Introduction
•Health
care financing offers hospitals a chance to address its expenses.
•The
existence of government-based, employer-sponsored and out-of-pocket forms of
payment has improved the situation.
•An
analysis of the performance of these health care financing initiatives is
necessary for improvement purposes.
•This
presentation evaluates the influence of the health care financing models and
their effectiveness.
•Comparison
of Employee-Based, Government-based, and Individual-Based Health Care Financing
•Under the Affordable Care Act, employer
mandate states that organizations with over 50 employees should offer health
insurance (Norris, 2019).
•Ones that do not offer the appropriate
insurances programs are penalized (Graves & Mishra, 2016).
Employee-Based
Health Insurance
•The
employer-sponsored health insurance programs also benefit a few selected
dependents that are family members of the employee (Graves & Mishra, 2016).
•The
small-group coverage has offered the employees attractive premiums that can
cater for the health expenses (Norris, 2019).
•Comparison
of Employee-Based, Government-based, and Individual-Based Health Care Financing
Cont’d
•Medicaid, Medicare and Children’s Health
Insurance Program are the most common programs (Kominski, Nonzee, &
Sorensen, 2017)
•Pays for hospitalization, lab tests,
diagnosis, nursing facility, family planning, & pediatric (Fahle, McGarry,
& Skinner, 2016).
•Covered services together with
cost-sharing features.
Government-Based
Health Insurance
•Medicaid
is a state and federal program while Medicare is only a federal program
(Nikpay, Freedman, Levy, & Buchmueller,
2017).
•Medicare
targets patients over 65 years, while the ones that are under 65 years should
have disabilities (Nikpay et al., 2017).
•Medicaid
focuses on the low-income earners (Nikpay et al., 2017).
•Comparison
of Employee-Based, Government-based, and Individual-Based Health Care Financing
Cont’d
•Focuses on over-the-counter medications
and prescription drugs (Fahle et al., 2016).
•At times, flexible spending accounts and
health saving accounts might be required (Smith, 2017).
Individual-Based
(Out-of-Pocket) Health Expenditures
•The
underinsured and uninsured consist of the large population.
•Cost-sharing
has made it easier for even government-based or employee-based beneficiaries to
use out-of-pocket expenditures.
•Key
Economic Goals
•The economic goal of public insurance
is to focus on ensuring that more people can get
insurance coverage.
•In 2015, around 37.1% of Americans were
under the public health insurance plans (The Commonwealth Fund, 2019).
Population
Covered
•Private
health insurance helps people get quality treatment for all the dependents
according to their existing household budgets.
•In
2013, 54% of Americans that are below the age of 65 were receiving private
health coverage under their employers (Graves & Mishra, 2016).
•Key
Economic Goals Cont’d
•The
ACA insists that the private and public health insurance plans should cover the
10 essential services.
•Emergency,
ambulatory patient intervention, maternity, hospitalization, substance abuse
treatment, mental health, rehabilitation, lab tests, prescription medications,
pediatric, preventive and wellness, dental and vision, and the management of
chronic diseases for private and public insurance plans (The Commonwealth Fund,
2019).
•Key
Economic Goals Cont’d
•Cost-sharing and
out-of-pocket spending usually occur regardless of the insurance coverage.
•Hospitals can enjoy the benefits of case
mix systems that nurture efficiency.
Services
Included Cont’d
•The
economic goal focuses on offering a wide range of services at affordable prices.
•Public
health insurance assists the low-income earners get quality treatment.
•Private
health insurance promotes extensive coverage of all dependants on lower premium
rates.
•Key
Economic Goals Cont’d
•Public health insurance relies on taxes,
premium subsidies and federal revenues (The Commonwealth Fund, 2019).
•The economic goal is to lower the
number of uninsured people and reduce disparities in the provision of
healthcare.
Financing
Arrangements
•Private
health insurance depend on expenses shared between the employers and the
beneficiaries (The Commonwealth Fund, 2019).
•The
approach will make the health insurance plans a bit affordable for employees
and their dependants.
•Key
Economic Goals Cont’d
•In private and public insurance plans,
the bundled payments should focus on the entire cycle of care involving a
patient or a condition.
•Even the incorporation of case mix
funding can prioritize efficiency in hospitals (Hopfe et al., 2015).
Reimbursement
Strategies
•The
swift reimbursement systems should prioritize patients’ interests (Hopfe et
al., 2015).
•Patients
will get quality care due to the presence of enough funds to address their
medical needs.
•Key
Economic Goals Cont’d
•Heterogeneity in the demand for the
health insurance has lowered the monopoly (Glazer & McGuire, 2017).
•Health status and the taste in Gold or
Silver plans can make it easier for clients to get numerous choices.
Competition
Policies
•Discriminatory
premiums will make patients to shift to affordable health insurance plans
(Glazer & McGuire, 2017).
•Competition
policies reduce the aggressive marketing and unfair initiatives among insurers.
