There are several sources of reimbursement for health-care service delivery in rural areas, which are primarily divided into public and private. For 1975-1976, general taxation accounted for $44,310 million for the United States; while public insurance accounted for $17,232 million; private insurance was responsible for $33,618 million; direct payment was responsible for $39,425; and, "Other" accounted for $4,427 million (Maxwell, 1981, p. 163). For the 1975-1976 period, the United States reimbursed health-care delivery at a rate of 42.7% public funds, with the remainder being private (p. 60). Finkel (1985, p. 4) reports that, for 1981 and 1985, the total (i.e., public and private) national health-care delivery expenditures equaled respectively $278,543 and $462,229. Lewis, Fein and Mechanic (1976, p. 144) report that Medicare and Medicaid are the primary public sources for reimbursement, while private sources include insurance companies, employers, and other entities.
Medicare was implemented subsequent to the enactment of the 1965 Social Security Amendments, Title XVII specifically, which modified the 1935 Social Security Act. While the 1935 Social Security Act expanded public health activities, among providing other socially-oriented services, the 1965 Amendments allowed for the provision of health-care services specifically for the elderly who receive Social Security. In addition, other individuals who are in the Qualified Railroad Retirement program, or who otherwise are entitled to Social Security assistance are eligible for the provision of health-care services through Medicare. In 1972, Medicare was amended to include individuals who are disabled and receiving Social Security. The Medicare reimbursement program is divided into Part A and Part B. The former allows reimbursement of health-care services through hospitals, nursing homes, and home health agencies, while the latter addresses out-patient physician and oth...