Prelim 1 Study Guide
Prelim 1 Study Guide PAM 3780
Popular in Comparative Health Care Systems
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This 12 page Study Guide was uploaded by Ashley Notetaker on Tuesday March 8, 2016. The Study Guide belongs to PAM 3780 at Cornell University taught by Nicolas Ziebarth in Spring 2016. Since its upload, it has received 46 views. For similar materials see Comparative Health Care Systems in Political Science at Cornell University.
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Date Created: 03/08/16
The HE Triangle 39 5 II 139 1 L171 1quot f a quotI quot IIquot I P vate heal i mammals a MEGS Care rga izati sj Medicare Medicaid SEEHIP Ha m al Mamet Private health i EiiI fi MEGS Wimaged Earle igai aa a 113ml Entitlement K 1 t 73931 idem Sewerage 7 Pm eriai Elf il t h Stamens at Whale mu11 Witt Introduction Concepts of Health care and Health Insurance Baicker Katherine and Chandra Amitabh 2008 Myths and Misconceptions about US Health Insurance Health Affairs 276 W533 W543 httpWWWhksharvardedufsachandr What is health Biolmedical definition the absence of disease To be healthy is to be free of symptoms and not require treatment 0 Focus on what health is not 0 Prevention of disease and health promotion is secondary 0 Health care deliverymedical care delivery 0 US health care largely driven by this concept Public Health definition the state of total physical mental and social wellbeing not merely the absence of disease or infirmity Q Triangle has physical wellbeing mental wellbeing and social wellbeing at separate points 0 Problem I Each of these can be very interdependent I How do you measure all of these things esp things like socail well being Measurements of health 0 Subjective O Surveys 0 SAH 0 Issues with measurement errors 0 Cheap easy to collect O Quasi objective O Converts subjective answers to objective measures in order to compare to more reliable objective measures 0 Objective 0 Invasive v Noninvasive O Expensive can t guarantee representativeness 0 very narrow mostly about physical health What is health care Definition maintenance or improvement of health through diagnosis treatment and prevention of illness injury disease and other physical and mental impairments in humans Preventative Care Diagnostic Care Curative Care Restorative Care Palliative Care Health Care Svstem Definition all activities whose primary purpose is to restore maintain or promote health 0 Public Health 0 Global Health Health Determinants to Premature Death 0 Genetic Makeup 20 0 Health Behaviors amp Lifestyle 50 0 Social amp Environmental factors 20 0 Medical care 10 Public Health v Medical Care Public Health wider lens focus on prevention and health promotion populationbased interventions provides education to pass laws 0 Successes Smoking Prevention Medical Care focus on the individual patient aim to find biological stems of health problems focus on treatment of diseases more expensive per person than population The US Health Care System 16 million people employed 165 million Americans with private health insurance 50 million Medicare beneficiaries 65 million Medicaid recipients 10 million dual beneficiaries 50 million uninsuredpost Obama care30 million 0 America has the most without health insurance 1300 insurance companies National Health Expenditures Q Total amount of all spending in the US on health care I 2013 29 trillion 0 GDP total value of all domestically produced goods and services I 2013 167 trillion l NHE as a percentage of GDP 174 I NHE per capita 9255 Average Annual US Expenditures by household 8 on Health care 12 on food 6 on cars 333 on Housing 09 on alcohol Total annual spending 53495 Insurance 0 000000 Purpose Protection against risk Risk is the possibility of a substantial financial loss from an event whose probability of occurrence is small An insurance serves as protection against catastrophic loss 0 Process l Insured pays a premium I Insurer covers losses as described in contract between parties I Insurer pools risks amp collects premiums from many insurees l Insurer risks paying a lot of money for the benefit of a few Drivinq Forces of Health Care Expenditures An International Comparison STABILE Mark THOMSON Sarah ALLIN Sarah BOYLE S an BUSSE Reinhard CHEVREU Karine MARCHILDON Gret and MOSSIALOS Elias 2013 High Health Care Cost Containment Strategies Used in Four Other HighIncome Countries Hold Lessons for the United States Health A airs 324 643 652 PUBLIC BROADCASTING SERVICE PBS 2008 Sick around the World Can the US learn anything from the rest of the world about how to run a health care system httpwwmpbsorgwgbhpages trontlinesickaroundtheworld PUBLIC BROADCASTING SERVICE PBS 2009 Sick around America httD www obs orgvideo I 09985 7730 Reasons for Rising Health Expenditures 0 Common to all industrialized countries 0 GDPrising incomes l more income means you re more willing to spend money on your health care 0 Changing demographicpopulation aging l population aging ISNT a major driving force of rising medical expenditures I expansion of morbidity theory I compression of morbidity theory 0 Medical Progress I QALYs l CostUtility Analysis 0 costutlility ratio spentbenfits in QALY units l Common estimate 1 year of Iife7500150000 0 100000 is the common estimate for one QALY 0 Others I Increasing insurance coverage I Change in