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The Health Care Financing Administration (HCFA) was created in 1977 to combine under one administration the oversight of the Medicare program, the Federal portion of the Medicaid program, and related quality assurance activities.

Medicare provides health insurance coverage for people age 65 and over, younger people who are receiving social security disability benefits, and persons who need dialysis or kidney transplants for treatment of end-stage renal disease.

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Medicaid is a medical assistance program jointly financed by State and Federal governments for eligible low-income individuals. It covers health care expenses for all recipients of Aid to Families With Dependent Children, and most States also cover the needy elderly, blind, and disabled receiving cash assistance under the Supplemental Security Income Program. Coverage also is extended to certain infants and low-income pregnant women and, at the option of the State, other low-income individuals with medical bills that qualify them as categorically or medically needy.

The Medicare/Medicaid programs include a quality assurance focal point to carry out the quality assurance provisions of the Medicare and Medicaid programs; the development and implementation of health and safety standards of care providers in Federal health programs; and the implementation of the end-stage renal disease and the peer review provisions.

"I am so thankful for Care Credit. Because of you, I was blessed to be able to have skin removal surgery after large weight loss. I was able to have a mini tummy tuck, brachioplasty, medial thigh lift and extensive liposuction . I would never have been able to do this on my own without being able to finance part of my surgeries(3). These surgeries were not out of vanity but a need because after losing over 100 pounds, I was still having to buy clothing to accommodate the skin, not my new size!

"For sometime, I had to make tough choices on which health issues I could afford to address first, second, and third. I had to address my hearing by having a cochlear implant to be able to hear my students as I am a teacher. Next, I had to make sure I had glasses or contacts to see. Lastly, I had to put on hold needed dental care as I couldn't afford my hearing, eyes, and dental at the same time. With care credit, I am able to take care of all three. I thank God for Care Credit!!

The 2015 legislature and governor created a task force on health care financing to advise them on strategies to increase access and improve the quality of health care for Minnesotans. These strategies include options for sustainable health care financing, coverage, purchasing and delivery for all insurance affordability programs.

This succinct, engaging text for graduate and undergraduate nursing programs distills the complexities of health care finance, economics, and policy into a highly accessible resource that can be applied to any practice setting. It presents economic and financial dynamics in healthcare as a precursor to policy and advocacy in nurses. The second edition adds graduate-level considerations and is updated to reflect our current political and legislative landscape.

In today's evolving health care environment, when hospitals are struggling to maintain their margins in the face of rising costs, decreased payment and increased expectations for quality care outcomes, every health care clinical leader has increased accountability for bottom-line results.

To equip nurse executives for these challenges, AONL, in partnership with the Healthcare Financial Management Association (HFMA), offers a Certificate in Health Care Finance for Nurse Executives. The certificate program includes the two-day event, web-based learning and collaboration and individual project plan development.

The program is for nurse executives who have a strong foundation in nursing finance and are interested in knowing how to participate in discussions with CFOs, assess and justify requests, quantify clinical activity and spot profit drains.

The American Organization for Nursing Leadership is authorized to award 16 contact hours of pre-approved ACHE Qualified Education credit (non-ACHE) for this program toward advancement, or recertification in the American College of Healthcare Executives.

Healthcare Financial Management Association (HFMA) Educational Foundation is registered with the National Association of the State Boards of Accountancy (NASBA) as a sponsor of continuing education on the National Registry of the CPE sponsors. State boards of accountancy have final authority on the acceptance of individual course for CPE credit.

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Health financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. Today, millions of people do not access services due to the cost. Many others receive poor quality of services even when they pay out-of-pocket. Carefully designed and implemented health financing policies can help to address these issues. For example, contracting and payment arrangements can incentivize care coordination and improved quality of care; sufficient and timely disbursement of funds to providers can help to ensure adequate staffing and medicines to treat patients.

Knowledge of why people choose alternative arrangements, either in markets or through the political process, is one key to understanding the problem. In addition, choices with regard to the financing of health care are also crucial, because they determine methods of payment for health care, and payment methods in turn influence the supply decisions of health care providers. This creates an important connection between the financing of a health care system and its performance. The problems of financing and the links among financing, payment, and performance will constitute the core topics of International Journal of Health Care Finance and Economics.

The OECD countries finance their health care through a mixture of taxes, social insurance contributions, private insurance premiums and out-of-pocket payments. The various payment sources have very different implications for both vertical and horizontal equity and on redistributive effect which is a function of both. This paper presents results on the income redistribution consequences of the health care financing mixes adopted in twelve OECD countries by decomposing the overall income redistributive effect into a progressivity, horizontal inequity and reranking component. The general finding of this study is that the vertical effect is much more important than horizontal inequity and reranking in determining the overall redistributive effect but that their relative importance varies by source of payment. Public finance sources tend to have small positive redistributive effects and less differential treatment while private financing sources generally have (larger) negative redistributive effects which are to a substantial degree caused by differential treatment.

Overview: The Health Care Financing Administration (HCFA) is responsible for administering the Medicare program, provided for in title XVIII of the Social Security Act, and Federal participation in the Medicaid program. HCFA will spend approximately $84 billion for Medicare and $27 billion for Medicaid in 1988. Almost 400 million individual Medicare claims were processed in 1987.

The Medicare law provides coverage for broad categories of benefits, including inpatient and outpatient hospital care, skilled nursing facility care, home health care, and physicians' services. It places general and categorical limitations on the coverage of the services furnished by certain health care practitioners. Medicare payment is prohibited for any expenses incurred for items and services ''which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.'' HCFA regulations do not define "reasonable and necessary," and the regulations do not denote a process for how this term is to be applied.

The process used for making Medicare coverage determinations is largely a decentralized one. Most decisions are made by the 35 carriers, 54 fiscal intermediaries, and 54 professional review organizations (PROs) that contract with DHHS to review and adjudicate Medicare claims. (In general, carriers administer hospital services and related aspects of Part A of Medicare, intermediaries administer physician claims and other aspects of Part B, and PROs review appropriateness of services, utilization, and related aspects of delivery of services under Medicare.)

Although most "reasonable and necessary" coverage issues can be decided by contractors based on the Medicare statute, regulations, and policy precedents, some cannot be resolved without seeking additional expertise. Some 20 to 30 procedures per year are subject to a centralized technology assessment process coordinated by the HCFA Central Office. These issues are referred within HCFA to the Bureau of Eligibility, Reimbursement and Coverage (BERC), which assists in development of national policy on coverage, payment, and eligibility of services under Medicare and Medicaid.

Medicare coverage of drugs is treated differently from procedures. Current Medicare manual instructions provide for coverage of drugs that have been approved for marketing by FDA, except when a particular use has been expressly disapproved or withdrawn from the market by the FDA, or designated as not covered in a national HCFA instruction. e24fc04721