Stanfield's Introduction to Health Professions: U.S. Healthcare Expenditures and Insurance

Flashcards covering U.S. healthcare expenditures, Medicare and Medicaid financing, home- and community-based services, provider career shifts, and employer-sponsored private health insurance.

Medicare Spending (2019)

Total national spending of $\$799\text{ billion}$, which represented $21\%$ of all national healthcare spending and experienced an average annual growth deceleration to $1.7\%$ between $2010$ and $2018$.

Medicaid Expenditures (2019)

Total national expenditures reaching $\$613\text{ billion}$, financing nearly a fifth of all personal healthcare spending and providing critical financial support for hospitals, community health centers, and nursing homes.

Long-Term Services and Supports (LTSS)

Assistance designed to help seniors and individuals with disabilities with self-care (bathing, dressing) and household tasks (meal preparation, medication management), accounting for approximately one-third of all Medicaid expenditures in $2018$.

Home- and Community-Based Services (HCBS)

Care delivery programs providing LTSS in community settings rather than institutions; demonstrated to be less costly (e.g., $\$9{,}129$ per person annually in California in $2008$ versus $\$32{,}406$ for institutional care), though Medicaid does not reimburse room and board in home-based settings.

Healthcare Employment Transition

The industry shift of service delivery from institutions to community settings, leading to greater job growth for healthcare personnel in clinics, ambulatory care centers, and homecare agencies rather than hospitals and nursing facilities.

The Nation's Health Dollar: Revenue Sources (2019)

The distribution of national health financing where nearly $73\%$ originated from health insurance ($31\%$ private/employer-based, $41\%$ government-sponsored), $11\%$ came from out-of-pocket expenses, and $17\%$ derived from other third-party payers, investments, and public health activities.

Out-of-Pocket Expenses

Direct consumer payments accounting for $11\%$ of national health spending in $2019$, covering deductibles, copayments, prescription medications, and services omitted by Medicare, including dental care, vision care, and hearing aids.

Total Healthcare Spending (2019)

Aggregate national healthcare expenditure of $\$3.8\text{ trillion}$, equal to $\$11{,}582$ per person and accounting for $17.7\%$ of the U.S. gross domestic product (GDP).

Hospital Care Expenditure Share (2019)

The largest individual sector of total national healthcare expenditures in $2019$, accounting for $31\%$ of all healthcare spending.

Physician and Clinical Services Spending (2019)

The second-largest component of national healthcare spending in $2019$, comprising $20\%$ of total healthcare costs.

Preferred Provider Organization (PPO)

The most widely utilized private employer-sponsored health plan type, accounting for $44\%$ of enrolled workers in $2018$.

High-Deductible Health Plan with a Savings Option (HDHP/SO)

An employer-based private insurance option combining a high deductible with a savings vehicle, representing $30\%$ of enrolled workers in $2018$.

Health Maintenance Organization (HMO)

A managed care plan model representing $19\%$ of worker enrollment among individuals with employer-based coverage in $2018$.

Employer-Based Family Coverage Premium (2019)

An average annual insurance premium of $\$20{,}576$, for which workers contributed an average of $30\%$ ($\$6{,}172$ per year) and employers covered the remainder.

Employer-Based Single Coverage Premium (2019)

An average annual insurance premium of $\$7{,}188$ for an individual employee, with the worker paying an average of $18\%$ ($\$1{,}293$ per year).

Deductible

An annual fixed sum that an insured individual must pay out-of-pocket before insurance benefits begin; required by $82\%$ of employer plans with an average single coverage amount of $\$1{,}655$ in $2019$.

Copayment

A predetermined fixed dollar fee paid by an insured individual at the time of receiving specific services, such as office visits, outpatient surgery, hospitalizations, or prescription drugs.

Coinsurance

A cost-sharing requirement under health insurance policies where the covered individual pays a set percentage of the total approved service cost.

Annual Out-of-Pocket Maximum

A protective policy ceiling that limits the total amount a covered beneficiary must pay during a plan year, commonly ranging between $\$2{,}000$ and $\$6{,}000$ or more.