Health Care Reform?. Health Care Costs/Total Compensation Insurance System Progression Understanding G.U.’s Medical Insurance Programs Super Size It! Costs of Lifestyle Choices What Can We Do?. What’s Happening With Benefits Costs And My Total Compensation?.
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Health Care Costs/Total Compensation
Insurance System Progression
Understanding G.U.’s Medical Insurance Programs
Super Size It!
Costs of Lifestyle Choices
What Can We Do?
And My Total Compensation?
to cover catastrophic events...
By the 1990’s, we were using “health insurance”
to finance “health care.”
Selected Years 1960-2000
Over the last several decades, the public sector share of health spending has increased, while the share from out-of-pocket spending has declined.
Dollars in Billions
Total Medicaid, SCHIP expansion and SCHIP
Private Health Insurance
Source: CMS, Office of the Actuary, National Health Statistics Group.
Employer providescoverage above the gap
Coverage takes effect when expenses exceed employer’s Health Savings Account contribution plus the employee-funded gap
Employee isresponsible for gap
Used by employees for routine care; unused amounts roll over year-to-year
Employer deposits money into an employee’s account
Premera – Self-Funded
Group Health – Fully-Insured
Choice between 2 companies:
High Option (copay plan) or
Low Option (deductible plan)
Preferred Provider Plan (PPO) – See PPO provider for maximum benefits:
$10 generic drugs; $20 preferred name brand; $40 non-preferred name brand
Home Delivery/Mail order – 1 copay for 90 days supply
$20 per office visit
prescriptions - $15 generic; $30 name
$400 per day to a
maximum of 5 days
$200 ded. per person, PCY
prescription - $15
generic; $30 name brand
wellness exams covered
expense $2,000 (plus ded.)
Funding Level (100%) $3,243,091
Stop Loss Expense $161,102
Net Paid Claims $2,604,721
Total Expenses $3,080,818
Expense Loss Ratio 95%
“The concept that Western diseases are lifestyle related, and therefore are potentially preventable and reversible, is the most important medical discovery of the 20th century.”
—Denis Burkitt, MD
How much larger is the average soda in the U.S. compared to France?
yogurt 82% ↑; candy bars 41% ↑;
hot dog 63% ↑
U.S. spending is significantly higher than other OECD countries.
Median: $64 $146 $591 $1,270 $1,798
*Expenditures in U.S. dollars using purchasing power parity rates.
**For some years, no data was available.
***1998 data was used because 1999 was not available.
Note: The data is arrayed by expenditure levels for 1999. The medians include all OECD countries.
Source: OECD Health Data 2002.
what is right, but only after trying everything else.”
G.U. Total Medical Costs – $4.1 Million
Behavior Medical Costs = 60% of Total
$2,460,000 SAVINGS OPPORTUNITY
Chronic diseases greatly influenced by lifestyle choices:
Expenditures, by Age and Sex, 1995
“Nobody spends someone else’s money
as carefully as they spend their own.”
– Milton Friedman
not a sprint, but a marathon
Stage 1. Precontemplation
Nope…Not interested in changing now.
Stage 2. Contemplation
Hmm…I’m giving change serious consideration.
Stage 3. Preparation
Yep…I’m getting ready to change…soon.
Stage 4. Action
Let’s go…I’m taking action.
Stage 5. Maintenance
Old news…I’ve been doing this for a long time.
of issues including: