Chapter 15 Flashcards
4 Major Problems in U.S Healthcare Delivery
- Rising healthcare expenditures
- Large number of uninsured in the population
- Considerable waste and inefficiency
- Harmful insurer practices
Reasons for increase in spending
- Advances in technology - over 1/2 of the cost increases
- Cost insulation because of 3rd-party players
- Employer-sponsored health insurance
- Fee-for-service defects
- High administrative costs
- Lack of transparency in the cost and quality information
- State mandated benefits
- Cost shifting by medicare and medicaid
- Rising prices in the healthcare sector
- Defensive medicine (avoid malpractice)
Why are people uninsured?
- High cost of coverage
- Loss of job leading to loss of health benefits
- Loss of medicaid coverage or ineligibility for coverage
- People not aware of subsidies under ACA
Sources of wasteful spending include:
- Duplication of tests
- Medical errors that are largely preventable
- Unnecessary tests - fear of lawsuits
- High admin costs and excessive/redundant paperwork
- Readmissions into hospitals because of inadequate or ineffective initial treatment
- Hospitalizations for preventative conditions
- Fraud and overbilling by healthcare providers
- Overuse of expensive medical tech. and emergency rooms
Examples of harmful insurer practices
- Exclusions for preexisting conditions
- Recession of insurance contracts to limit benefits
- Lifetime or annual limits on benefits
Long-Term Care Insurance
Pays a daily or monthly benefit for medical or custodial care received in a nursing facility, in a hospital, or at home
Two Types of Coverage
- Reimbursement Policies
- Indemnity Policies
Reimbursement Polices
Policies that reimburse for actual charges up to a daily limit which can range from $50-$350 or more
Indemnity Policies
Pay a flat dollar amount per day regardless of actual expenses
LTC insurance policies cover a wide range of services including:
- Nursing home care
- Home healthcare
- Hospice care
- Personal care in the home
- Services in assisted living facilities, adult daycare centers, and other community services
Individual Disability-Income Insurance
Inability to perform the material and substantial duties of your occupation, and are not engaged in any other occupation
Partial Disability
Perform some but not all of the duties of your occupation. Insurance benefits at a reduced rate for shorter period
Residual Disability
Applies when you are gainfully employed and not totally disabled but, solely because of sickness or injury, your loss of income is at least 15% of your prior income
Benefit Period
Length of time that disability payments are payable after the elimination period is met
Elimination Period
Time benefits are not paid
