MGT 388 Week 2 Audio Lecture

Information about MGT 388 Week 2 Audio Lecture

Published on August 2, 2014

Author: wholly

Source: authorstream.com

Content

Paying for Health Care: Paying for Health Care MGT 388 Understanding Health Policy, Chapter 2 Payers: Payers Out-of-Pocket Payments (OOPs) Individual Private Insurance Employment-Based Private Insurance Experience rating Community rating Government Financing Modes of Paying: Modes of Paying Government Financing Medicare and Medicaid Medicare Covers: All U.S. citizens over age 65 years Certain disabled persons under age 65 years All persons with end stage renal disease Medicare Part A: Medicare Part A Covers inpatient hospital services, hospice care, very limited skilled nursing facility care Has deductibles, copays No premiums Medicare Part B: Medicare Part B Is optional and has required premiums Pays physician services, certain outpatient care, certain home health care, physical therapy, durable medical equipment Has deductibles and copays Has a prescription drug program with deductibles and copays Medicare Does NOT Cover: Medicare Does NOT Cover Most over-the-counter drugs Acupuncture Dental care Health care outside the United States Hearing aid or glasses Routine physical exams or eye exams Medicare Options: Medicare Options Medigap policies: optional insurance policies sold by private insurers; cover some deductibles and copays, some cover other services. Medicare + Choice: optional managed care plans that Medicare recipients in which may enroll; operated by private insurers; variety of features; may cover otherwise uncovered services such as Rx drugs. OSF Care Advantage is a local example. Medicaid: Medicaid Health insurance for the poor Program operated by state governments under Federal guidelines Costs shared by both Federal and state governments CHIP: program started in Clinton administration to increase health insurance for children Medicaid: Medicaid Programs vary by state Typically pay for certain inpatient and outpatient care, prescription and some nonprescription drugs, physician services, nursing home care In traditional Medicaid, there are no deductibles or copays; in CHIP, there are both Traditionally a fee-for-service program in most states More are moving to managed care Burden of Financing Health Care: Burden of Financing Health Care Payments are classified as Progressive As income increases, percentage taken increases Federal income tax Regressive As income increases, percentage taken decreases OOPs Experience-rated health insurance Proportional Ratio of payment to income is the same for all income classes All taxes that finance health care Access to Health Care: Access to Health Care MGT 388 Understanding Health Policy, Chapter 3 Access to Health Care: Access to Health Care The ability to obtain health services when needed. Access to Health Care: Access to Health Care Barriers to Health Care Financial barriers Non-financial barriers Financial Barriers to Health Care: Financial Barriers to Health Care Lack of Insurance High cost of health insurance Destabilizing U.S. economy and work force Welfare reform Experience rating Administrative costs Financial Barriers to Health Care: Financial Barriers to Health Care Who are the uninsured? Financial Barriers to Health Care: Financial Barriers to Health Care What is the effect of health insurance on use? # of times a person accesses health care People without insurance People with insurance Financial Barriers to Health Care: Financial Barriers to Health Care Health Outcomes People with insurance People without insurance Financial Barriers to Health Care: Financial Barriers to Health Care What is the effect of Medicaid on health service use? What is the effect of Medicaid on health outcomes? Financial Barriers to Health Care: Financial Barriers to Health Care Underinsurance Catastrophic expenses Preexisting illness Services not covered Insurance deductibles and copayments Gaps in Medicare coverage Long-term coverage Non-Financial Barriers to Health Care: Non-Financial Barriers to Health Care Gender Race Access to Health Care: Access to Health Care Health Care and Health Status Income Race Access

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