Post on 31-Dec-2015
transcript
Managed Care & Health Care ReformCost of Health Care
$2.4 trillion in 2008 ($7.900 per person)
17% of GDP US
10.9% Switzerland
10.7% Germany
9.7% Canada
9.5% France
Cost of Health Care (cont.)
4%-5% annual increase in health care spending in US
Employer health insurance increased by 5%
• Two times rate of inflation
Annual premium for family of 4 = $12,700
Health care spending 4.3 times that spent on national defense
Division of Health Care CostsHospital care 34%
Physician care 20%
• Together make up 54% of health care costs
Home health care 3%
Public health 3%
Research 3%
Health Insurance Costs Employer-based health insurance increased
by 5% (2008)
Employer health insurance plan for family of 4 = $12,700 (2008)
Workers contributed $3,400 or 12% more in 2008
Average employee contribution increased more than 120% since 2000
Health Insurance Costs (cont.) Average out-of-pocket costs for deductibles,
co-payments for medications, co-insurance for physician and hospital visits rose 115% since 2000
Health insurance expenses fastest growing cost component for employers
Health care costs have increased 10-12% annually; inflation increases 2-3% annually
Impact of Rising Health Care Costs Increase in bankruptcy filings
Average out-of-pocket medical debt was $12,000
68% of those filing for bankruptcy had health insurance
50% of all bankruptcy a result of medical expenses
Every 30 seconds in US someone files for bankruptcy after serious health problem
Impact of Rising Health Care Costs (cont.) 1.5 million families lose homes to foreclosure every year
due to unaffordable medical costs
US has $480 billion in excess spending compared with Western European nations with universal health insurance coverage
• due to excess administrative costs and poorer quality of care
US spends 6 times more per capita on administration of health care system than Western European nations
Characteristics of the UninsuredBorn in America 79.0%
Not a citizen 21.0%
Blacks 15.0%
Hispanic 30.0%
White 48.0%
Other 7.0%
Education of Uninsured
No high school 28.0%
High school graduate 18.8%
Some college, no degree 15.0%
Associate degree 12.1%
Bachelor’s degree & higher 8.4%
Uninsured in NCUninsured increased by 22.5% from 2007−2009
• Largest percentage increase in US
Estimated number of uninsured (1/09) 1.75 to 1.80 million
• This is 21.2% to 21.7% of all non-elderly North Carolinians
Five Largest Percent Increase in Uninusred
State Percent Growth in Uninsured (2007-2008)
North Carolina 22.5
Rhode Island 22.3
Indiana 22.0
Nevada 21.0
Michigan 20.2
United States 13.7
Health of UninsuredNo use of preventive health care
Seek treatment when illness more advanced
Deficits in cancer screening, cardiovascular risk reduction, and diabetes care
Receive inadequate care
Less likely to see a physician when needed
Less likely to receive routine checkup
Higher morbidity and mortality rates
Response of US Government to Health Care CrisisRetrospective payment system
Reimbursement per unit of service
Prospective payment system
Reimbursement based on average value of service
Managed Care PlansCharacteristics
Prepaid health insurance plans
Health care providers accept lower payments
Gatekeepers to health care services
Positive Influence of Managed Care Plans
Expanded role for nurses
Increased emphasis on health promotion and disease prevention
Possible control of health care spending
Negative Influences of Managed Care Plans
Built incentive to limit referrals to specialists
Physicians leaving medicine
Most are for-profit organizations
Limited ability to sue managed care organizations
Employment Retirement Income Security Act (ERISA) 1974
Protects employer-sponsored pensions from litigation (HMO’S)
Racketeering Influence and Corrupt Organizations Act
Other Health Care Reform EffortsHealth Insurance Accountability Act (1997)
• Ensures those with medical conditions can change jobs
• Guarantees workers at small companies will not be rejected for coverage
• Provides benefits for self-employed
COBRA
Prescription Drug Reform (Part D of Medicare)
Consolidated Omnibus Budget Reconciliation Act (COBRA) 1986
Provides insurance when unemployed
Event Beneficiary Coverage
Termination or Employee, 18 monthsReduced hrs. spouse, child
Divorce or Child 36 monthsspouse separation
Health Care Reform OptionsMaintain current Managed Care Plan option
Create National Health Insurance Plan (one-payer system or Universal Health Care)
Managed Competition
HR3590 Patient Protection and Affordable Act
No changes to current health plan if satisfied
If no insurance, will have affordable choices
Three main objectives of the reform
• Adopt state-of-the-art health information technology systems
• Ensure patients receive and providers deliver best care including prevention and chronic disease management
• Reform health care market to increase competition
HR3590 Patient Protection and Affordable Act Health insurance Expansion of coverage Health insurance market reforms Consumer choice through health benefit exchanges Shared responsibility for health care (individuals) Other provisions
• Improved access to Medicaid
• Enhanced support for Children’s Health Insurance Program (CHIP).
• Improving Medicare for patients and providers• Medicare Part D improvements (Prescription drug plan).