u.s. healthcare policy. project 4: one page summary of the project including comments on the...

U.S. Healthcare PolicyU.S. Healthcare Policy

Project 4:

One page summary of the project including comments on the student's contributions.

Describe how the project contributed to your learning on marketing and other management themes.

Text and Bodenheimer article Describe the factors/agents that work to increase

health care costs. Describe those that work to lower health care costs. Relate these factors to nutritional services.

Text What is capitation? How does a system of capitation impact

reimbursement for nutrition services? Comment on the different definitions of ‘primary care’.


Concept ChecksConcept Checks


Objectives

• Review the Economic Trends

• Review the components of Health Care

• Compare Health Insurance Plans

• Discuss current issues in health care coverage

and insurance


Health Insurance Plans

Traditional Care / Fee-for-Service

Health Maintenance Organizations

Preferred Provider Organizations

Medicare

Medicaid

Disability Insurance

Hospital Indemnity Insurance

Long Term Care


Fee-for-Service

Client may visit any physician, use any hospital

Pay a premium each month

Deductible; after deductible provide a copay

Patient may need to submit bill

Limited services

Preventive Care

Experimental; Home Health Care; Long-term care; PT;


Health Maintenance Health Maintenance OrganizationOrganization

HMOs are organizations that insure groups of individuals against the costs of medical services and also provide those medical services

Shouldice 1991


Health Maintenance Organization (HMO)

• Pay a premium each month

• Receive ‘complete’ care

• ‘Primary Care Doctor’ you must select

• Some preventive services covered, such as well baby check ups, immunizations

• Care must be provided by HMO’s practice group

• Cannot self-refer to a specialist

• No claim forms to fill out

• Small copay


Preferred Provider Organizations (PPO)

• Combination of a fee-for-service and HMO

• Limits choice of doctors / hospitals


Preferred Provider Organizations

•Has arrangements with doctors, hospitals, and other providers of care who have agreed to accept lower fees from the insurer for their services.

•Copay

•More expensive outside the network

What are the pros and cons of managed care? How well do you think managed care

promotes wellness and preventive services?




Rank the following organizations, from highest to lowest, according the statement: “I have a favorable opinion of”

Airlines Banks Doctors Health Insurance Companies HMOs Hospitals Oil Companies Pharmaceutical companies Tobacco companies

In general, do you think managed care health plans are doing a good job or a bad job in serving health care consumers?


How worried are you about each of these? (Perception of risk) Having to pay more for your health care insurance Your income not keeping up with rising prices Not being able to afford health care services you think you need Your health plan being more concerned about saving money than about

what is best for your The quality of health care services you receive getting worse Losing your health insurance coverage Not being able to pay your rent or mortgage Being the victim of a terrorist attack Being the victim of a violent crime Being the victim of a food borne illness due to the mass distribution of food Losing your job or not getting a job Having to stay in your current job instead of taking a new job for fear of

losing health benefits.


Which of these is a very important factor in rising health care costs? High profits made by drug and insurance companies Number of malpractice lawsuits Amount of greed and waste that is in the current health care system Aging of the population Use of expensive high-tech medical equipment and drugs Doctors making too much money People having little incentive to look for lower cost doctors and

services

Other

How satisfied are you with what you pay for health insurance?


Kaiser Health Care Survey

http://www.kff.org/spotlight/healthcosts/index.cfm

Maciosek article What is the premise of the article? Define QALYs Do you think the methods describe adequate represent

an assessment of nutrition interventions? Why or why not?

How could this system be incorporated into U.S. Health Care policy?



Blackburn article Describe the Chronic Care Model What are the strengths and weaknesses

of this model How might this address issues in health

care costs?



u.s. healthcare policy. project 4: one page summary of the project including comments on the...

Documents

health care services

health care insurance

care health plans

health care coverage

components of health

health care consumers

healthcare policy slide

care pt slide