VIEWS: 10 PAGES: 41 POSTED ON: 4/17/2012
OUR HEALTHCARE SYSTEM!!! BY : Neel, Nick, Karissa & Rachel OUTLINE Some statistics to start with What are the different ways of getting insurance Some problems associated with each of these ways of getting insurance Privacy issues Political effort to reform our system – some bills that have been passed and proposed Ethical issues The Dilemma of Uninsured Americans Statistics Nearly 44 million Americans are uninsured The number of uninsured has increased by 4.6 million between 2001-2004(growth = 11.2%) Half of these uninsured are between the ages of 19-34 CHARACTERISTICS OF THE MAJORITY OF UNINSURED Low-income Young (60% under age 34) – this mainly includes students who are in college Non-white Surprisingly Only 20% of the uninsured are unemployed Only 23.7% lack a high school diploma 73.7% are native born WHAT DO THESE NUMBERS TELL US??? These numbers show that most of the uninsured Americans have a high school diploma and have jobs. This means that lack of education and unemployment aren’t a big factor affecting the growth of the # of uninsured Americans. Majority of these uninsured are also students and this is because once they reach a certain age they aren’t covered under their parents’ insurance. And they can’t get their own insurance because they are too busy to find a full-time job. DIFFERENT WAYS OF GETTING HEALTH INSURANCE HMOs – private and through employers Medicare Medicaid Supplemental Insurance Student Insurance HMOs Stands for Health Maintenance Organization It is basically a prepaid health plan providing comprehensive care to members through designated providers. Almost 30% of the Americans are enrolled in HMOs Unlike traditional insurance HMO sets out guidelines under which doctors can operate Is either offered to you through your employers or can be purchased privately Is comparatively cheaper than traditional insurance – requires a monthly premium HMOs (contd….) There are 2 reasons as to why HMOs cost less: a.) It is able to provide better and more affordable insurance by contracting with specific care providers and dealing with he amounts of patients. b.) It reduces costs by eliminating treatments that it views as unnecessary and by focusing on long term health of the patients. Patients get to choose a primary care physician, who then negotiates with the HMO about what kind of care and treatments are required by a patient Examples include Blue Cross, Aetna, Blue Shield, etc. MEDICARE It is a federal health insurance program for people ages 65 and older, people with disabilities and people with permanent kidney failure Paid for by the money of the taxpayers Involves insurance through various HMOs It is a combination of 4 different parts. Medicare (contd…) Part A covers inpatient care which includes hospital and nursing facility stays – no premium required since the patients or their spouse paid medicare taxes. Part B covers outpatient care and doctor’s services – requires a monthly premium – if Part B isn’t purchased at the time of enrollment, the premium will go up every year thereafter. Part C is called Medicare + Choice and is basically extra insurance through an HMO. The last part, called Part D deals with prescription drug coverage MEDICAID Available to only certain low-income individuals and families who fit into a category defined by federal and state law State administered program Depending upon your state, you might be asked to pay a premium. Expenses are covered by taxpayers’ money SUPPLEMENTAL INSURANCE Is like an extra insurance which may be purchased by individuals whose insurance doesn’t cover all the major benefits. Is cheaper because it is not a major insurance, only a supplemental insurance. It only provides limited benefits STUDENT INSURANCE Offered to students by their colleges and universities. You need to be a full-time student Requires the payment of a premium Is comparatively cheaper and offers most of the benefits Students are encouraged to use the healthcare facilities on campus Problems with the Healthcare System Medicare Does not cover long-term care Medicare coverage provides for 30 days of SNF (Skilled Nursing Facilities) coverage following a hospitalization Decreased rates of coverage beyond 30 days; coverage rapidly runs out Many elderly and almost all young people requiring long-term care services are ineligible Medicare Prescription Coverage Limit as to the amount of coverage Affects people who take medication regularly – People who depend on prescriptions are more likely to go without the medications they need for periods of time – An estimated 85 percent of Medicare's 40 million beneficiaries suffer from at least one chronic condition – People who rely on a number of maintenance drugs, such as those with heart and respiratory problems, Alzheimer's disease, or arthritis, are likely to be most severely affected by the gaps in the drug benefit Medicare Part D Three tiered system based on drug types Some medications are now less affordable Encourages drug substitution New side effects, different efficacy Some drugs