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. What would you like to do?
Orthotist and prosthetist
Blood bank tech
Doctor of osteopathy
Teacher of the visually impaired
Vision rehabilitation therapist
Skilled Nursing Facility
go in for procedure and out same day
Who started the idea of national insurance?
Roosevelt in 1912
What happened in 1965?
Johnson created Medicare and Medicaid
What happened in 2003
Bush created Medicare Modernization Act which added Parts C and D
What happened in 2009
Obama started the ACA
- Age 65
- paid SS for at least 10 yrs
- Permanently disabled
- Financed through taxes
- Automatically qualify
- Free if pay 10 yrs SS
- If not, purchase with premium
- Pay deductible each time visit
- Medical Costs
- (Doctors Visits, Preventive screenings)
- Automatically Enrolled
- Pay monthly premium
- Medicare Advantage
- Combines part A and B
- Usually contains extra benefits and Part D
- Not Free
- Have networks
- Not Automatically enrolled
- Only through private plans
- Pay premiums
- if not purchased right away- premium penalty
- fed gov pays 50-70% of cost
- low income, elderly, disabled, bind, children under 6, pregnant with fam below 133% pov level
Hoe did health insurance come about?
In WWII companies lured workers by coupling insurance with their job
What is Professionalism
- Behavior that will lead to;
- adherence to ethical practice
- effective interactions with patients
- effective interactions with staff
- reliability, and commitment to improvement
- Fee for service
- Can see any doctor that accepts Medicare
- lower copay and deductible
- extra benefits
- have to see physicians in network
Who are the stockholders?
- Priv insurance
- Tax payers
- Health care provider
Why gov gave 14% more money to Medicare Advantage than directly to health care providers?
If procedure $20, gov have to pay $25. $20 for the procedure and $5 to the private insurance company
Modes of paying for health care
- out of pocket
- individual private insurance
- employment-based group private
- gov financing
Why out of pocket bad?
- need vs luxury
- hard to plan for
- only rely on HCP recommendations
Higher risk of problem, higher premium
Everyone pays the same premiums whether young or old
Types of Private insurance
- Traditional Fee for Service
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
Traditional fee for service
- most expensive
- most flexibility when choosing HCPs
Health Maintenance Organization (HMO)
- lower copay
- cover costs of more preventative services
- few choices of HCPs
- need PCP
- HCP makes choices on surgeries not insurer
Preferred Provider Organization (PPO)
- lower copay (like HMO)
- Pay more but get more options
- more choices of HCPs than HMO
- Can go out of network but have to pay more
- dont need PCP
Money you pay up to an amount and then insurance pays with you ($3000)
What are copays for?
Insurance company made to deter you from going somewhere so the doctors also make less money
If insurance pay 80% you have to pay the other 20%
If you cost too much, stop paying
Amount you pay each month (part by employer and part by employee
Why do some have inadequate access to health insurance?
- Financial restrictions
- Non financial barriers
- dont have insurance
Why has private health insurance coverage decreased over the past decades?
- cost of insurance has sky rocketed and employers cant afford
- our workforce has changed
Consolidation Omnibus Budget Reconciliation Act of 1985 (COBRA)
can continue coverage with post employment for 18 months if pay full premium
Who benefits from the link between employment and insurance?
- insurance company- employers forced to buy insurance whether their employees use it or not
- Employee- get insurance w/o paying full price
- Gov- less people to pay for on gov insurance, keep you working bc get benefits from job
Who is mostly uninsured?
- Hispanics or income <$25,000/yr
- bc low income have smaller jobs that dont have good insurance or work under the table
Why is access not guarenteed to those with Medicaid?
- HCPs receive less for care than those with private insurance
- many have stopped accepting medicaid
Why is there a lack of prompt access?
- shortage of PCPs
- fewer accepting Medicaid
- increase in wait time bc of universal insurance
Why is race a barrier to health care?
- cultural differences (beliefs and religion)
- Ineffective communication (language)
- minorities recieve less care even if pay the same amount
- neighborhoods with high minoritys have fewer physicians
What would you like to do?
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