Health Systems Policy & Management (III) U.S. Healthcare

Question 1

What percentage of all U.S. health expenditures (17% of the GDP) go toward public health?

Answer 1

2% (0.34% of the GDP)

Question 2

What is the ACA Medicaid expansion?

Answer 2

An expansion of Medicaid to cover all individuals under 65 years of age and below 138% of the FPL.

Originally, the law only covered pregnant women, women, children, and some disabled individuals (impoverished men are now included).

Question 3

Have all states implemented the Medicaid expansion?

Answer 3

No, the SC ruled that it is not mandatory.

Question 4

If all states had implemented the Medicaid expansion, what estimated percentage of Americans would be covered by some sort of insurance (Medicaid or not)?

Answer 4

95%

Question 5

What is the percentage breakdown of types of insurance Americans hold?

Answer 5

Question 6

How is the Medicaid expansion financed?

Answer 6

The vast majority of funds come from the federal government.

Savings come through the associated reduction in costs of uninsured patients, which are more expensive than insured patients

Question 7

What was a vital part of the ACA that has now been neutered?

Answer 7

The individual mandate

Question 8

Are only the poorest of the poor uninsured in the U.S.?

Answer 8

No, ironically, it is the medium-poor

Question 9

What are methods of cost reduction in the U.S. healthcare system?

Answer 9

EHRs incentives and penalties (HITECH Act of 2009) → Both Medicare and Medicaid provide incentive payments and also payment penalties for failure to use

Value-based purchasing program → hospitals are rewarded based off their level of improvement over threshold of benchmark hospitals and also against the baseline set for each hospital as an individual entity (i.e. hospitals scored against each other and in their own improvement against their own baseline)

Payment reductions and penalties → excess patient readmission ratios leads to payment reductions

Question 10

What is the benefit of the ACA online healthcare exchanges?

Answer 10

It is a ‘single door’ to health coverage - the system also tells individuals if they qualify for Medicaid, tax credits, or unsubsidized exchange coverage in real time and allows for selection of these programs

Question 11

Individuals up to what percentage of the FPL can receive some federal subsidies on the healthcare exchanges?

Answer 11

400% FPL

Question 12

What are some required covered benefits the ACA mandates that insurers provide?

Answer 12

Preventive services, ambulatory services, emergency services, hospitalization, maternity and newborn care, mental health services, prescription drugs, rehabilitative services, laboratory services, and pediatric services

(every insurance plan in the country now covers these items)

Question 13

What are some benefits of the ACA?

Answer 13

• More covered benefits
• Remain on parents’ insurance until age 26
• No more denials or insurance policy cancelations based on health status or pre-existing conditions
• More community health centers

Question 14

Are insurance premiums increasing or decreasing (overall)?

Answer 14

Increasing

Question 15

Are the ACA healthcare exchanges becoming more or less competitive (are there more or less insurance options)?

Answer 15

Less competitive (less options available)

Question 16

Describe the U.S. medical system in general terms.

Answer 16

A loose, non-centralized system

Varying sponsors (private and public), providers (institutions and physicians), and access (by age, health, and economic status)

The third-party system isolates patients and physicians from the true costs of procedures so that it is difficult for anyone to make informed decisions based on actual costs

Question 17

Should the U.S. healthcare system adopt a model such as the Beveridge, Bismarck, out-of-pocket, or national health insurance models?

Answer 17

Not necessarily;

other countries’ successes and failures do not directly predict the success of a health system here. There are too many external factors that make countries different from one another (e.g. geography, size, demographics, morbidity, mortality, culture, political climate, wealth, etc.)