Economics Of Healthcare

Front 1

% GDP healthcare used in the US in 80s vs 2010

Back 1

9% to 17%

Front 2

Reasons for increased HC expenditure, percentage used by elederly

Back 2

population aging, technology advancements and incerased reliance on.
34%

Front 3

When medicaid and medicare passed?.

Financed by gov but provided...

Back 3

1965
privately, by hospitals and facilities

Front 4

Medicare provides AD

Back 4

Acute care, (hospital, physician)
and drugs for elderly and disabled

Front 5

Entitlement program

Back 5

People contribute through taxes and are entitled to benefits regardeless of income and assets

Front 6

How is medicare financed?

P B(acc) G

(post bacc, gee)

Back 6

-Payroll taxes (1.45% which is also matched by employer)
-Beneficiaries (through annual deductible, co-payment and coinsurance)
-General tax revenue

Front 7

Medicaid A B C and D

Back 7

A = hospital/nursing/hospice
B= other (physician, outpatient, ER/ambulance, Home health)
C= "choice" advantage plan. Optional managed care, better preventive
D= drugs

Front 8

Part A covers then copays how long for hospital?

Back 8

-First 60 days hosptial = covered after $1068 deductible
-Days 61-90 dovered with $267/day copay

Front 9

Skilled Nursing Facility requirement

Back 9

only after a 3-night hospital stay, and only for acute care in nursing facility

Front 10

Part A nursin home payment

Back 10

Fully paid first 20 days
$133.50 copay for days 21-100

Front 11

Part A Home Health and Hospice payment

Back 11

-Fully cover 100 home health visits following hospital
-Fully paid hospice terminally ill

Front 12

Part B parts (A OUL)*
(A owl)

Back 12

Ambulance and ER services
Outpatient services
Unlimited Physician care
Limited Home Health (if not post-hospital)

Front 13

Part B payment (MAC)

Back 13

Monthly premium ($106+/month)
Annual deductible $135
Coinsurance of 20% per service

Front 14

Part C Info/Payment

Back 14

Optional managed care plan (no ABD if chosen)
Fully cover wide range services, especially preventive but no nursing home and stuff

Front 15

Part D info / started when

Back 15

-voluntary prescriptions drug benefit
-started 2006

Front 16

Part D payment

Back 16

-Monthly premium $25/month
-Annual deductible $295 after which
covers 75% of Drug costs til $2700
then hole until $6154

Front 17

Medicare limitations* (Veldh)

Back 17

No covers:
-Vision and eyeglass
-experimental treatment
-LTC
-Dental care
-hearing aids (cost thousands)

Front 18

Other costs with Medicare

Back 18

-No limitation on out of pocket spending
-Medigap insurance policies ($150/month (private to cover remainder of medical bills)

Front 19

Total Medicare cost breakdown

Back 19

$281 /month (B+D+gap premium)
+ any copya, deductive, out of pocket

Front 20

Prospective Payment System - Hospital

Back 20

(1983) hospitals only receive fixed amount for a specific diagnosis

Front 21

Diagnostic related group

Back 21

over 500 DRGs, are used to determine payment for PPS

Front 22

Prospective Payment System - Skilled nursing facility

Back 22

based on case-mix, classify pateints based on 44 resource utilization groups (so sicker = more $)

Front 23

Ways to reduce medicare costs (COPE)

Back 23

Covered Services less
Out of pocket more
Pproviders less payment
Eligibility age to 67

Front 24

Medicaid funded by?

Back 24

Federal government to provide healthcare for the poor

Front 25

Means-tested Medicaid requirements

Back 25

Qualify based on income/assets regardless of age ...
-<$11k/year, <2k in assets (not include house)

Front 26

Medicare paid by state/gov?

Back 26

50/50, biggest state expenditure though

Front 27

Medicade covers what %elderly, what kinda care?

Back 27

12% of elderly (tho thats 75% of budget)
-pays for LTC, esp institutional