This 45 page paper explores the Balanced Budget Act of 1997, the prospective payment system instituted, and the effect on Medicare beneficiaries. Specifically, the writer offers a proposal for a study focusing on the increased costs for seniors as a result of the BBA and the PPS. An extensive literature review explains the changes in Medicare benefits as a result of the BBA, including the Medicare+Choice option now given to seniors. The PPS has had a dramatic impact on nursing homes and skilled nursing facilities. The caps placed on rehab services and the changes in federal Medicaid benefits have all combined to result in a greater proportion of out-of-pocket expenses for the Medicare beneficiary. Bibliography lists 22 sources.
Name of Research Paper File: MM12_PGmedcar.rtf
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that no doubt helped many seniors continue living. The Balanced Budget Act of 1997 included the first significant changes to the Medicare health insurance plan since its inception. The Act
was designed to offer seniors more choices in their health care plans, for instance, managed care plans were extended and easier to obtain. The Act also put into effect a
new payment system for health care providers called the prospective payment system. It is based on a complex series of calculations which looks at groups with the same illness or
incident rather than on each individual case. The data is also usually about two years behind in terms of costs for different services. The Act has, in fact, reduced certain
kinds of services to seniors which means that if they are to obtain these services, such as nursing homes and rehab therapy, they will have to pay for it themselves.
Out-of-pocket expenses increased by 4.4 percent between 1993 and 1997. It is hypothesized that seniors have experienced an even greater increase just since 1997. Prior to this legislation, between thirty
and fifty percent of the seniors income were going towards health care. It is expected that this proportion has also increased, especially among the low-income group. The investigator demonstrates how
a study can be conducted and makes conclusions based on the expected results. Logic suggests that if caps are placed on certain kinds of services and if hospitals and skilled
nursing facilities are receiving lower reimbursements, then the patient is the one picking up these costs. Even with the Medicare+Choice options, seniors are no doubt dedicating more of their income
to medical and other health related costs. Chapter 1: Introduction and Hypothesis Medicare is the largest single system of health coverage in the United States. Nearly 34
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