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Health Policy lecture 1, Healthcare lecture 4, Health Care Lecture 2,…

- - - - state departments of insurance
      - standards for medical malpractice litigation
  - - - individual lifestyle choices
    - - support/replace private markets
    - - redistributive policies- subsidies
- - - - 8.5% inflation
      - average of 31% over 5 years
      - Specialty drugs: high costs dug; intravenous; designed specifically fo you; special storage and close monitoring needed; infused o injecttible dugs;
        
        incease by cost 15% per year
    - - allow medicare to negotiate
      - cap insulin costs
    - - 10-40% waste due to over treatment, lack of coordination, excess admin costs, inflated costs
      - Moral hazard: providing more care
- - - - care supplied by a goup of affiliated physicians
      - patients who use MOs pysicians get cae at some minimal co-pay
      - no reimbursement for using providers outside HMO
      - costs less-> limits choices (must go through primary healthcare doctor)
      - around 15%
    - - wider netowrk of physicians
      - patients pay minimmall co-pay iifi within the PPO
      - patients get reimbursed at a significantly lower ate if they outside the netwok
      - around 50% of plans
    - - lower premium and higher deductible
      - "catastrophic coverage"
      - patientt pays high deductible
      - health savings plan: provies tax break; pre tax money
      - around 30%
    - - cheaper individual
    - - government subsidized large portion by giving tax credits to employers
- - - - most generous covers 60%; least is 40%
      - half of medicaid beneficiaries are children
        
        CHIP: state child health insurance programs
        
        low cost health care to children
        
        children not families qualify
    - - Fed government gives certain amount to states for program
      - 69% comes from federal fundss
      - State flexibility in implementation: elegability, benefits, payment policy
    - - Enrollment outpaced CHIP enrollment
    - - amount of people in the state
      - no cap of amount of money
    - - doctors, pysicians
      - hospitals
      - drug benefits
      - long term care
    - - eligible for medicare and Medicaid
      - Account for around 33% of spending in both
    - - children living in low income families?
      - elderly - long term care
        
        Important role of medicaid in long term care for the elderly
        
        most have cognitive impairment
        
        more care needs
  - - - how many people are covered?
        
        63M to 93M
      - How costly is it?
        
        19% of spending
    - - Medicare will rise from 4% of GDP in 2021 to 6%
    - - Part A: hospital insurance
        
        funded with 1.45%
        funded by HI trust fund
        
        Accounts for 2/3 of program
      - Part B: supplemental medical insurance: physician, labs- goes into SMI
        
        1/3 cost of program
        
        funded by SMI partially; rest you pay for
      - Part D: supplemental prescription drug coverage (optional)
        
        funded by premiums, co pays, deductibles
        supported by beneficiaries and general funds of the treasury
        
        voluntary
        
        paid through premiums and general tax revenue- premiums vary by type of plan
        
        offered by private health insurance companies
      - Part C: combines part A and B; private insurance companies sponsored; more benefits
- - - - able to use old healthcare data to set premium
  - - - technology innovation in specialty drugs
        
        only serve 2.5% of population
        
        spending reached 52%
        
        311 B by 2023
        
        3/4 of medications
        
        spending increased by 55%
    - - say: streamline care
      - meant to lower healthcare costs but doesn't do so; 50% higher
      - worse health outcomes and patient satisfaction
      - 12% increase in physician prices and 6% in specialty
    - - Fee for service
        
        physicians decide on amount of care
        
        Provide more care; more income
        
        What are attempts to control it
        
        Managed care
        
        fixed budget per patient/procedure
        
        Used in HMO and PPO
        
        What is moral hazard?
        
        patients insured by litle for additional cae and consume more medical care that has no marginal benefit
        
        Insurer maximums
    - - incentive to overuse care
      - Moral hazard: patients sufficiently well insured that they pay little for additional carre and consue more
  - - - good innovation; little wait times; great choice of providers
    - - uninsured high
      - overcrowding in emergency rooms
      - refusal of care
    - - premiums high
      - fraud in medicaid/medicare
      - technology driving cost
      - gov does not negotiate to drive down drug prices
    - - Affordable care act
        
        narrowly passed
        
        Focused on access
        
        Individual coverage- individual mandate: fine for no health insurance
        
        no annual or limits on healthcare expenditures
        
        All plans; minimal acceptable coverage: routine coverage
        
        Regulation
        
        young adults can stay on HI until 26
        
        HI can set premiums based on: not medical history, age, fam structure, smoking, and wellness program -> no risk selection
        
        Cannot be dropped from coverage if becoming sick
        
        If cannot afford HI: tax credits
        
        Set up Health Insurance Marketplace: subsidized health insurance; americans making under 400% of federal poverty level
        
        Companies
        
        50+ employees provide health hinsuancce othewise fee
        
        <50 : small business health insurance program
        
        <25: go to marketplace to purchase subsidized insurance for employees
        
        Medicaid expansion
        
        feds expand eligibility for medicaid
  - - - Focused on : cost, access, quality
      - less cost shifting = lower cost
      - no annualor life tme limits on healthcare expenditures
      - all health insurance includes minimal acceptable cocerage
      - young adults can sttay on insurance plan until 26
      - No risk selection(cannot refuse care to someone with certain conditions)
      - no pre existing conditions refusal of coverage
      - Individual Mandate
        
        penalty for not buying into health insurance
        
        Tax credits on healh insurance exchanges between 100 and 400% of federal poverty line