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(共27张PPT)
GOVERNMENT AND HEALTH CARE
C h a p t e r 9
U.S. Market for Health Care
Health insurance provided as part of compensation of most employees; elderly and poor who qualify are covered under Medicare and Medicaid
Any others can purchase health insurance in the marketplace – it is not a guaranteed right
Insurance-dominated market for medical care reduces price consciousness of the public
Other issues include problems of dispersing accurate information to consumers
Health Care Spending in the U.S.
Financing Health Care in the U.S.
Asymmetric Information
Situation in which sellers of medical care are better informed about cost and quality than are buyers
Often, information on cost of treatments, especially emergency treatment, is difficult or impractical to obtain in advance
Is a possible explanation for rising health care spending
If benefit of procedures is overstated or procedures prescribed for which benefits fall short of costs, more than the efficient amount of resources will be devoted to medical care
Risk and Health Insurance
Private insurance companies provide coverage while earning profit because they are able to pool the risks incurred by a large group of individuals.
Most people are risk averse – they prefer to incur a certain modest cost for insurance rather than risk high costs of a possible unforeseen event
Extension of health insurance to cover both high-probability and low-cost risks has resulted in high insurance premiums.
Third-Party Payments
Third-party payments – financing of health care in the U.S. where the third party is neither the purchaser nor the seller of the service
Deductible – in a typical insurance plan, the amount of expenditures patients must first incur before the plan begins paying benefits
Coinsurance – amount paid as an out-of-pocket cost by the individual
Moral hazard of health insurance – increase in incentive to consume and supply services resulting from reduction in price to consumers when third parties pay the bulk of expenses
Effect of Insurance on Health Care Spending
Contributors to Inefficiency, High Costs
Malpractice insurance
Skyrocketing costs have been passed on to patients as higher fees
Service to uninsured patients
Non-profit or government institutions, obligated to service uninsured patients who cannot afford to pay
Technological advances and lack of price competition
Because third-party payments encourage overuse of new technology, it has likely been overdeveloped beyond the point at which the benefit equals the cost
Government and Health Care
It is argued that government should be involved with:
Pure medical research with no ready or current commercial application that is therefore underfunded by organizations seeking profits
Also, by preventing patenting, and therefore right to charge royalties, cost of new medical technologies and procedures would be lower
Vaccines, as some positive externalities are associated with reducing contagious disease
Helping protect patients against incompetent physicians
Government and Health Care
Assuring access to medical services to all citizens irrespective of their ability to pay or employment status is viewed by many as a desirable government function
Alternative to equal care for all, many argue that citizens should be guaranteed minimum coverage regardless of income
Medicaid is designed to achieve this goal
Because many of the uninsured are employed, a way to accomplish universal insurance could be to mandate that all employers provide it
Government could also provide catastrophic health insurance, used only after patients have exhausted private benefits and paid a certain out-of-pocket amount.
U.S. Government Spending on Health Care
Much of the growth of federal spending is accounted for by the largest federal health program, Medicare.
U.S. Government Spending on Health Care
Medicare
Aging of the population has contributed to rising Medicare spending.
The Medicare fee schedule (MFS) keeps costs down by setting payments according to time, skill, and intensity of service rendered.
Also limits payments for specific hospital providers to certain amounts independent of actual costs of procedures
Despite limits, costs have risen faster than the average rate of cost increases in health care spending for the nation as a whole.
Increase in tax rates for Part A and fees for Part B are likely in the future.
Medicare Part D
Optional drug purchase insurance plan provided by the Medicare Prescription Drug and Modernization Act of 2003
Those who choose to enroll pay a premium set by the private provider of the plan they choose
Uses a deductible and coinsurance
Provides tax-free subsidies to employers who maintain drug coverage for retirees
Estimated cost of the Drug Purchase Plan over the next 10 years is $700 billion
Part of costs will be offset by higher premiums for Medicare Part B
Medicaid
Entitlement program available to many low-income people who meet eligibility criteria
Administered by state, not federal, governments
Designed to ensure that the poor and those who become so because of catastrophic medical expenses will be able to obtain medical care
Health insurer of last resort – takes many cases that no other insurance program will
Indirect Government Health Care Finance
Favorable tax treatment to employee compensation in the form of health insurance premiums paid by employees
Encourages employers to provide employees compensation in the form of health insurance
Allowance of limited deductions for direct out-of-pocket medical expenses paid by individuals
Lost revenue from tax exemption should be added to direct government spending on health care
Indirect Government Health Care Finance
Health Care Reform Issues
Controlling growth of health care spending to prevent health care from absorbing ever-increasing shares of U.S. GDP
Moving toward universal coverage for Americans by making health insurance a government-guaranteed right for all citizens
Controlling Health Care Spending
Increase out-of-pocket price of those services to the individuals who consume them
Quantity demanded would decline
Provide incentives for economizing on the use of services
Government would have to ban development of supplementary insurance that would turn patient’s share into a third-party payment
Increase consumer cost sharing by:
Increasing deductible amounts for consumers
Increasing coinsurance rate paid by consumers
Indirect Government Health Care Finance
Managed Care
Control rate of increase of medical services by intervening in decisions of providers and patients directly
Decisions of physicians are reviewed for appropriateness
Patients required to purchase services from a specific network of providers
Patients often charged no direct price for services, but providers receive capitation payments, which are fixed amounts per patient per year
Controls and Regulation
Pricing controls set on physician reimbursement for both government and private programs
Medicare’s Prospective Payment System gives hospitals a fixed payment per patient for expected costs of treating patients with specific illnesses.
Governments can also intervene to increase competition among providers.
Gaps in Coverage
In 2008, it was estimated that 14.3% of the U.S. population had no health insurance.
Because uninsured will obtain treatment in nonprofit hospitals, costs are borne by others, as hospitals increase fees for insured patients
Some uninsured reduced to poverty status as a result of medical problems
Decline in coverage due to reduction in employees covered by their employers
Many low-income workers not low enough to qualify for Medicaid
Most insurance does not cover long-term care services for functional limitations or chronic health problems
Tax Credits for Health Insurance
A way to extend insurance to uninsured is through government subsidies to lower cost per policy
Government could pay certain percentage of basic plan, phase out percentage to zero as recipient’s income increased
Implementation must be sure not to reduce supply of employer-sponsored plans
Universal Entitlement Systems
Could build on current system of employer-provided and government programs by government mandate that all employers provide insurance
Government fill in gaps to help those who are unemployed, not in labor force, etc.
Involves increase in labor costs for some employers
Some small companies may be forced out of business
Some workers with generous benefits could suffer a decrease in benefits or increase in costs
Health care providers would need to be induced to keep costs down
National Health Insurance
System of comprehensive national health insurance would fill in gaps and assure all Americans access to at least minimal health care
National system, however, would still face issues of rationing faced by current system
Could limit reimbursements and review procedures
Could have deductible and coinsurance
National systems typically face severe problems with shortages, long waiting periods
Freedom to choose practitioners limited
National program financed through taxation would benefit some at the expense of others

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