health behaviorstatus l Increase in supply of providers amp physician induced demand I 0 US specific driving forces 0 Increased insurance coverage 0 High administrative costs private health insurance etc 0 High Malpractice Q As a result of malpractice defensive medicine and unnecessary tests 0 High pharmaceutical costs 0 Unhealthy lifestyle I Obesity causes a whole bunch of issues 21 of NHE on obesity l BUT we re relatively good in terms of alcohol consumption amp smoking 0 Leader in development and application of new technology 0 high provider salaries and reimbursement rates 0 Preventative care is less common large fraction of uninsuredunderinsured have no access to continuous and coordinated care Consequences of rising health expenditures 0 Employment in medical sector is constantly growing and creating jobs 0 Higher prices just mean that the sector of the economy is growing eg new iphones shouldn t we be happy about it Q In all countries problem comes with financing 0 Public Health expenditures I Have increased substantially and will further increase over time 0 Problem you have to increase the amount of taxes in order to finance it 0 income tax sales tax contribution rates 0 or you have to cut spending from another sector 0 Basically it puts public budgets under pressure 0 and politiciansvoters decide how much to spend on public health care 0 Private Health care I more individualized choice I more regressive l more inequality l private contract with private insruance Q In US Labor Market 0 increasing contribution from employers bc cost of insurance is increasing and they have to pay 80 of premiums 0 1 Therefore employers will hire fewer people fulltime because they don t want to have to cover medical costs 0 2 Employers might decide not to offer health insurance anymore I Which would increase the number of uninsured l but if this happens ACA reuqired employers to pay penalty and this could have effects on job creation 0 3 Employers offer lower premium plans with higher costsharing I Results in higher outofpocket payments for the sick 0 4 Employers might pay lower share of premium I leaves less money for employee to pay for other consumption goods foodhousing l some employees may decide to go uninsured l ACA penalty 0 5 Employers might pay lower wages l 10 increase in premiums result in 1 lower wage Health Care Cost Containment Strategies Used in 4 Other HighIncome Countries Canada UK Germany France 0 Budget shifting 0 increase costsharing amounts 0 Budget setting 0 set upper limits on govtthird party payer spending 0 Controls of health care supply 0 control costs by controlling how many providers supply health care I Price controls I Volume controls I Health Technology Assessment Private Health Insurance in the US Purpose of leurance Economic Theory 0 Premiums 0 Calculation l Experience Rating I Community Rating 0 DOUBLE CHECK FEDERAL POVERTY LEVELS 0 Most to least regressive least to most progressive funding for health care system 0 Private insurance 0 PublicPrivate insurance 0 public insurance 0 Cost Sharing 0 Definition the insured pays a certain percentage of actual costs out of pocket in addition to the premium 0 Types l Deductible I CoPayment l Coinsurance usually for hospital stays or outpatient physician fees 0 Stop loss provision 0 Lifetime benefit limit gtprohibited after 2010 O HMOs 0 P08 0 PPOs 0 Public Health Insurance in the US Medicare Medicaid SCHP Summary R ducing Moral 39 Madicare A Bi Dut id if US mpggy aw magma i insumd have frat chalice If rmrid rs d i i ma a b3 r wid rs Mamu lad care 39 131115 HMO FPO US via prmridezr tW ka restricting access 10 care 10w cast Shat msmnce company manages CHIE of that mamEd and may intervena mg d y tr ttn mts Elf 111 pa 01f th casts C sum r d v la s 7 7 Eda pers a ze care accnumts mamas that hindividuals k w best bum in 5631 can spend awn m m g alm st Exclusiv lgr viva cnwst Shmi u 1 Physical we llibcing Mental wellbei11g Sncial we sbei g Health Maintenance Organization I Only Entrants Ematg ncy Emu aa madiaai cairn lui l fvisit Pravidars Natwark g mt Prmiders nut af Netwatk atgea Primary Cara m dical dDCt r Physician gara aw h apital rafatral I nutpatiant speciaiists in natwntk in sitals in EtW tk Pointiefi Suerviee Plan 1105 Duly surfers emergency medical care Pays were if non Pr videre in Netwnrk EIEEM Prmidere ut inf Netwerk I 39 emurise Primary Care Physician gere ewe medical deet r referral I quot referral ue e r epeeia ere nerwrjrk hagpitele in erwrjrk Preferred Provider Orgnizatinn E f A 40K I N d u hle agductibles 2 f jt 2D9f m gt 39 Preferred Prmiders insura ca Nnn Praferred Pr vid rs in netwnrk nut nif 11E 1 list if macal m diml d t t d t f list If h pi39t l h spit al ACA de nes Essential Health Bene ts 393 ND lifetime ND pie existing C d clauaes quot Essential bene t package I Datpa mt lapaIimt ill Mamamill Ea nmhmn Mental health HE addictim l3 Preac p en druga T l devices Ex labmamr Preventive wellness 3933 disease Hemmem 10 Pediatric 9 Camera at least 60 0f the actuarial value of the emigrated bene ta quot carat shaming 5950 individual 11900 REINHARDT Uwe E 2008 Why does US Health Care Cost so Much Part IV A Primer on Medicare The New York Times Blog available at httpeconomixblogsnytimescom20081212why doesus healthcarecostso muchpartiva primeronmedicare
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