Women And Medicare: Implementing Preventative Health Policy

Women and Medicare:
Implementing Preventative Health Policy

Women and Medicare: Implementing Preventative Health Policy

Medicare is a federally funded health insurance program that provides coverage and benefits to nearly 50 million seniors and individuals with disabilities. If it were not for the assistance of Medicare, millions of Americans would not be able to afford testing, preventative services, hospital stays and physician care that is provided under this program. (National Women’s Law Center, 2012). In order to implement the policies that allow specific coverage to the beneficiaries under Medicare, there are three stages that must be followed: the formulation stage, legislative stage, and the implementation
stage. Currently there are over 22 million women collecting Medicare benefits. This includes older women and many younger women who have permanent disabilities. Medicare is available for women in order to provide affordable, low cost health insurance coverage. The costs that are covered under the program include hospital and physician care and other basic health services, but fail to cover the costs of many prescription drugs. (The Medicare Program, 2001). In the United States (U.S.) women typically live longer than men and because of that more than half of those on Medicare are women. As a matter of fact, fifty-seven percent of those on Medicare happen to be women. Because women have a longer lifespan on average, women rely on the coverage of Medicare benefits because they are more prone to multiple chronic disorders and other health issues such as heart disease, arthritis, and osteoporosis. Long-term care is also a necessity for many older women on Medicare. Women make up nearly seventy percent for both home health users and nursing home residents. (The Medicare Program, 2001). Many older women who have poor health are also living with low income households. Nearly two-thirds of the women on Medicare are living below the national poverty level. Those individuals with lower income qualify for more benefits under the Medicare program due to their living conditions. With statistics previously mentioned, it allows Congress to formulate policies to benefit as many individuals as possible. Policies are constantly being reviewed and considered to help improve the American Health Care system especially for health care plans like those for women under the Medicare plan. Each policy has the potential to impact each American on a daily basis, so careful consideration should be taken when policies are proposed. There are three stages that will be discussed in this paper on how policies become implemented. That includes the formulation stage, the legislative stage and the implementation stage. First, policies are passed down from the government entity, whether it is local/state or federal, to the Medicare program to enforce any health care policy that it implements.
Considering the Medicare program is funded by the federal government, Congress is the entity that will pass down and approve policy before it can be implemented. This first stage of implementing policy is called the formulation stage. The second stage is the legislative stage. In this stage, legislative intent is required to be translated into legitimate policy rules and guidelines. As aforementioned, Congress is the legislative body. In the final stage, effective policy implementation is established. This is where the actual policy is put into action under the Medicare program. One such policy that has been an issue for women is Medicare’s Prevention Policies. “The problem, simply stated, is how to modernize Medicare’s prevention policies to better promote health and prevent disease for its beneficiaries. The changes would be implemented through the use of clinical preventative services and other prevention strategies.” (Kamerow,
2008). Medicare is a funded by the federal government to formulate and implement policies. When Medicare was first created in 1965, the only services that were covered were diagnostic services and some treatment services. Medicare has been amended many times since it was founded. It was revised over and over to include additional services, where Congress gradually added different preventative services to benefit those with coverage. Due to the inconsistencies of Medicare coverage, the federal government has required the program to come up with a better action plan for creating a comprehensive prevention policy. In order to do this, Medicare must follow the three steps of implementing healthcare policy. The first stage is called the formulation stage in this process. By formulating an action plan, Medicare has enacted a Medicare Improvement for Patients and Providers Act of 2008. This allowed the United Stated Department of Health and Human Services (HHS) to add desired and necessary preventative services to the health care program without having approval from Congress first. This further provided Medicare the opportunity to implement many policies that will “modernize Medicare’s prevention policies.” “Clinical preventative services are interventions delivered in the health care setting designed to prevent or detect diseases before they can sicken or kill patients.” (Kamerow, 2008). There are four types of clinical preventative services that include screening tests, immunizations, counseling, and chemoprevention. Screening tests allow physicians to test women through mammograms and other screenings which would detect risks and disease so it can be treated and/or cured. Immunizations prevent disease by providing shots such as the H1N1 (or swine flu) vaccine. Third, counseling provides therapy to teach individuals to change their behaviors which could lower or eliminate risk and prevent disease. Finally, chemoprevention is the use of medication in order to postpone or prevent the onset of disease. It is through these preventative services that allow Medicare to lower risk factors in elderly women and women with disabilities. Although currently Congress does not have to necessarily approve these policies, the legislative stage plays a large role in implementing healthcare policy, especially in its earlier years. Between 1965 and 1980, Congress denied over 300 proposed bills for preventative services but finally in 1981 the first preventative service was approved and implemented: pneumococcal disease immunization. Since then, a few clinical preventative services have been added to Medicare plans through legislation. Then in 2005, Congress allowed Medicare to include a one-time “Welcome to Medicare” (WMV) visit. “The visit, which was advocated by Partnership for Prevention, was designed to include education and counseling, screening tests, and immunizations for persons enrolled in Medicare’s Part B.” (Kamerow, 2008). After the formulation stage and legislative stage of implementing health care policy comes the final stage: the actual implementation of the policy.
Medicare offers education and other strategies for implementing this policy for beneficiaries. Materials and pamphlets have been created through the “Medicare Learning Network” to assist individuals seeking information about what preventative services are covered as well as other important facts about recommendations and billing information. Furthermore, in order to implement these policies with physicians, Medicare provides incentives to doctors and health plans that deliver Medicare-covered preventative services. To push the education further, Medicare makes attempts at improving awareness among beneficiaries and providers about the Welcome to Medicare (WMV) visit. When first introduced, women only had 6 months to take advantage of this benefit. Currently, Medicare allows one year to use the preventative
services. Overall, women are major stakeholders in regards to Medicare coverage and the benefits this program provides. If it were not for the assistance of Medicare, millions of Americans would be without healthcare coverage and would not have the ability to afford testing, preventative services, hospital stays and physician visits that are provided. It is important for the government to consider the aging population and take into account that women make up the majority of those requiring assistance. Since women live longer and have been known to have more chronic health issues, things like long-term care and preventative services are needed more by millions of women. Through the three stages of implementing health care policy, Medicare can provide as many individuals with quality healthcare and include necessary preventative services that are needed by these millions of women.

References
Kaiser Family Foundation (KFF). (2001). Women and Medicare. The Medicare Program. Retrieved from http://kaiserfamilyfoundation.files.wordpress.com/2013/01/women-and-medicare- fact-sheet-2.pdf
National Women’s Law Center. (2012). The Importance of Medicare for Women. Retrieved from http://www.nwlc.org/resource/importance-medicare-women
Kamerow, D. MD, MPH. (2008). Modernizing Medicare’s Prevention Policies. Partnership for Prevention. Georgetown University, Washington, DC.