PLS 200-05

*** TEST REVIEW TODAY, TEST FRIDAY ***

Health care

  • Medicare
    • federal program from SocSec Act
    • age 65+
    • hospital ins
    • medical Ins
    • Prescription ins
    • certain types of disability
    • end stage renal failure
  • Medicaid
    • Managed & operated @ state level
    • receives federal money
    • low income (means test)
    • In Ohio ($13.3 billion):

    • 6 state agencies
    • 88 county agencies
    • 88 boards of mental retardation
    • 86 behavioral health boards
    • 8 managed care orgs
    • 46,000 health care providers
  • Cost: amount of money spent (how is cost distributed?)
    • insurance costs (malpractice coverage)
    • preventive care
    • patient coverage
    • others pay -> usage increases -> cost increases
    • medical fees
    • lack of cost controls
    • administrative costs (bureaucracy)
    • aging population
    • advertising
    • Options for cost reduction:
      Cut insurance, more burden on individuals, restrict procedures, fix costs, restrict technology availability, eliminate malpractice suits, stop coverage

  • coverage: types of procedures covered
  • procedures on demand

  • open, competitive, profit-motive
  • Socialized medicine (example: NHS @ UK)
    • full universal coverage
    • cost = free (40%-60% income taxes in UK)
    • coverage: most procedures covered, but long waits
    • limited specialization & technology
  • National Health Care (Canadian model)
    • Dental, optical care covered
    • prescriptions not covered
    • “Many player, many payer” = high bureaucracy
    • cost limits
    • employer to ensure compliance
  • Rationed care (State of Oregon)
    • support lowest/low income individuals & families
  • allocation: where accessible
  • Health coverage in US: non-wage expense, coverage linked to work/employment

  • Managed care/HMO’s (in USA)
  • SCHIP = State Children’s Health Ins. Prog.

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