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Medical care

Medical care. Chapter 13. Elders’ Sources of Income. Social Security Began in 1935 Financed by working adults Earn credits in your working career In 2005, the average SS income for a man was almost $350 over the poverty level, and even less for a woman.

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Medical care

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  1. Medical care Chapter 13

  2. Elders’ Sources of Income Social Security Began in 1935 Financed by working adults Earn credits in your working career In 2005, the average SS income for a man was almost $350 over the poverty level, and even less for a woman Supplemental Security Income Established in 1974 to assist aged, blind and disabled SSI is not tied to participation in the workforce In 2004, SSI helped 7 million people, 30% were elders

  3. Other sources of income Personal assets Savings Home equity Pensions From employers Individual Retirement Accounts (IRA) Money set aside form paychecks, usually in stocks and bonds Some elders continue to work

  4. Use of Medical Services Elders average about 7 doctor visits per year, twice that of younger adults The hospital admissions rate is three times that of younger adults Elders are twice as likely to be prescribed medicine from a physician Elders spend three times more from their own pockets than those under 65

  5. Financing Medical Care In 2002, Elders spent about $11,000 in medical costs, three times that of other adults Costs are covered by Medicare, Medicaid (MediCal in California), US Department of Veteran Affairs, Indian Health Service, private insurance or out of elders’ pockets

  6. Medicare • Divided into four parts: • Part A is hospital insurance • Supported by payroll tax • Part B is medical insurance • Assistance through Medicaid may pay the premium for low-income elders • Part C is a private managed care plan • Elders give up some choice for greater benefits • Part D is prescription drug coverage

  7. Original Medicare Plan • Elders can go to any doctor, hospital or pharmacy, as many times as needed • May lead to uncoordinated treatment • The government pays the most for the sickest patients • Standardized and available throughout the country • Covers about 87% of elders

  8. Managed care plans Managed care plans can be either HMO or PPO A single point of contact – your primary care physician – manages all care Less choice of doctors, not standardized throughout country Increased benefits and lower out-of-pocket costs They want to enroll the healthiest elders

  9. Medicare • Benefits • Universal availability • Free choice of providers • No need for permission to see specialists • Limitations • Does not reimburse all services • Too complex • Doctors get less money and have to make up for it • Tremendous cost to all Americans

  10. Supplemental health insurance Many elders buy Medigap insurance to help cover their healthcare costs Medigap insurance is regulated and categorized “A” through “L” for easy comparison Medigap insurance should be purchased near the 65th birthday as companies cannot turn you down at this point

  11. Medicaid (MediCal in CA) Medicaid supports the poor, blind and disabled of all ages In 2004, 1/3 of expenditures were for long-term care Eligibility is based on monthly income and total assets, and determined by each state Dual-eligibility elders use both Medicare and Medicaid

  12. U.S. Department of Veterans Affairs All veterans over 65 qualify for services VA facilities play a role in medical education and research The VISNs coordinate care with local general-practitioner groups The VA offers physician services, hospitalization, home health and long-term care In 2004, 10 million veterans were 65 and older

  13. Indian Health Service An agency within the Department of Health and Human Services Indian elders comprise less than 6% of the service population There are not enough resources to help with long-term care or rehabilitation Federal funding is about 60% that of the rest of the population

  14. Out-of-pocket expenses In 2002, elders spent an average of $3,741 – 19% of the average income Medicare was created to help elders who were paying about 15% of their income Health care costs increase faster than inflation

  15. PROBLEMS AND PROSPECTS Medical Care:

  16. The high cost of care The US faces increasing numbers of elders each year – elders are high users of medical services Profits from prescription drugs are high Fraud and waste drive up the costs Hospital administration costs are high Hospitalization expenses are the highest single item in the national health bill You cannot shop for the best price

  17. For-profit medical care • Studies indicate that for-profit hospitals are costlier and less efficient • They may not have important services like an ER or trauma care • These services are important but unprofitable. • Higher death rates and higher payments for care

  18. A hospital does not work in a market economy

  19. Inequities in treatment • Race and ethnicity • There is a difference in care between blacks and whites rather they use Medicare, private insurance, etc. • A major goal in Healthy People 2010 to reduce inequities • Gender • Women have higher rates of chronic illnesses and disability • But are less likely to receive some services • poorer outcomes due to more advanced age

  20. Inequities in treatment • Age • Health care professionals lack geriatric training • Elders are less likely to get preventive care • Elders are less likely to be screened for or diagnosed with life-threatening diseases • Elders are more likely to receive inappropriate or incomplete treatment • Elders are underrepresented in clinical trials

  21. Patient safety concerns • Iatrogenic illness – when medical treatment or environment make the person sick • Common in hospitals or nursing homes when infections are passed from one patient to the next • Can be from errors or mistakes • Doctors need to report mistakes so we can find solutions

  22. Inaccessible services Going to the doctor can be very difficult for some elders Medicare raised the reimbursement rate for house calls Medical House Call Program is a model for serving home-bound elders

  23. Lack of training in geriatrics • By 2030, elders will comprise half of the patient load of many doctors • Should there be geriatric specialists, or should all doctors be trained in geriatrics? • Medicare helps finance physician education though the Graduate Medical Education Program

  24. Lack of Standardization of Medical Practice • Doctors treat patients based on education, experience and intuition • Practice-based medicine is more popular than evidence-based medicine

  25. Doctor-Patient Relationship • Communication • Slow down • Include a family member • Interpret “doctor-speak” • Improvement of Health Literacy

  26. Low Health Literacy • Health Literacy: the ability to seek-out, process and understand basic information and services needed to make good decisions • Half of Americans have low health literacy leading to poor compliance • more common in those who do not speak English well • Those with low-literacy use the healthcare system more often • Solutions: use interpreters, go to the doctor with a friend, health professionals need to watch their use of language and assure understanding

  27. The Need for Comprehensive Care • When an elder sees many specialists, this may cause overlap or unnecessary services • Medical services and community services are often not coordinated elders may have trouble navigating the system. • Solutions: • Primary care provider or case manager can coordinate services • Managed care may help • Interdisciplinary team approach

  28. FUTURE DIRECTIONS IN MEDICAL CARE

  29. Medicare demonstration projects • Testing for improvements in Medicare • Usually targets elders with specific illnesses • Heart Partners • Senior Risk Management Program • Disease management programs • Many came from Medicare demonstration projects • Additional education, tools for monitoring and information on managing • Don’t seem to save money

  30. Ambulatory Surgical Centers • Operating room facilities • Usually less expensive than hospitals • Many focus on one type of procedure • Mostly found in urban areas • Innovative Use of Personnel • Using mid-level practitioners to help see many patients • May become experts in specific areas • Less trained than doctors • Hospitalists

  31. Electronic Medical Records • There are no comprehensive medical records that follow you from doctor to doctor • Government and private initiatives are trying to create a unified electronic system, but it is difficult. • Patient Privacy • The Health Insurance Portability and Privacy Act (HIPPA) protects patient privacy • Patient information cannot be shared without permission and signed consents

  32. Cybermedicine • Cybermedicine is patients communicating with doctors through email • Can be convenient, cheap, private and anonymous • Without a physical exam or lab tests or verification of credentials, patients must beware • Telemedicine refers to connecting with doctors through the telephone, fax, and/or audio-video links • Improves access in rural areas

  33. Complementary and Alternative Medicine Most doctors in the US practice Allopathic medicine Complementary means with Alternative means in place of Many elders have used some sort of complementary medicine including supplements It is important to share this information with your doctor

  34. Medical care Chapter 13

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