are no longer covered i.e. Benzodiazepines Before the new entitlement, most had virtually all their medications covered fully by the states. Tens of thousands of indigent patients were told to get prior authorization, pay a large initial deductible, or make substantial co-payments for regularly used medicines they previously received at no cost Medicaid Health care costs higher for Medicaid patients than for general population Treatment costs for elderly are more expensive than costs for other patients Medicaid programs must often be cut because an open-enrollment policy must be kept Medicaid Based on Income and Assets Elderly have no income Elderly with assets must spend down their assets month-by-month until eligible for Medicaid Assets include cars, homes, etc. Gifts given to applicants within 2 years of the application date counts towards total assets regardless of intention Medicaid Most people are ineligable Most dual earning families working full time Most disabled children Adults who are non-disabled without children, yet poor People with conditions that could be debilitating i.e. HIV patients HMOs In the past five years, private health insurance premiums have risen 73 percent Usually the number of doctors a patient can see and which tests he or she can get is limited Often a patient must see a "gate keeper" doctor who determines whether consultations with specialists are necessary and therefore reimbursable Usually covers bare minimum care HMOs The doctors say that the managed-care system prevalent in America today influences doctors to make medical decisions based on financial considerations Stresses cost cutting over cures Penalizes doctors for recommending certain tests, treatments and consultations with specialists may actually reward them for withholding care HMOs Managed-care companies are denying essential mental health services Cost-cutting is leading to worsening psychiatric problems Companies are not paying for long term psychotherapy Managed-care companies have financial incentives to deny psychiatric care to the very patients whose health interests they are supposed to protect Rutgers Health Insurance Basic Full Time Student $5000/illness or injury Additional coverage of $50000 or $100000 available Last January an international student suffered from encephalitis and slipped into a coma Hospital costs - $33000/day Has incurred over a million dollars in medical expenses Doctors want to move her to a rehabilitation clinic, but the hospitals are reluctant to take her because she is at this point uninsured Possible Beneficial Procedures Positron-Emission Tomography (PET) scans are beginning to be used in association with cancer therapies Gives a more accurate reading than CT scans alone Estimated mean cost per scan of $1,800 to $1,900 Possible Beneficial Procedures Genetic Testing for hereditary breast or ovarian cancer Earlier treatment and assessment could help greatly combat deadly disease Sequencing tests cost several thousand dollars Labor intensive Most insurance companies only offer the test after you or a close relative is diagnosed with breast/ovarian cancer Privacy Issues Privacy Act 1988 Personal information shall not be collected by a collector for inclusion in a recorder in a generally available publication unless: – For a lawful purpose directly related to a function or activity of the collector – The information is necessary for or directly related to that purpose Personal information to be used only for relevant purposes Limits on use of personal information Disclosures Without Your Authorization Public health activities Research purposes Government purposes Organ or tissue donation/transplant Determination of compensation benefits Non-medical Use of Health Data Health insurance and pharmaceutical benefits Regulation of health care professionals Health care professionals as police Increased government interventionism and concentration Online Access to Medical Records With all the new technology it is easier to gain access to other people’s records We will need to develop acceptable procedures for the following: -Back up data -Who conducts audits? According to HIPAA, a patient’s consent is not required: When emergency care is needed When a provider is required by law to administer treatment When substantial communication barriers exist and, in a professional’s judgment, the circumstances infer the individual’s consent; For a provider with an indirect treatment relationship to provide services (e.g., laboratories); For a health plan to use the information for treatment, payment, or healthcare operations; and For a clearinghouse to use the information for treatment, payment, or healthcare operations. Specific Privacy Issue A woman has filed a lawsuit against Emory Healthcare after she underwent surgery there with instruments that had been exposed to a fatal disease similar to the human version of mad cow disease. The Ethics Of It All…. (3 main issues) Privacy How private is our information really? Not ethical to disclose personal medical issues to the public Affordability Companies that provide no insurance or unaffordable insurance to their employees Costs of insurance just keep increasing with no improvement Availability The issue of not providing healthcare to people who really need it Not covering much needed medical procedures Already Instated Healthcare Reform Bills Canada Healthcare Act (2005) $1 Billion Home Care Transfer fund established to build a national platform for home care services all Canadians will have access to essential mental health, post-acute and palliative care regardless of where they live ensure that the necessary community based services are integrated within the health system the important preventive, health promotion and maintenance functions of home care will continue to be part of the continuing care envisioned by Commission. _____________________________ Healthcare Reform Bills (cont’d) Small Business Health Fairness Act (2005) Enables small businesses to band together through trade associations to purchase coverage for their employees regulated by the Employee Retirement Income Security Act of 1974 (ERISA) - exempt from state health insurance mandates and regulations significantly expanded access to health coverage for uninsured Americans” by giving small businesses improved bargaining power and relief from costly state regulations _____________________________________ http://www.heritage.org/Research/Healthm Healthcare Reform Bills (cont’d) Healthcare Choice Act of 2005 Introduced May12, 2005 – last reviewed Feb. 16, 2006 – placed on Union Calendar would allow individuals and families to purchase health insurance that is offered in other states legislation would allow insurance companies to sell their products across state lines, under specified conditions, without generally being subject to the mandates and regulations of other states would broaden the health insurance market and bring more competition to the marketing and purchasing of health insurance for millions of Americans _______________________________________ Most Recent Healthcare Reform Bills Fair Share for Healthcare Act – New York (3/20/06) covers large businesses – those with more than 100 workers, and building services at office buildings over 100,000 square feet and residential buildings with 50 units or more ensures that large businesses pay their fair share for workers' health benefits sets a minimum amount that large businesses must spend on employees’ health benefits The Fair Share Threshold – covered business provide non-supervisory workers with health benefits worth at least $3/hr. If cost of health insurance goes up, benefits do not go down Healthcare Reform Bills (cont’d) Massachusetts Health Care Reform (April 4, 2006) The first state to require that all of its citizens have some form of health insurance Single adults making $9,500 or less a year will have access to health coverage with no premiums or deductibles Those living at up to 300 percent of the federal poverty level, about $48,000 for a family of three will be able to get health coverage on a sliding scale also with no deductibles Fines of more than $1,000 a year by the state for people able but unwilling to purchase health insurance $295 per employee annual fee for companies who do not offer health insurance mms://wm.world.mii- streaming.net/media/whdh/windowsmedia/news_articles/l060404 _health_care.wmv What Can We Do to Make a Difference? (Our Proposed Bill) The Fair Health Act All employers must offer and pay a major percentage (80%) of health insurance All employees offered insurance must work a minimum of 32 hrs./wk. Increased documentation of health insurance coverage SOURCES www.medicare.gov, www.cms.hhs.gov, www.makingakilling.org, www.policyalamanc.org, http://www.opha.on.ca/, http://www.hcfama.org/, http://www.aflcio.org http://www.heritage.org Danky, James Prof. Medicaid (Lecture). University of Wisconsin. http://mendota.english.wisc.edu/~danky/medicaid.pdf. Connolly, Ceci. “Drug Benefit Disparities Cited Those With Chronic Conditions Will Pay More, Study Says”. Washington Post. April 19, 2005. Hubbard, Allan B. “The Health of a Nation”. New York Times. April 3, 2006. Avorn, Jerry, M.D. Part “D” for “Defective” — The Medicare Drug-Benefit Chaos. New England Journal of Medicine. Volume 354:1339-1341, No. 13. March 30, 2006. Goleman, Daniel. “Critics Say Managed-Care Savings Are Eroding Mental Care”. New York Times. January 24, 1996. Juweid, M.D., Malik E. and Bruce D. Cheson, M.D. Positron-Emission Tomography and Assessment of Cancer Therapy. New England Journal of Medicine. Volume 354:496-507, No. 5. February 2, 2006. Fergus, Kathleen, MS, CGC. Breast and Ovarian Cancer: Considering Genetic Testing. http://www.genetichealth.com/BROV_Genetic_Testing_for_Breast_and_Ovarian_Cancer.shtml Guzowski, Stephanie. “Uninsured and uncertain: Bills pile up for Mason Gross cellist in a coma; peers plan benefit concert”. Daily Targum. January 26, 2006. Critical Coverage: Benzodiazepines under Medicare Part D. Medicare Rights Center. June 2005.
Pages to are hidden for
"healthcare"Please download to view full document