Class 1: 12Sep20 - Insurance Lecture Flashcards
What are the 3 components of the health crisis in the US dating back to 1976?
Cost, Access, Health Levels
How much is today’s healthcare cost of the overall national income?
20%
What are the main healthcare topics of debate?
Drug prices and health insurance
What are “new: tools to impact healthcare?
Economic tools, strategy. big data
What was Dave Ridley idea for a loaw and what it impacted
Priority review voucher for neglected diseases, each voucher >$100Mil
Avg. healthcare cost per person in US? whats the breakdown on contributins?
$10K ($1k out of pocket and $9k by a third party, taxes and with premiums by emplpoyeers and employers)
What is the issue with insurance and price sensitivity?
There are no STOPS for getting more services or higher cost ones
Who would be potentail players to set a top to high healthcare cost?
Payer (insurer/employer), Provider (doctor), Patient, Goverment?
What is CAPITATION with regards to healthcare provider costs?
A fix amount (budget) to spend on someone, but will provider then skimp on quality?
How many amerivcans get insurance from employers? and how many are not insured at all?
1/2 americans, less than 10% are not insured.
What is an insurance premium?
The fixed monthly payment to keep insurance. Employers tend to mapy most of it.
What is an insurance deductible?
The amount of care I pay per year before the plan kicks in
What is co-insurance?
The percentage of the care cost that I would pay (i.e 20%. Co-insurance is payment AFTER the deductible is met
What is the “Diminishing marginal utility of income”
Each extra $ of income makes us happier but at a diminingh rate
Describe and differentiate RISK AVERSION and LOSS AVERSION
Risk Aversion: Give up out later money to not lose it all (values her first dollar); Acceptlower incomr in exchange to eliminating possibility of no income
Loss Aversion: This person value his current wealth and frames LOSES based on his REFERENCE current/starting wealth
How does insurance benefot patients, providers, and insurers?
Patients pay a small amount to avoid a big loos; Insurers use the law of large numbers that allow pooling of risk and profits; Provides get reliable payments
What are two insurance problems?
- Adverse selection (those who need insurance, get insurance) this could cause the insurance market to unravel
- Moral hazard: people who get insurance ,use it- as theya re no tpaying the full cost
Why don’t healthy people not exit the insurance market?
- responsible and risk averse
2. receive tax advantages of empoyer-provided insurance ($10k in insurance or $7k CASH after tax)
Why may excepting tax from health insurance be unfair?
- disproportionat help to high incomes
- inefficint as it then makes health insurance on sale; you get more coverage and with that people become insensitive to health care costs. ->basically more bang for your buck and you get price insensitive
Why get insurance via employer?
- Untaxed when provided by emplpoyeer
- Employer has large risk pool to spread risk
- Large employeers are required to do this, per Affortable Care Act
How have HDHI (High decutible health insurance) helped on cost issues? how many people have it?
- It pushed cost to invidividuals to be more price sensitive
- Makes people shop around more, although no tmany providers are sharing cost info
- 1/4 of americans
- What are some ocncers with high decutible cost insurance plans?
- can people make health decisions?
- should yound people, who lean this way, have the oppotunity to opt-in to this degrees, unabalcnig the pools of older/sick inidivduals?
- overall savings seem not to be there, breakpoint is
$7k in costs. The top 5% spend $50/k per year abd that is 50% of the total spending
HDHI Pro and Con?
Pro: More efficient market
Con: Can’t ask patient to shop for health care, can’t trust them
Contarst Medicare AND Medicaid? How much of US fed budget is this? Which one covers long term care?
Medicare: [CARE]
- Regargeless of income, 65yrs +, 9 million disabled, if less than 65 (diability sociail security payments ongoing, kidney fail, ALS)
Medicaid [AID] [32 states and collab with Fed Govt.; 18sattes need extra conditions)
- Low income, aged, disabled, pregnant, children (CHIP)
Medicaid covers long-term care for low-income seniors, because Medicare does not cover long-term care.
Together this is 1/4 of Fed budget
