managed care & health care reform cost of health care $1.03 trillion in 1997 15% of gnp 4%-5%...
TRANSCRIPT
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Managed Care & Health Care Reform
Cost of Health Care
$1.03 trillion in 1997
15% of GNP
4%-5% annual increase in health care spending
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Division of Health Care Costs
Hospital care 34%
Physician care 20%– Together make up 54% of health care costs
Home Health care 3%
Public Health 3%
Research 3%
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The Uninsured
43.6 million in 2002
15.2% of population
1 in 7 uninsured
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Characteristics of the Uninsured
Born in America 12.8%
Naturalized citizen 17.5%
Not a citizen 43.3%
Blacks 16.9%
Hispanic 23.4%
White 54.3%
Other 5.4%
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Household Income for Uninsured
Under $25,000 23.5%
$25,000 - $49,000 19.3 %
$50,000 – 74,999 11.8%
$75,000 & over 8.2%
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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%
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Employment
Private sector 60.2%
Self-employed 12.7%
Public sector 5.5%
Unemployed 21.6%
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Health of Uninsured
No use of preventive health care
Seek treatment when illness more advanced
Receive inadequate care
Higher morbidity and mortality rates
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Response of US Government to Health Care Crisis
Retrospective payment system
Reimbursement per unit of service
Prospective payment system
Reimbursement based on average value of service
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Managed Care Plans
Characteristics
Prepaid health insurance plans
Health care providers accept lower payments
Gatekeepers to health care services
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Positive Influence of Managed Care Plans
Expanded role for nurses
Increased emphasis on health promotion & disease prevention
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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
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Employment Retirement Income Security Act (ERISA) 1974
Protects employer-sponsored pensions from litigation (HMO’S)
Racketeering Influence and Corrupt Organizations Act
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Health Insurance Accountability Act
Ensures can change jobs without losing health insurance coverage
Guarantees coverage for small companies & self-employed individuals
Provides new benefits for self-employed
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Consolidated Omnibus Budget Reconciliation Act (COBRA) 1986
Provides insurance when unemployed
Event Beneficiary CoverageTermination or Employee, 18 monthsReduced hrs.Spouse, child
Divorce or Spouse, child36 monthsseparation
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Health Care Options
Maintain current Managed Care Plan option
Create National Health Insurance Plan (one-payer system or Universal Health Care)
Managed Competition