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Major Financing Mechanism of the U.S. Health Services System

Financing the U.S. Health Services System

Health Insurance: What exactly is it?

How IS healthcare financed?

No Cherry Picking or Cream Skimming

  • Was it always like this?
  • Was insurance always financed in this way?

Selecting only participants less likely to present claims.

  • Government
  • Employer-sponsored
  • Self

A mechanism to protect against unpredictable financial loss in the event of unpredictable catastrophic events such as illnesses

This is accomplish through the widespread distribution of infrequent large losses

The insurer (i.e. HIP) will determine an approximate RISK it may have to assume for a particular group of people or an individual

This RISK is asesses in two ways

Through the underwriting process

Through experience rating

For example, the growing population over age 65 consumes the largest portion of healthcare services (~65%), and yet only represents about 20% of the total population. Furthermore, because the primary payer source for this cohort is Medicare and about 60% of hospitals lose money on Medicare reimbursement, fewer people with Medicare (over 65) can be treated to keep organizations in business.

Characteristics such as age, income, health status, and chronic conditions impacts the way health services are utilized. Each of these characteristics will have a different impact on access, cost, and quality.

http://documentarystorm.com/sicko/

UNINSURED & ASSOCIATED PROBLEMS

  • What are some of the problems that may be created within our healthcare system due to the high number of uninsured Americans?
  • What is at least ONE strategy that may be used at the local, state, or federal level to curb the growing number of uninsured? What problems do your foresee that may be encountered in implementing this strategy?
  • Overuse of expensive emergency room care
  • Individuals do not receive primary care which increases overall healthcare costs and delays treatment, which makes patients more acute

  • Options to curb the problem of the uninsured population include national health reform, the Massachusetts healthcare initiative and establishing statewide insurance programs.

There are several populations that compose the uninsured population in the U.S.

These include the poor and low-income individuals and families, the unemployed, college students, populations with specific ethnicities, employees of small businesses, and individuals who choose not to purchase health insurance. Options to curb the problem of the uninsured population include national health reform, the Massachusetts healthcare initiative, and

establishing statewide insurance programs.

Access to Health Service

Please review the following for your upcoming Midterm during Week 4:

Yet approx. 48 million are NOT insured

Referred to as the Uninsured

Medicare benefits provide services to older adults and people with disabilities, whereas Medicaid provides services to families who fall under income guidelines.

Medicare is a federally-operated program with standardized benefits. Medicaid is administered by each state and each state determines its array of services.

  • This population is referred to as the uninsured
  • How is the growing number of uninsured Americans impacting the U.S. healthcare system?
  • What are strategies used at the local, state, or federal level to curb the growing number of uninsured?
  • Why has not yet been implemented?
  • America does not have a national health system or insurance
  • people have financial access to health care through private or public health insurance
  • Private is closely linked to employment
  • Public such as:

a. Medicare

b. Medicaid

c. Indian Health Insurance

d. ChampVA

e. SCHIP

- Your text

- Study notes

- Weekly Wrap Ups

- Prezi PowerPoint

You have until Sunday of next week to complete the exam!

Good luck!

Are Medicare and Medicaid roles in the healthcare system different?

How does each agency impacts costs, quality, and access in the

delivery of medical care in America?

Which program is doing a better job balancing these issues, and why?

Medicare is funded by federal dollars and Medicaid is funded by both federal and state dollars. Students should provide a solid rationale for which program they believe is better balancing the issues of access, costs, and quality.

Who are the specific population(s) of people receiving services financed by:

- Medicaid

- Medicare

- Indian Health Insurance?

- SCHIP?

What are strategies used by the agency who oversees each of these insurance to manage access, costs, or quality?

Massachusett's Statewide Healthcare Initiative

  • This state requires all citizens to have healthcare coverage or face strict and severe tax penalties.
  • People under the poverty level will still be eligible for Medicaid programming
  • There will be two other programs that will exist on an
  • income-bracketing system for the remaining citizens.
  • This ultimately reduces risk profiles and betters the health of the entire state, thereby reducing costs in the long run.
  • What about New York?
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