文档介绍：CHAPTER 10
GOVERNMENT AND THE MARKET FOR HEALTH CARE
SOURCE: Centers for Medicare and Medicaid Services [2005a].
CHAPTER 10
GOVERNMENT AND THE MARKET FOR HEALTH CARE
SOURCE: Centers for Medicare and Medicaid Services [2005a].
SOURCE: Centers for Medicare and Medicaid Services [2005a].
Private Health Insurance
The Implicit Subsidy for Employer-Provided Insurance
World War II era price controls
Federal tax subsidy
The Advantages of Employer-Provided Health Insurance
Increase the risk pool
Reduce adverse selection
Lower administrative costs
Employer-Provided Health Insurance and Job Lock
Job lock
Health Insurance Policy Portability and Accountability Act of 1996 (Kennedy-Kassenbaum Act)
Cost Control and Private Insurance
Cost-based reimbursement (fee-for-service)
Managed care
Capitation-based reimbursement
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Point-of-service (POS)
Medicare: Overview
SOURCE: Centers for Medicare and Medicaid Services [2005a].
Real expenditures on Medicare
Expenditures on Medicare as a Share of GDP
How Medicare Works
Benefits
Part A – Hospital insurance (HI)
Part B – Supplementary medical insurance (SMI)
Financing
Payroll tax funds HI
General revenues fund SMI
Prescription Drug Benefit
Part C – Medicare Advantage
Part D – Prescription Drug Benefit
Monthly premium
Low deductible
Donut hole
Generous coverage for high costs
Cost Control Under Medicare
Medicare’s retrospective payment system
Medicare’s prospective payment system
Diagnosis related groups
Resource-based relative value scale system
Medicare Managed Care
Medicare: Impacts on Spending and Health
Expenditures on health care for the elderly
Health outcomes
Medicaid: Overview
Medicaid
State Children’s Health Insurance Program
SOURCE: Centers for Medicare and Medicaid Services [2005a].
Financing and Administration
Joint Federal-State financing
State administration
Benefits
States obligated to offer minimum package of be