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by: Keira Schimmel

Public Admin POLS 304

Keira Schimmel
Harding University
GPA 3.96

Lori Klein

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Lori Klein
Class Notes
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This 3 page Class Notes was uploaded by Keira Schimmel on Monday October 12, 2015. The Class Notes belongs to POLS 304 at Harding University taught by Lori Klein in Fall. Since its upload, it has received 13 views. For similar materials see /class/222128/pols-304-harding-university in Political Science at Harding University.

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Date Created: 10/12/15
POLS 304 Public Policy Spring 2008 Health Care Policy l Ten Quick Facts Medicine is both labor and technology intensive Health care problem in the US can be broken into four interrelated categories Access Cost Quality Aging Population Health care is fourth in public concern after the economy the war and terrorism Average US Individual Health Care Expenditure 1990 2000 2000 6280 44 million uninsured 83 million uninsured children 3A of uninsured work full time or a have a full time worker in the house Medicaid is the single largest expenditure for states after education Spending on Long Term Care 1970 8 billion 2003 120 billion Health care is a global issue Kaiser World Health Map httpwwwglobalhealthfactsorg 2 De nitions Common Insurance Terms Premiums 7 What you and or your employer pay for insurance coverage Deductible 7 A set amount that you must pay out each year before coverage kicks in Copay 7 Flat per visit or per prescription fee not related to overall cost of service 8020 plan 7 The insurer covers 80 of costs the insured is responsible for 20 Out of Pocket 7 A combination of your deductible and your copay or 20 Some insurers set a maximum annual outofpocket payment Primary Care Physician 7 Your general health care provider Refers you out to a specialist if needed Gatekeeper Long term care 7 In home health care and nursing home care Often a separate policy Most insured Americans have third party employment based managed care coverage Third Party Payer Not the patient or the provider but a third party an insurer or the government who is responsible for payment Employment based Insurance coverage is provided as part of a compensation package Costs are shared between employers and employees Portability an ability to maintain and transfer coverage when employment changes COBRA Managed Care Attempts to decrease costs and increase health via negotiated contracts management of resources and a focus on preventative care PPO 7 Preferred Provider OI 39 quot 7 An 39 quot of39 J J physicians who contract for discounted fees for service HMO 7 a prepaid group practice Other Options for Providing Health Care Socialized Medicine 7 Health care is provided by governmental agencies much like education or law enforcement Single Payer 7 A system where the government is the singular provider of health insurance coverage Universal Coverage 7 Full access to health insurance coverage via governmental subsidies and incentives Mandatory Coverage 7 Governmental requirements to offer or obtain health insurance Compliance is achieved through subsidies grants and economic disincentives Employer mandates 7 Requirements for ALL employers to offer ALL employees coverage Individual Mandates 7 Requirements for individuals to obtain medical coverage Public Health Care Coverage Medicaid 7 Provides medical bene ts for the indigent and disabled Funding split between federal and state governments States set eligibility requirements and administer programs Medicaid waivers allow states to adjust their programs to meet the needs of their citizens SCHIP 7 State Children s Health Insurance Program Joint state federal program created to cover the gap between too rich for Medicaid and too poor for private coverage Medicare 7 Federal program which provides medical bene ts to complement Social Security bene ts Funded by salary taxes and supplemental premiums Medicare Modernization Act of 2003 7 Provides prescription drug bene ts to Medicare recipients Estimated Cost 7 2006 7 billion 2015 174 billion 3 Twenty Plus g Questions 4 Four Big Questions 1 What should we do about the cost of prescription drugs 2 What should we do about medical malpractice and damages caps 3 How will we pay for Medicare 4 What will happen in terms of overall health care reform


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