Healthcare Policy Evaluation Analysis – Medicare


Medicare is, arguably, one of the most successful healthcare policies in the history of the United States. Its relative success has often been attributed to its origins as a federal health insurance policy and the support it has received from successive administrations ever since its inception in 1965. Medicare comprises of a three-pronged approach that seeks to improve the provision of hospital insurance, medical insurance, and coverage for prescription medication to vulnerable sections of the American population.

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How was the success of the program or policy measured?

Proponents of Medicare today cite senior citizens, middle-aged individuals living with various forms of disability, and those with permanent kidney failure as vulnerable segments of the general population who benefit the most from Medicare’s comprehensive health insurance coverage. For instance, inpatient services provided in hospice care benefits low-income earners; allowing them to receive comprehensive access to healthcare (Moon, 2018). The success of the Medicare program was, therefore, measured through its ability to provide insurance cover to retirees, the disable, and individuals with advanced cases of kidney failure while promoting the implementation of related services to boost preventative care.

How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?

Since its inception in 1965, the Medicare program has been hailed for it success in promoting key aspects of universal care and its reach within the American population. Current estimates place the total number of individuals covered by the program at 42 million, with the number projected to experience further growth within the coming decade (Moon, 2018). Its success within a relatively short period is mostly attributed the dedication of policy makers from the Department of Health and Human Services (HHS) whose primary focus was on increasing the population of vulnerable segments of society covered by the policy. This has had a significant impact in the United States. Benefits of Medicare are now evident in the reduction the population of American citizens living under the poverty line, an overall improvement in the quality of care provided by major healthcare providers due to an overall circulation of financial resources. Its success was largely gauged using client satisfaction as a useful parameter in gauging overall success within a specified period. The results have been commendable. Medicare is rated highly by its clients and often recommended in mainstream society compared to acclaimed insurance providers.

What data was used to conduct the program or policy evaluation?

Life expectancy and the functional basis of the populations covered by Medicare formed the basis of its evaluation. For instance, the disabled and elderly are disproportionately affected by chronic health conditions such as hypertension, cardiovascular disease (CVD), and diabetes (Schmeida & McNeal, 2013). Medicare’s success can, therefore, be ascertained from data gathered from the number of vulnerable patients whose outcomes and quality of life are greatly improved by services offered under the program and the level of satisfaction recorded among patients. This data was, therefore, instrumental in painting a complete picture of health coverage under Medicare to the disabled, the elderly, and those with chronic health conditions.

What specific information on unintended consequences were identified?

The main unintended consequence of the widespread implementation of the Medicare services was an increase in the cost of crucial medications such as those prescribed for patients with bladder cancer. This reality first became apparent between 2004 and 2006 when patients were treated to unprecedented changes in the cost of office-based prescribed medications that are normally recommended by physicians (Elnour et al., 2015). Although the full extent of its impact is yet to be documented comprehensively in peer-reviewed journal articles, complaints lodged to the Centers for Medicare and Medicaid Services indicate that a considerable population of patients suffering from bladder cancer were affected by this new directive which ultimately hindered access to specialized care.

What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.

Medicare is based on an elaborate structure and system also tasked with the responsibility of evaluating and reviewing the program. Major stakeholders responsible for conducting the preliminary evaluation include federal and state actors such as executives from Agency and Medicare, state Governors, healthcare providers, the legislature, and patients. Each of the stakeholders play an autonomous and invaluable role in the evaluation to ensure the Center for Medicare and Medicaid Services receives a complete and truthful overview of the services provided and their quality. The reporting then benefits a number of groups. They include senior citizens, persons living with intellectual or physical disabilities, those with a psychiatric problem, and those unable to secure private insurance. Each state is evaluated on the basis of the quality of services offered and whether the framework implemented in each of the jurisdictions identified promotes patient outcomes.

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Did the program or policy meet the original intent and objectives? Why or why not?

The current position of Medicare as the most popular federal healthcare insurance provider is evidence of its success and ability to meet set objective. It succeeded in insuring senior citizens, the disabled, those living under the poverty, individuals deemed ineligible to receive private insurance coverage, and patients with end-stage renal diseases (ESRD) (Wells & Root, 2015). Furthermore, the Center for Medicare and Medicaid Services has been actively involved in patient education campaigns while promoting preventative care in order to curb the emergence and proliferation of chronic diseases. The program has also succeeded in dramatically reducing the number of uninsured people living under the poverty line across all states within the United States.

Would you recommend implementing this program or policy in your place of work? Why or why not?

Yes, I would recommend the implementation of Medicare in my workplace environment. It is deeply entrenched in providing healthcare service to vulnerable sections of society. I would particularly recommend it within the context of my workplace environment, especially as a significant healthcare program that addresses the immediate needs of employees after retirement.

Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after one year of implementation.

Nurses can also play a significant role in evaluating perceived benefits introduced by a given healthcare program. This can be done by conducting a comprehensive review of the actual quality of the services provided and the cost of office-based prescription drugs. The quality of healthcare services can be assessed by interviewing patients and assessing their review of the services offered and whether they met their expectations (Bury, 2012). This will provide a complete picture of the overall effectiveness of recommended services, their impact in reducing hospitalization stints and improved patient outcomes. Similarly, the cost of office-based prescription drugs is an important indicator of whether the program has succeeded in its plan to reduce the overall cost of medications on offer.

General Notes/Comments

Medicare is one of the most impactful healthcare programs ever implemented in the United States. It has had far-reaching consequences for at-risk populations within the United States and has steadily sought to address the disproportionate provision of healthcare services across the board. Medicare has, therefore, become one of the most iconic healthcare programs in the United States due to its focus on the provision of cost-effective care while also striving to reduce the population of ineligible persons living under the poverty line.

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