Module11 Flashcards
Questions to consider when thinking about health care financing
Is the ability to have good health a right or a privilege?
Is the ability to see a Health Care Provider when you are sick a right or a privilege?
Is the ability to have health insurance a right or a privilege?
Should access to good health be dependent upon one’s ability to pay?
What is the individual’s responsibility for one’s health?
What is the government’s responsibility for its citizen’s health?
What is society’s responsibility for its members health?
What barriers are present that prevent people from attaining good health?
What important factors are influencing the demand for health care?
Demographics:
- Baby boomer life expectancy increased w/ more chronic disease as a result
- Foreign born population is growing
- US Household of 2 parent families decreasing, single parent families increasing
- Increased income inequality - urban population has limited incomes
- Limited health workforce
When discussing important resources for insurance, what are the two most importnat?
People
Money
What important factors are influencing resource allocation for insurance?
Public Insurance (Medicare and Medicaid)
Private Insurance (For Profit Health Plans Raise Premiums to increase profit margin)
Consumer Demands for access to health care
New medical technology
Overuse and Misuse of medical services
High administrative costs
Escalating prescription drug costs and utilization
Medical needs and demands of 77 million baby boomers
Uninsured
Populations living in poverty
What important factors are contributing to increasing health care costs?
Increase in chronic illness
People are living longer
Advances in treatments and therapies
Prescription Drugs: Including Direct to Customer marketing
Physician Salaries: Physician as an employee v Physician as self employed
Insurance company mergers: less competition existing
Moral Hazard
Being Uninsured (Ult. taxpayers have to pay through medicare/aid to offset)
Moral Hazard
When people have insurance they tend to use the health care system more frequently
they may engage in higher risk behavior because they have better access to the health care system
The majority of the uninsured are …
people in low-income WORKING families
Who is more insured, adults or children?
Adults are more likely to be uninsured than children, r/t limited availability of public coverage
0-18 get free insurances
Who has a higher risk of being uninsured than non-Hispanic whites?
POC
Hispanic People (insanely high uninsured rate)
Non-white races
Adults making under 21,000 a year have a high chance of being …
uninsured
75% of uninsured people are…
actually WORKING FULL TIME
because of this employment, they cannot get public assistance insurance
What are some reasons why people remain uninsured?
Expensive premiums
No insurance offered through their job
They may be in a state that did not expand medicaid
Undocumented immigrants are ineligible
A shift from supportive manufacturing jobs to non supportive service sector jobs
Shift from full time to part time employment
Decreasing unionization trends
Decline in real wages
What are some important trends in regard to the uninsured/insurance?
- Trend in uninsured relates to the economy. Number of uninsured people increased during recessions when people lose their jobs
- Public programs fill in some loss of coverage (decrease uninsured), but many adults are currently ineligible for them
- As the economy has stabilized recently, coverage losses have slowed
Reasons people state they are uninsured?
Cost is too high
lost job or changed employers
lost medicaid
employer does no offer or ineligible for coverage
family’s status change
no need for it
How does being uninsured affect people?
- 1 in 5 adults go without needed med care
- Deaths among uninsured adults (25-64) is 22,000 a year, while diabetics only have 17,500 in the same age group
- less preventive care –> diagnosed at more advanced disease stages –> tend to get less therapeutic care –> High mortality
- Controlling for age, race, sex, income: uninsured cancer patients are 1.6x more likely to die within 5 years than insured
What are age trends related to uninsured status?
People tend to be insured between 0-18
There is a spike in un-insurance at age 19 to age 30 and may not feel they need insurance
The amount of uninsured decreases slowly to age 64
Medicare kicks in at 65 and people are insured again
What are the financial implications of having high uninsured populations?
- Uninsured face bills they cannot afford
- Medical bills quickly translate into debt, since they have low/mod income with little to no savings
- Hospitals charge the uninsured higher rates than those paid by public programs or private health insurers due to the latter’s negotiations
- Hospitals and other providers raise rates to offset the costs of those that do not pay their bills
What is medical bankruptcy
bankruptcies from unpaid medical bills which effected 2 million people in 2013
This makes health care the #1 cause of such filings, and outpacing bankruptcies due to credit card bills or unpaid mortgages
How much of the population age 19-64 will struggle with health care related bills this year?
more than 20% (56 million)
How many adults with year round health insurance coverage will accumulate medical bills that they cannot pay off this year?
almost 10 million
Ways to pay for health care
- Self Pay
- Private Insurance companies
- Public or Government insurance programs
What kinds of private insurance companies are there?
- Managed Care Organizations (3: HMO, PPO, POS)
2. Indemnity Plans (ex: Blue Cross/Blue Shield)
What are important examples of public/government insurance programs?
- medicare
- medicaid
- child health plus
- veterans administration (VA)
- indian health service
- workers comp
Almost half of health insurance of the insured in the US is from …
employer sponsored health insurance