse a high percentage without the social security benefit coverage.

Therefore, the major mechanism for reimbursement for end stage renal care and for long-term care is the government. Specifically, insurance coverage received along with any benefits from social security are additional reimbursement providers along with state and federal government coverage via Medicaid and Medicare, respectively.

The economics of providing ESRD treatment from the organizational POV

Term Paper on Economics of End Stage Renal Disease Assignment

From the organizational point-of-view, the economics of providing End Stage Renal Disease ESRD treatment is a net-positive economically speaking. Given the range of services and reimbursement provided for coverage of services provided by the organization, ESRD cases provide their organization with 100% reimbursement. Coverage includes the type of care found with geriatric patients receiving long-term care such as the activities of daily living or ADL's.

ESRD is covered by Medicaid and Medicare for reimbursement of all costs associated with care and for almost all ESRD patients, the Social Security coverage will also be received ensuring the patient pays zero out-of-pocket. Specifically, the variable costs for ESRD are a function of the variance from the mean cost of care for ESRD patients. The deviation for any one patient would equal the variance from the mean and therefore the variable cost function.

The fixed cost function for ESRD patients is ostensibly the same for all other patients. Therefore, a patient with a condition that does not receive full… [END OF PREVIEW] . . . READ MORE

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"Economics of End Stage Renal Disease."  Essaytown.com.  March 27, 2011.  Accessed February 26, 2020.
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