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This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing.
Thanks to remarkable advances in modern health care attributable to science, engineering, and medicine, it is now possible to cure or manage illnesses that were long deemed untreatable. At the same time, however, the United States is facing the vexing challenge of a seemingly uncontrolled rise in the cost of health care. Total medical expenditures are rapidly approaching 20 percent of the gross domestic product and are crowding out other priorities of national importance. The use of increasingly expensive prescription drugs is a significant part of this problem, making the cost of biopharmaceuticals a serious national concern with broad political implications. Especially with the highly visible and very large price increases for prescription drugs that have occurred in recent years, finding a way to make prescription medicinesâ€"and health care at largeâ€"more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual's insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability issue will require considering all of these factors together. The current high and increasing costs of prescription drugsâ€"coupled with the broader trends in overall health care costsâ€"is unsustainable to society as a whole. Making Medicines Affordable examines patient access to affordable and effective therapies, with emphasis on drug pricing, inflation in the cost of drugs, and insurance design. This report explores structural and policy factors influencing drug pricing, drug access programs, the emerging role of comparative effectiveness assessments in payment policies, changing finances of medical practice with regard to drug costs and reimbursement, and measures to prevent drug shortages and foster continued innovation in drug development. It makes recommendations for policy actions that could address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care.
Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already existâ€"like evidence-based medicationsâ€"are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.
The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.
To provide effective service in helping people understand how they are going to be affected by health care reform and how to obtain coverage, pursue an appeal, or plan for long-term care or retirement, you need the most current information from a source you can trust - Medicare Handbook. This is the indispensable resource for clarifying Medicare's confusing rules and regulations. Prepared by an outstanding team of experts from the Center for Medicare Advocacy, it addresses issues you need to master to provide effective planning advice or advocacy services, including: Medicare eligibility rules and enrollment requirements; Medicare covered services, deductibles, and co-payments; coinsurance, premiums, penalties; coverage criteria for each of the programs; problem areas of concern for the advocate; grievance and appeals procedures. The 2019 Edition of Medicare Handbook offers expert guidance on: Medicare Enrollment and Eligibility Medicare Coverage in all Care-Settings Medicare Coverage for People with Chronic Conditions Medicare Home Health Coverage and Access to Care Prescription Drug Coverage Medicare Advantage Plans Medicare Appeals Health Care Reform And more! In addition, Medicare Handbook will help resolve the kinds of questions that arise on a regular basis, such as: How do I appeal a denial of services? What steps do I need to take in order to receive Medicare covered home health care? What are the elements of Medicare's appeal process for the denial of coverage of an item, service, or procedure? Does my state have to help me enroll in Medicare so that I can get assistance through a Medicare Savings Program? When should I sign up for a Medigap plan? If I am enrolled in Medicare, do I have to buy health insurance in the insurance marketplace created by the Affordable Care Act? Is it true that I have to show medical improvement in order to get Medicare for my nursing and therapy services? And more! The 2019 Medicare Handbook is the indispensable resource that provides: Extensive discussion and examples of how Medicare rules apply in the real world Case citations, checklists, worksheets, and other practice tools to help in obtaining coverage for clients, while minimizing research and drafting time Practice pointers and cautionary notes regarding coverage and eligibility questions when advocacy problems arise, and those areas in which coverage has often been reduced or denied And more! Note: Online subscriptions are for three-month periods. Previous Edition: Medicare Handbook, 2018 Edition ISBN 9781454884224
To provide effective service in helping people understand how they are going to be affected by health care reform and how to obtain coverage, pursue an appeal, or plan for long-term care or retirement, you need the most current information from a source you can trust - Medicare Handbook. This is the indispensable resource for clarifying Medicare's confusing rules and regulations. Prepared by an outstanding team of experts from the Center for Medicare Advocacy, it addresses issues you need to master to provide effective planning advice or advocacy services, including: Medicare eligibility rules and enrollment requirements; Medicare covered services, deductibles, and co-payments; coinsurance, premiums, penalties; coverage criteria for each of the programs; problem areas of concern for the advocate; grievance and appeals procedures. The 2020 Edition of Medicare Handbook offers expert guidance on: Medicare Enrollment and Eligibility Medicare Coverage in all Care-Settings Medicare Coverage for People with Chronic Conditions Medicare Home Health Coverage and Access to Care Prescription Drug Coverage Medicare Advantage Plans Medicare Appeals Health Care Reform And more! In addition, Medicare Handbook will help resolve the kinds of questions that arise on a regular basis, such as: How do I appeal a denial of services? What steps do I need to take in order to receive Medicare covered home health care? What are the elements of Medicare's appeal process for the denial of coverage of an item, service, or procedure? Does my state have to help me enroll in Medicare so that I can get assistance through a Medicare Savings Program? When should I sign up for a Medigap plan? If I am enrolled in Medicare, do I have to buy health insurance in the insurance marketplace created by the Affordable Care Act? Is it true that I have to show medical improvement in order to get Medicare for my nursing and therapy services? And more! The 2020 Medicare Handbook is the indispensable resource that provides: Extensive discussion and examples of how Medicare rules apply in the real world Case citations, checklists, worksheets, and other practice tools to help in obtaining coverage for clients, while minimizing research and drafting time Practice pointers and cautionary notes regarding coverage and eligibility questions when advocacy problems arise, and those areas in which coverage has often been reduced or denied And more! Previous Edition: Medicare Handbook, 2019 Edition ISBN 9781543800456