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Costs of aspects of healthcare made explicit Improve equity and access to healthcare Care managed by companies to ensure it is effective/legitimate Freedom to choose healthcare provider High quality facilities -----Those who need insurance most can't afford it Often an employment benefit, so excludes unemployed No coverage of public health or prevention programmes
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Expensive medical technology: diagnostic & treatment equipment & pharmaceuticals: computerization; highly trained personnel; incentives for high volume use Aging population: longevity increasing: major consumers of hospital care, pharmaceuticals Specialty medical care: 60% + physician specialists; patient self-referrals; use of highest cost interventions without payment restrictions often ...
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-large employers' workforces can predict their own medical expenditures and assumes all risk and pays all claims-ex. Hopkins and Yale have their own health plans Individual private health insurance -directly purchased from the insurer -for those who do not have group insurance -individual pays the entire premium -about 6% of the US population in 2019
- mandated fee schedule set by Medicare - covers 80% of allowed charge - 20% paid out-of-pocket or covered by supplemental insurance plan - Insurance premium: $164 - 560/month - Deductible: $226 per year - co-pay: 20% co-pay after deductible, pt's often have supplemental insurance plan that covers this 20% - payment determined by CPT codes
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