Overview of health insurance and its various aspects.
Key topics: healthcare finance, alternative health insurance forms, growth of health insurance, policies, health economics, risk management, and health services research.
Public vs. Private Insurance:
Public insurance: government-provided plans (e.g., Medicare, Medicaid).
Private insurance: plans purchased from private companies or employer-provided.
Importance of understanding funding flow through government budgets.
The role of out-of-pocket payments in influencing the demand for health insurance.
Health insurance as an "indirectly demanded" good, helping mitigate financial burdens associated with healthcare costs.
The concept of health as the ultimate goal rather than healthcare itself.
Health insurance plans allow individuals to cover health-related expenses.
Many U.S. citizens acquire insurance via their employer or family members' employers.
Health capital as a valuable asset representing individuals' health.
Payments from insurers correspond to individuals' health states, raising questions about the value of a human life and recovery to full health.
Health cannot be traded as other products, complicating valuation for insurance.
Challenges of pricing insurance due to the subjective value of health capital.
Asymmetric information poses dilemmas in both health insurance and broader insurance markets.
Individuals and insurers may possess differing information regarding risk assessments.
Insurers and healthcare providers hold expertise not easily accessible to consumers.
Knowledge gaps give providers an informational edge in the healthcare market.
Consideration of personal financial strategies (savings and loans) to cover future healthcare costs.
Preventative activities serve as both alternatives and complements to insurance.
Public health initiatives present cost-effective alternatives to private insurance.
Programs demonstrating economies of scale can enhance health outcomes at lower costs.
Historical roots of health insurance traced to accident and disability policies.
Cooperative societies and employer-provided group health insurance played significant roles.
Cooperative associations developed rules to manage asymmetries in information.
Health cooperatives are owned by the individuals they insure, resembling mutual aid.
Group health insurance (e.g., industrial sickness funds) was a precursor to modern health insurance.
Baylor Hospital introduced prepaid hospital coverage, laying groundwork for future models.
Blue Cross offered unique assurances for hospital services, separating them from traditional commercial insurers.
Introduction of Medicare and Medicaid in 1965 fundamentally shaped the U.S. health insurance landscape.
Key differences in eligibility criteria and funding structures.
Medicare: age-based eligibility; Medicaid: income and health-based eligibility (federal/state partnership).
Experience rating vs. community rating: understanding different pricing models in insurance.
Community rating aims for uniform pricing regardless of individual health differences.
Intersection of health and insurance policy, focusing on regulations that impact health outcomes.
The Affordable Care Act (ACA) exemplifies the application of health insurance policy.
Distinction between demand and supply in health insurance markets.
Numerous consumers include individuals, employers, and governments seeking health insurance coverage.
Insurance companies are central producers in the market, catering to diverse health risk profiles.
Health insurance acts as both a financial mechanism and a risk management tool.
Discussion on market failures and public policy interventions to mitigate them.
Importance of addressing failure within the healthcare system and insurance market.
Insured-insurer relationship complexities due to non-disclosure of health conditions.
This issue can prevent adequate insurance coverage and expose weaknesses in market design.
Insurance serves to manage various risks, including health, driving, homeownership, and professional services.
Goal: provide financial protection and recovery mechanisms for losses.
Underwriting practices are vital for risk management and solvency in insurance contracts.
Key to the financial health of insurance companies.
Mutuality and solidarity principles underpin insurance contracts.
These principles guide risk sharing and highlight distinctions between private and social insurance approaches.
HSR focuses on healthcare outcomes and effectiveness, integrating social, financing, and personal behavior factors.
Studies how various factors influence health access, quality, and cost.
HSR examines other mechanisms like precautionary savings and preventative strategies, potentially serving as complements to health insurance.
Recognition that social determinants can significantly impact health outcomes.