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The Future of Healthcare in America

The Future of Healthcare in America. Medicare. Financing Financial resources of government are limited Obligations of an insured $30,000 spell of illness $18,000 will be paid by Medicare $12,000 will be patient’s responsibility. Medicare. Growing role of supplemental insurance

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The Future of Healthcare in America

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  1. The Future of Healthcare in America

  2. Medicare • Financing • Financial resources of government are limited • Obligations of an insured • $30,000 spell of illness • $18,000 will be paid by Medicare • $12,000 will be patient’s responsibility

  3. Medicare • Growing role of supplemental insurance • Depended upon to pick up the difference • Gaps here as well & growing • Pharmaceuticals

  4. Upcoding Phantom billing Bogus billing Unnecessary services Double billing or unbundling Pharmacy fraud Laboratory fraud Mental health fraud Kickbacks Home health fraud Managed care fraud Medicare • Fraud & abuse concerns

  5. Medicaid • Uncertainty as how far federal mandate for coverage will be extended • Will variations among states be narrowed • Will added funding be available

  6. Managed Care • How far will federal & state officials go in enacting patients’ bill of rights • What will happen to costs as access to care is mandated by law

  7. Private Health Insurance • Limited understanding of Americans regarding the impact of health care costs on other insurance coverage • i.e. hospital, physician, & pharmaceutical costs impact several insurance costs

  8. Private Health Insurance • Other insurance coverage(cont.) • General liability coverage • BI component • WCN coverage • Part A medical expenses & rehabilitation costs • Part B employer liability BI • Auto coverage • Medical payments

  9. Private Health Insurance • Failure to understand & appreciate the importance of alternative forms of insurance to protect welfare of persons in old age • 50+ years = 63M people • 65+ years = 34M people • Those who are 50+ years control $800B in disposable income = 1/2 of total disposable income of all Americans

  10. Private Health Insurance • Welfare of persons in old age(cont.) • 90M seniors are projected by 2010 • By 2030, proportion of seniors will be 22% of the population • Between 1990 & 2020, nursing home utilization will double • Today 64% of persons over 85 need nursing home care

  11. Private Health Insurance • Welfare of persons in old age(cont.) • Probability of needing nursing home care grows as person ages • Age 55 = 10% chance • Age 65 = 40% chance • Age 75 = 60% chance

  12. Misconceptions Regarding Available Resources • Medicare will cover use • Less than 5% of $65B spent on long term care is paid by Medicare • Now up to 100 days & only after hospital stay + 50 day lifetime for longer than anticipated LTC stay • Medicare Supplements will pay the difference • Coverage not addressed by Medicare is similarly uncovered by supplements

  13. Misconceptions Regarding Available Resources • Medicaid can be relied upon • Only if you “spend down” to poverty level • You can keep your home, your care, and $2,000 in assets • My family will care for me • Seldom is this realistic

  14. Misconceptions Regarding Available Resources • I’ll use my personal assets • Very few people can self insure to that level or extent • Denial of possibility of a future problem is the most significant challenge faced today

  15. Additional Facts • 34% of persons entering a long term care facility today will be there from 1 to 5 years • 21% will be there 5+ years • Average LTC facility stay is 2½ years • Average annual cost = $40,000

  16. Cost of LTC Insurance • Premiums • 50 year old subscriber will pay approximately $600/year • For couple from 50 years to 75 years: $1,200/year x 25 years = $30,000 in premiums • If one spouse is admitted to LTC facility for one year = $40,000 cost • Will have saved equivalent premiums paid by end of 8th month

  17. Eligibility for LTC • Necessity of human assistance for 2 or more activities of daily living (ADL) • Dressing • Toileting • Continence • Transferring (in & out of chair or bed) • Eating • Cognitive impairment • Injury or sickness

  18. Tort Reform • Malpractice • Limits on liability exposure for non-economic damages • Limits on lawyers fees

  19. Disability Compensation Laws • Currently we have WCN, LTD, & STD • Confusing & fraught with cost shifting • Are we headed for 24 hour coverage?

  20. Disability Compensation Laws • Disaffection with current system is a function of: • Soaring cost of benefits • Medical costs = 40% of total WCN costs • Significant increase in litigation costs • Fragmentation of the system

  21. What are the solutions to these issues?

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