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Managed Care & Health Care Reform. Cost of Health Care $1.03 trillion in 1997 15% of GNP 4%-5% annual increase in health care spending. Division of Health Care Costs. Hospital care 34% Physician care 20% Together make up 54% of health care costs Home Health care3%

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Managed Care & Health Care Reform

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Managed care health care reform l.jpg

Managed Care & Health Care Reform

Cost of Health Care

$1.03 trillion in 1997

15% of GNP

4%-5% annual increase in health care spending


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Division of Health Care Costs

Hospital care 34%

Physician care 20%

  • Together make up 54% of health care costs

    Home Health care3%

    Public Health3%

    Research3%


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The Uninsured

43.6 million in 2002

15.2% of population

1 in 7 uninsured


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Characteristics of the Uninsured

Born in America12.8%

Naturalized citizen 17.5%

Not a citizen43.3%

Blacks 16.9%

Hispanic23.4%

White54.3%

Other 5.4%


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Household Income for Uninsured

Under $25,000 23.5%

$25,000 - $49,00019.3 %

$50,000 – 74,99911.8%

$75,000 & over 8.2%


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Education of Uninsured

No high school28.0%

High school graduate18.8%

Some college, no degree15.0%

Associate degree12.1%

Bachelor’s degree & higher 8.4%


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Employment

Private sector60.2%

Self-employed12.7%

Public sector 5.5%

Unemployed21.6%


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Health of Uninsured

No use of preventive health care

Seek treatment when illness more advanced

Receive inadequate care

Higher morbidity and mortality rates


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Response of US Government to Health Care Crisis

Retrospective payment system

Reimbursement per unit of service

Prospective payment system

Reimbursement based on average value of service


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Managed Care Plans

Characteristics

Prepaid health insurance plans

Health care providers accept lower payments

Gatekeepers to health care services


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Positive Influence of Managed Care Plans

Expanded role for nurses

Increased emphasis on health promotion & disease prevention


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Negative Influences of Managed Care Plans

Built incentive to limit referrals to specialists

Physicians leaving medicine

Most are for profit organizations

Limited ability to sue managed care organizations


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Employment Retirement Income Security Act (ERISA) 1974

Protects employer-sponsored pensions from litigation (HMO’S)

Racketeering Influence and Corrupt Organizations Act


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Health Insurance Accountability Act

Ensures can change jobs without losing health insurance coverage

Guarantees coverage for small companies & self-employed individuals

Provides new benefits for self-employed


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Consolidated Omnibus Budget Reconciliation Act (COBRA) 1986

Provides insurance when unemployed

EventBeneficiaryCoverage

Termination orEmployee,18 months

Reduced hrs.Spouse, child

Divorce orSpouse, child36 months

separation


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Health Care Options

Maintain current Managed Care Plan option

  Create National Health Insurance Plan (one-payer system or Universal Health Care)

Managed Competition


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