Health Care Financing

About health care systems

Methods of health care delivery and management.

Types of Health Care Services

• Primary Prevention

  • Focus on health promotion and illness prevention

• Secondary Prevention

  • Focus on early disease detection, treatment

  • Prevent progression of disease

  • Early detection through screening

• Tertiary Prevention

  • Focus on restoring function, decreasing disease=related complications

  • Includes rehabilitation and palliative care

Primary Care delivery

• Physician’s offices

• Clinics

• Community health centers

• Public health service organizations

• Often the entry point for managed care.

Secondary and tertiary care

• Secondary care delivered in:

  • Hospital

  • Outpatient surgical center

  • Specialist’s office

• Tertiary care delivered in:

  • Hospital

  • Acute care facility

  • Rehabilitation center

  • Extended care facility

Economics of Health Care

• Private Insurance

  • Offered by employers as part of benefits package

  • Administered by private companies

  • Purchased individually

• Managed Care

  • Primary care providers

  • Health Maintenance Organizations (HMO)

  • Preferred Provider Organizations (PPO)

  • Exclusive Provider Organizations (EPO)

Third Party Payer System

• Deductible- payment before insurer pays for services.  

• Co-payment – fixed amount required to be paid for services.

• Annual limits: maximum amount to be paid.

• Fee for service: fees billed per units of service

• Capitation:  pre-paid fixed fee per person

Medicare

• Covers elderly (65 and older) and non-elderly with disabilities.

• Administered by the federal government (single-payer)

• Financed through:

• Federal income taxes

• Payroll taxes

• Out of pocket payments by enrollees.

Medicare

• Four Parts

  • A:  hospital insurance

  • B: supplemental insurance

  • C: managed care

  • D: prescription drugs

Medicaid

• Covers certain low income individuals

• Administered by state government.

• Financed jointly by the state and federal governments

State Children’s Health Program (S-CHIP)

Supplements Medicaid by covering low income children who are ineligible for Medicaid.

Administered and financed similarly to Medicaid.

Other Public Insurance Programs

• Veterans Health Administration

• Health benefits plan available to all veterans.

• Services delivered through VA health care facilities

• Financed by federal government

• Indian Health Service

• Available on reservations

• PPACA (Obamacare)

• Health Insurance Exchange