Exam #3: Political Activism Flashcards
Cost of Healthcare
National Health Expenditure
- -2.8 trillion dollars in 2012
- -17.2% of GDP
National Health Expenditures by Category (2011)
Hospital care: 31.5%
Nursing home facilities and continuing care retirement communities: 5.5%
Physician and clinical services: 20.0%
Prescription drugs: 9.7%
Who pays for healthcare?
Self-pay Employee insurance Government --VA --Medicare --Medicaid
Private vs. Public
Households: 28% Fed. Govn't: 26% Private Businesses: 21% State and Local: 18% Private Revenues: 7%
Distribution of Costs
10% of population accounts for 63% of all healthcare spending
1% of population accounts for 21% of all healthcare spending
50% of population accounts for 3% of all healthcare spending
40% of Medicare Costs occur in last month of life
Federal Agencies: Department of Health and Human Services
Public Health Service Center for Medicare and Medicaid services (formerly Health Care Financing Administration) Administration for Children and Families Administration of Aging Office for Civil Rights
Agencies under Public Heath Service
Agency for Health Care Research and Quality
CDC
FDA
National Institutes of Heath (NIH)
Health Resources and Services Administration (HRSA)
Indian Health Services
Substance for Abuse and Mental Health Services
Agency for Toxic Substances and Disease Registry
Social Security
In 1935, Social Security Act
Amendments:
- -Old Age and Survivor’s Insurance
- -Unemployment compensation
- -Disability Insurance
- -Medicare
- -Medicaid
When was Social Security formed?
1935
Old Age and Survivor’s Insurance
Provides monies to workers or family upon retirement, disability, or death
2 companies: Social Security and Disability
Federal Insurance Contributions Act (FICA)
- -FICA rate (2014)
- ->7.65% up to max of $117,000
- ->self-employed 15.3%
In 2014, benefits sent to 55 million
Amount based on average earnings and length of employment
Retirement age: 62 with partial benefits
–trending to be 67 before you can receive full benefits
3% contributing to 1% receiving SS
In 2014, SS benefits were sent to how many million?
55 million
Disability Insurance
8 million receiving benefits
–around 70% of people are denied Disability Insurance (years of abuse of the program have led to strict Fed. regulations on who can receive it)
Qualifications:
- -covered by social security 5-10 years
- -physical or mental disability
- -unable to work
5 month waiting period
Paid to worker or dependents
Unemployment Insurance
Protect workers out of work through no fault of their own Governed by states Qualifications: --no work for > 1 week --able to work and take job --previous job ended through no fault
Do not have health insurance when collecting unemployment insurance
Supplemental Security Income (SSI)
Provides direct cash benefits to aged or disabled with decreased income
Amount based on need, not on contributions made throughout your lifetime
Somewhere between $400-$600/month
- -however if that parson is receiving food stamps from SSI they need to subtract that amount
- -so they’re usually earning about $100-$200/month
Sent out to 5 million people per year
Medicare
Established in 1965
Funds 20% of all health services
Provides health insurance to citizen or permanent residents over 65 who have worked at least 10 years (Part A)
Can purchase Supplemental Insurance (Part B) for additional cost
Medicare Part A
Hospital room fee is covered Deductive is $1216 per benefit period (2014) Will pay some nursing home costs Hospice care is covered for 210 days Home health services
When are most Americans automatically enrolled in Medicare Part A?
Once they turn 65
Medicare Part B
Purchased through a private entity
After $147 deductive, Part B pays 80% of all allowable expenses (2014)
–physician services
–labs
–durable medical equipment (braces, walkers, canes…)
–outpatient services
–prescription drugs not self-administered
Cost $104.90/month (2014)
Medicare Part C
Medicare Advantage Plans
- -available only in select locations
- -managed-care options run by private companies
- -provide a few additional services
- -high plan cost paid by all members, not just those in Medicare Part C
If you have Part A, you’re also paying for people to receive the extra services through Part C but you yourself are not receiving those benefits
Medicare Part D
Prescription Drug Coverage
- -complex regulations
- -monthly fee purchased from private plans
- -cost: $0-$50 per month with $310 deductible, patient pays 35% up to $2850. Then patient pays 47.5% (brand name) and 72% (generic) up to $4550 (gap, donut hole). After that, patient pays about 5% for drugs. (2014)
Going to be changing because of the Affordable Care Act
Medicaid
Pays or medical services for low income Program designated by each state Majority in managed care plans Does not cover all poor Major financial support for persons in nursing homes (up to 45% cost)
Medicare/Medicaid Legislation
Quality Improvement Organizations
The Health Care Quality Improvement Act
Medicare/Medicaid Legislation: Early 1980’s
Drastic cuts to Medicare and Medicaid
Prospective payment system developed
Diagnostic Related Groups (DRG)
Medicare/Medicaid Legislation: Results of Prospective Payment System (PPS) - DRGs
Shorter length of stay
Increased patient acuity
Nursing home admissions increased x3
Increased demands on family, community, and home-care provider resources
