Ch8 Flashcards
rationing
interest is renewed in rationing bc of increased healthcare spending; implies reduced access to care and decreases in acceptable quality of services offered
access to care barriers
insured not approving or covering for care
preexisting conditions
physicians refuse insurance plan
childcare needs hinder ability to go to dr to seek care
current trends
Given that economics in general and health care economics in particular are concerned with resource use and decision making, any discussion of the economics of health care must consider past and current health care spending.
Past spending reflects past decision making; likewise, past decisions reflect the values and beliefs held by society and policy makers that undergird policy making at any given point in time.
the science concerned with the use of resources (producing, distributing, and consuming resources)
economics
concerned with how scarce resources affect health industry
health economics
affects resource allocation in healthcare
uninsured
provide services to uninsured or under insured
safety net providers
who is most likely to be uninsured?
low paying or part-time jobs, small biz, children-medicaid, elderly-medicare, those working for big companies have employer-sponsored health insurance
primary determinant to health care
ability to pay for services
healthy people 2020 goals
strategies to provide better access for all people
teen mom- long term primary prevention measure to break cycle of poverty what do you do?
encourage education to break the cycle
What level of prevention are most healthcare dollars spent?
secondary and tertiary care (only 3% is spent on primary care)
work with legislators and insurance companies to provide coverage for health promotion to reduce the risk of disease
primary prevention
provides hospital insurance and medical insurance to persons aged 65 years and older, permanently disabled persons, and persons with end-stage renal disease
medicare
primarily financed by federal payroll tax that is paid by employers and employees. The proceeds for this tax go to the hospital insurance trust fund, which is managed by CMS. Available to ALL persons eligible to receive medicare
part a
requires a deductible from recipients for the first 60 days or services with a reduced deductible for 61-90 days of service, based on a rate equal to a 1 day stay at a hospital.
Medicare Part A
supplemental (voluntary) program available to all eligible to Medicare, but must pay a monthly premium. Majority of medicare covered persons elect for this coverage. Provides coverage for lab services, ambulation transport, prostheses, equipment, and some supplies
Medicare Part B
purpose was to shift const incentives away from providing more care toward more efficient services
prospective payment system that came about in 1983 as hospital and medicare costs rose
what is the basis for prospective reimbursement?
Diagnosis-Related Groups (DRGs)
provides financial assistance to states and counties to pay for medical services for poor older adults, the blind, the disabled, and families with dependent children
Medicaid
jointly sponsored and financed with matching funds from the federal and state govts
medicaid
the federal govt finances health services for military and dependent persons through
TRICARE
How poor must you be to qualify for Medicaid?
children under 6 and pregnant women under 133% of poverty level
major cause of rising health care costs
excessive and inefficient use of services in healthcare delivery
