Financing Health Care

FinancingHealth Care

FinancingHealth Care

Q1.How hospitals compare to the national benchmarks

Hospitalsin New Jersey use Hospital Compare, a consumer-oriented website, tooffer information on how they provide health care to their patients.They compare themselves with other different hospitals, as well astheir services (Centres for Medicare and Medicaid Services, n.d).

Q2.How and why may a consumer or a health care professional use thisdata to make a decision about their next hospitalization?

Theinformation provided by Hospital Care is important to consumersbecause it helps them to make informed decisions about their healthcare. For instance, the information helps them to select multiplehospitals, as well as directly compare their performance relating tovarious diseases such as heart attack, surgery, pneumonia, amongother conditions.

Q3.Will reporting this data have an impact on hospitals bottom line inaddition to financial penalties from CMS?

Yes.Reporting data have an impact on the hospital bottom line. Medicareimposes a financial incentive and a financial penalty on thehospitals with low and excess readmissions respectively. Likewise,the reported data has a significant impact on hospital bottom line.It is expensive and unaffordable procedure for most hospitals toimplement effective readmission reduction strategies, as well asemploy nurses to follow up their patients after discharge. Medicaredoes not provide any payment for services that prevent readmissionshence, the additional costs raise doubts on the cost effectivenessfor the hospitals to avoid penalties (Centres for Medicare andMedicaid Services, n.d).

Q4.Examples of how data may be used and what type of impact if may haveif at all on the hospitals

Thedata submitted in the Hospital Compare website can be used foranalysis. For instance, in 2013 CMS used the data to estimate thenumber of penalized hospitals. Additionally, this data offer anopportunity for policy makers to accelerate quality care based on sixdimension- patient centred, safety, timely, effective, efficient, andequitable.


Centresfor Medicare and Medicaid Services. (n.d.). Hospital Compare.Retrieved May 1, 2015, from

Financing Health Care

FinancingHealth Care

FinancingHealth Care


Foran individual to qualify for Medicaid benefits in New Jersey, onemust be a US citizen, national, qualified alien, or a permanentresident, a resident of the New Jersey state, in need of insurance orhealth care assistance, and his or her financial situation fallsunder low income. In addition, the person should either have disabledchildren, responsible for children below eighteen years or be apregnant woman (Medicaid Program n.d).


Theeligibility requirements are reasonable. This is because it benefitsthe poor people who would otherwise not be able to cater for theirhealth expenses. For instance, the disabled and the aged who cannoteven work and make a living.


TheMedicaid coverage is reasonable. At least, it has extended thebenefits to people who lose assistance. For instance, people who loseSSI because of increased social security benefit such as disabledwidows and widowers, disabled children, and the blind people. Thesepeople are eligible for Medicaid up to the time they qualify forMedicare.



Peopleunder Medicaid have access to the health care. Without Medicaid, mostpeople under it would go without specialized health care due to theirlow-incomes. Additionally, practitioners have guaranteed payment fromthe government. Finally, there is a steady customer base. Therefore,practitioners who accept Medicaid count it as a long-term source ofincome.


Thetwo main drawbacks of Medicaid are the coverage and reimbursements.It does not cover all treatments especially the unnecessary andexperimental. Consequently, these can cause problems, and it requiresa patient to seek verification from Medicaid administrators on thenecessity of the procedure. Further, the Medicaid reimbursement isnormally low than the practitioner’s charges. In addition, thereimbursement takes several weeks hence, not suitable forpractitioners who need quick payment to cater for operating expenses.


MedicaidProgram (n.d). – New Jersey Medicaid Program. (n.d.).Retrieved May 1, 2015, from