Managed Care & Health Care Reform

1. Managed Care & Health Care Reform Cost of Health Care $1.03 trillion in 1997 15% of GNP 4%-5% annual increase in health care spending

2. Division of Health Care Costs Hospital care 34% Physician care 20% • Together make up 54% of health care costs Home Health care 3% Public Health 3% Research 3%

3. The Uninsured 43.6 million in 2002 15.2% of population 1 in 7 uninsured

4. Characteristics of the Uninsured Born in America 12.8% Naturalized citizen 17.5% Not a citizen 43.3% Blacks 16.9% Hispanic 23.4% White 54.3% Other 5.4%

5. Household Income for Uninsured Under $25,000 23.5% $25,000 - $49,000 19.3 % $50,000 – 74,999 11.8% $75,000 & over 8.2%

6. Education of Uninsured No high school 28.0% High school graduate 18.8% Some college, no degree 15.0% Associate degree 12.1% Bachelor’s degree & higher 8.4%

7. Employment Private sector 60.2% Self-employed 12.7% Public sector 5.5% Unemployed 21.6%

8. Health of Uninsured No use of preventive health care Seek treatment when illness more advanced Receive inadequate care Higher morbidity and mortality rates

9. Response of US Government to Health Care Crisis Retrospective payment system Reimbursement per unit of service Prospective payment system Reimbursement based on average value of service

10. Managed Care Plans Characteristics Prepaid health insurance plans Health care providers accept lower payments Gatekeepers to health care services

11. Positive Influence of Managed Care Plans Expanded role for nurses Increased emphasis on health promotion & disease prevention

12. Negative Influences of Managed Care Plans Built incentive to limit referrals to specialists Physicians leaving medicine Most are for profit organizations Limited ability to sue managed care organizations

13. Employment Retirement Income Security Act (ERISA) 1974 Protects employer-sponsored pensions from litigation (HMO’S) Racketeering Influence and Corrupt Organizations Act

14. Health Insurance Accountability Act Ensures can change jobs without losing health insurance coverage Guarantees coverage for small companies & self-employed individuals Provides new benefits for self-employed

15. Consolidated Omnibus Budget Reconciliation Act (COBRA) 1986 Provides insurance when unemployed Event Beneficiary Coverage Termination or Employee, 18 months Reduced hrs. Spouse, child Divorce or Spouse, child 36 months separation

16. Health Care Options Maintain current Managed Care Plan option   Create National Health Insurance Plan (one-payer system or Universal Health Care) Managed Competition