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Medical and Health Policy in the United States

Medical and Health Policy in the United States. Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing -Voltaire

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Medical and Health Policy in the United States

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  1. Medical and Health Policy in the United States Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing -Voltaire Although I am not myself a devotee of bigness for bigness sake, I would rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of warm sympathy in a small one. -Anureie Bevin, Minister of Health of the UK

  2. So The US Spends a Lot? • Americans spend about 2.6T a year on healthcare… • Medicaid: $400 Billion • Medicare: $527 Billion • Other Government: $150-250 Billion • Private Insurance: 858 Billion • Out of Pocket Expenses: $300 Billion • Most health costs are consumed by… • Prescription drugs: $270 Billion • Hospital Care: $800 Billion • Personal/Specialty Physicians: $550 Billion Dollars

  3. Infant Mortality Per 1,000 Life Expectancy at Birth

  4. Medicare • Entitlement after benefit age. • Paid for by Federal Insurance Contribution Act Tax, but there is still a ‘Fee-for-service’ model. • Predicted to expand fastest of all the major programs • Organized into alphabetical “Parts” • Part A: Hospitalization + Emergency Care • Part B: Doctor’s Visits, Nursing Care • Part C: “Medicare Advantage” • Part D: Prescription Drug Benefits (NEW)

  5. Medicaid • Provides services to low-income, disabled, and disadvantaged individuals. • Implemented through state programs, funded through matching grants. • Includes different subsidiaries, like: • Special state level Medicaid programs. • SCHIP Children’s Health Insurance Programs. • Special state eligibility levels and benefits. • Tightly monitored entitlement spending. • Expanded rapidly in the 2008-10 recession • The PPACA would expand Medicaid coverage and provide special subsidies to states to pay.

  6. Private Insurance • Company Plans • HMO Organizations • Individual Plans • How does it work? • Risk pools and group rates. • Payment schedules and standardized costs. • Paycheck reductions and contributions. • Effective at providing some types of care • Flexible and preferential relationship with companies and hospitals. • Can reach across “networks” • Very ineffective at equitable coverage. • Employer interest in coverage minimal

  7. Revolutions of the 1980s-1990s • Private insurance companies expanded massively and through more employers after the 1970s. • HMOs or Health Management Organizations, provide employers with structure for coverage. • HMO-managed systems restrict physician lists, procedures, types of coverage in exchange for efficiency.

  8. Revolutions of the 1980s-1990s • Important milestones: • 1986: EMTLA (Emergency Medical Treatment and Leave Act) means you can go to an emergency room or facility and they must see you and provide services. • 1996: HIPPA (Health Insurance Portability Protection Act) made transfer of coverage easier and protected private information, moved toward electronic processing. • 2003 MMA (Medicare Modernization and Improvement Act) Created Medicare Part D, enabled stronger spending on drugs and to insurance companies.

  9. Other Government Services • Indian Health Services • Administered through Interior and HHS • Covers all care on reservations. • Reservations are the poorest places in the US. • Military Care / Tricare • High quality care, covers active duty. • Involves unusual injuries, rehabilitative care. • VHA • Covers veterans the rest of their lives, less specific care and not done exclusively by military doctors. • Altogether, 50-60% of all healthcare money spent in the United States is spent by a government agency or body, and 55% of emergency care is uninsured.

  10. Gaps and Problems • The Uninsured • 30-40 million people in the US are uninsured. • 30 million or more are underinsured. • 50-60% of emergency room visits are uninsured. • 60-70% of all personal bankruptcies in the US are related to healthcare expenditures, • Policymaking • Health industry is a top lobbyist. • AARP and other interest groups also intervene. • Attempts to implement National Health Insurance since the 1940s have failed in Congress. • Rising costs leave everyone looking to shift costs to the other partiesthrough legislation.

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