•Competition
have resulted in lower premiums and affordable insurance plans.
•the
key effects of labor market, insurance market, and competitive market factors
on health care delivery requirements
•Labor
Market
•People
look at employment as a way of getting private health insurance (Duggan et al.,
2017).
•Others
believe
that unemployment helps them qualify for public health insurance.
•Employees
around the retirement age might pay higher premiums (Duggan et al., 2017).
•Competitive
Market
•Consumer
choice is a priority due to finding an insurance plan that fits the household
budget and additional out-of-pocket expenditures (Duggan et al., 2017).
•Health
reforms have made the health insurance plans affordable for low-income earners
(Kominski et al., 2017).
•Insurance
Market
•The
ACA has reduced the number of uninsured from 49 to 29 million people, but
others still cannot afford the plans (Nikpay et al., 2017).
•Age
and income are essential in securing Medicaid and Medicare plans (Nikpay et
al., 2017).
•Employer-sponsored
plans supports around a half of non-elderly Americans (Graves & Mishra,
2016).
•changes
occurring in the economy or concerning labor and regulatory factors that must
be considered in the future
•Health regulations might increase the
compliance costs for different organizations.
•Technological advancement might cause
loss of jobs and more people seeking Medicaid.
•Reforms
will result in improved working conditions and affordable health insurance
plans (Kominski et al., 2017).
•More
immigrants seeking jobs will result in a higher underserved and uninsured
populations.
•the
key national trends that you believe currently affect competition and pricing
initiatives
•Increased competition has resulted in
reduced treatment expenses in hospitals (Schmitt, 2018).
•Reduced performance has led to mergers
that are linked with improved quality (Schmitt, 2018).
•Higher
prices for the prescription drugs can increase the out-of-pocket expenditures
(Fahle et al., 2016).
•Technological
advancement will result in higher prices, but accurate tests and quality
treatment.
•the
main quality indicators that typically affect health insurance pricing at the
local level
•Increased competition has resulted in
reduced treatment expenses in hospitals (Schmitt, 2018).
•Reduced performance has led to mergers
that are linked with improved quality (Schmitt, 2018).
•Higher
prices for the prescription drugs can increase the out-of-pocket expenditures
(Fahle et al., 2016).
•Technological
advancement will result in higher prices, but accurate tests and quality
treatment.
•Conclusion
•In
conclusion, the discussion highlights the convergence of economic models and
insurance plans.
•Public
health insurance assists low-income earners to get coverage.
•Private
health insurance helps employees and households secure quality treatment at
affordable rates.
•Competitiveness
and reforms have resulted in lower premium rates and reduced treatment
expenses.
•references
•Duggan,
M., Goda, G.
S., & Jackson, E. (2017). The effects of the Affordable Care Act on
health insurance coverage and labor market outcomes (No.
w23607). National Bureau of Economic Research.
•Fahle,
S., McGarry, K.,
& Skinner, J. (2016). Out‐of‐pocket medical expenditures in the United
States: evidence from the Health and Retirement Study. Fiscal
studies, 37(3-4),
785-819.
•Glazer,
J., & McGuire, T. G. (2017). Gold and silver health plans: Accommodating
demand heterogeneity in managed competition. In Models of Health Plan Payment and
Quality Reporting
(pp. 135-160).
•Graves,
J. A., & Mishra, P. (2016). The evolving dynamics of employer-sponsored
health insurance: Implications for workers, employers, and
the Affordable Care Act. The Milbank Quarterly, 94(4),
736–767. doi:10.1111/1468-0009.12229
•references
•Hopfe, M.,
Stucki, G.,
Marshall, R., Twomey, C.
D., Ustun, T.
B., & Prodinger, B.
(2015). Capturing patients’ needs in case mix: A systematic
literature review on the value of adding functioning information in
reimbursement systems. BMC health services research, 16(1),
40.
•Kominski,
G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Act's impacts
on access to insurance and health care for low-income populations. Annual
Review
of Public Health,
38,
489–505. doi:10.1146/annurev-publhealth-031816-044555
•Nikpay,
S., Freedman, S., Levy, H., & Buchmueller, T. (2017). Effect of the Affordable
Care Act Medicaid expansion on emergency department visits: Evidence from
state-level emergency department databases. Annals of Emergency Medicine, 70(2),
215-225.
•references
•Norris,
L. (2019). Are
you ready to offer small-group health insurance? Retrieved from
https://www.healthinsurance.org/small-group-health-insurance/
•Schmitt,
M. (2018). Multimarket contact
in the hospital industry. American Economic Journal: Economic
Policy, 10(3),
361-87.
•Smith,
S. R. (2017). High deductible health plans and health savings accounts:
Potential problems for taxpayers, opportunities for policy makers. American
Journal of Management,
17(1).
•The
Commonwealth Fund. (2019). The U.S. health care system.
Retrieved from
https://international.commonwealthfund.org/countries/united_states/
•
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