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Health Economics & Policy 3 rd Edition James W. Henderson

Health Economics & Policy 3 rd Edition James W. Henderson. Chapter 17 Medical Care Reform in the United States. The Push for Reform. Polls show satisfaction and unease Forces behind reform movement Advocates for elderly, poor, uninsured Middle class Rising out-of-pocket cost

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Health Economics & Policy 3 rd Edition James W. Henderson

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  1. Health Economics & Policy3rd EditionJames W. Henderson Chapter 17 Medical Care Reform in the United States

  2. The Push for Reform • Polls show satisfaction and unease • Forces behind reform movement • Advocates for elderly, poor, uninsured • Middle class • Rising out-of-pocket cost • Health insurance link with employment • Business • Rising cost creates wedge between cost of employment and salary paid • Potential liability risk

  3. The Moral Issues • Is medical care a right? • What is a right? • Difference between a right and an entitlement

  4. Goals of Reform • Who’s covered • What’s covered • Who pays and how much

  5. Health Insurance in the United States • Employer-based group plans • Individual insurance • Government entitlements

  6. Market Access Problem • Uninsured find it difficult to find willing providers • Insured find themselves underinsured

  7. Health Insurance Regulations • Federal responsibility • ERISA • Federal mandates • States’ responsibilities • Health insurance mandates

  8. Economics of Mandates • Correct perceived deficiencies in health insurance market • Tendency to undervalue certain types of benefits • Mental health • Long-term care • Adverse selection • Tendency for high-risk users to enroll in high benefit plans and low-risk users to enroll in low benefit plans • Viewed by state policy makers as a low cost way of improving access • Empirical evidence

  9. Types of Mandates • Benefits • Providers • Persons • Processes

  10. Benefit Mandates • Alcoholism treatment • Drug abuse treatment • Oral contraceptives • Mammography screening • Prostate cancer screening • Well-child care

  11. Provider Mandates • Chiropractors • Dentists • Nurse practitioners • Psychologists

  12. Covered Persons Mandates • Adopted children • Newborns • Handicapped children • Dependent students

  13. Process Mandates • Guaranteed issue • Exclusions of preexisting conditions • Premium caps • Guaranteed renewable

  14. U.S. Policy Alternatives • State-level experiments • Federal involvement • Market alternatives

  15. State-level Experiments • Hawaii • Oregon • Minnesota • Other states

  16. Federal Involvement • Universal coverage • Single-payer • Employer mandate • Individual mandate • Universal access

  17. America’s Market Orientation • Distrust of government • Heterogeneous population • Individualistic tradition • Equal opportunity • Philanthropic tradition

  18. Conditions for Market Response • Prerequisites • Rank preferences • Goods to buy • Money to spend • Cost-conscious behavior • When purchasing insurance plan • When purchasing medical services

  19. Market Alternatives • Managed competition • Medical savings accounts

  20. Immediate Prospects • Medicare reform • Patients’ bill of rights • Health care for the uninsured • Pharmaceutical drug pricing

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