U.S. Healthcare Policy

Project 4: One page summary of the project including comments on the student's contributions. Describe how the project contributed to your learning on marketing and other management themes.

Text and Bodenheimer article  Describe the factors/agents that work to increase health care costs.  Describe those that work to lower health care costs.  Relate these factors to nutritional services. Text  What is capitation?  How does a system of capitation impact reimbursement for nutrition services?  Comment on the different definitions of ‘primary care’. U.S. Healthcare Policy Concept Checks

U.S. Healthcare Policy Objectives Review the Economic Trends Review the components of Health Care Compare Health Insurance Plans Discuss current issues in health care coverage and insurance

U.S. Healthcare Policy Health Insurance Plans Traditional Care / Fee-for-Service Health Maintenance Organizations Preferred Provider Organizations Medicare Medicaid Disability Insurance Hospital Indemnity Insurance Long Term Care

U.S. Healthcare Policy Fee-for-Service Client may visit any physician, use any hospital Pay a premium each month Deductible; after deductible provide a copay Patient may need to submit bill Limited services Preventive Care Experimental; Home Health Care; Long-term care; PT;

U.S. Healthcare Policy Health Maintenance Organization Health Maintenance Organization HMOs are organizations that insure groups of individuals against the costs of medical services and also provide those medical services Shouldice 1991

U.S. Healthcare Policy Health Maintenance Organization (HMO) Pay a premium each month Receive ‘complete’ care ‘Primary Care Doctor’ you must select Some preventive services covered, such as well baby check ups, immunizations Care must be provided by HMO’s practice group Cannot self-refer to a specialist No claim forms to fill out Small copay

U.S. Healthcare Policy Preferred Provider Organizations (PPO) Combination of a fee-for-service and HMO Limits choice of doctors / hospitals

U.S. Healthcare Policy Preferred Provider Organizations Has arrangements with doctors, hospitals, and other providers of care who have agreed to accept lower fees from the insurer for their services. Copay More expensive outside the network

 What are the pros and cons of managed care?  How well do you think managed care promotes wellness and preventive services? U.S. Healthcare Policy Concept Checks

U.S. Healthcare Policy  Rank the following organizations, from highest to lowest, according the statement: “I have a favorable opinion of” Airlines Banks Doctors Health Insurance Companies HMOs Hospitals Oil Companies Pharmaceutical companies Tobacco companies  In general, do you think managed care health plans are doing a good job or a bad job in serving health care consumers?

U.S. Healthcare Policy  How worried are you about each of these? (Perception of risk) Having to pay more for your health care insurance Your income not keeping up with rising prices Not being able to afford health care services you think you need Your health plan being more concerned about saving money than about what is best for your The quality of health care services you receive getting worse Losing your health insurance coverage Not being able to pay your rent or mortgage Being the victim of a terrorist attack Being the victim of a violent crime Being the victim of a food borne illness due to the mass distribution of food Losing your job or not getting a job Having to stay in your current job instead of taking a new job for fear of losing health benefits.

U.S. Healthcare Policy  Which of these is a very important factor in rising health care costs? High profits made by drug and insurance companies Number of malpractice lawsuits Amount of greed and waste that is in the current health care system Aging of the population Use of expensive high-tech medical equipment and drugs Doctors making too much money People having little incentive to look for lower cost doctors and services Other  How satisfied are you with what you pay for health insurance?

U.S. Healthcare Policy  Kaiser Health Care Survey

U.S. Healthcare Policy

Maciosek article  What is the premise of the article?  Define QALYs  Do you think the methods describe adequate represent an assessment of nutrition interventions? Why or why not?  How could this system be incorporated into U.S. Health Care policy? U.S. Healthcare Policy Concept Checks

Blackburn article  Describe the Chronic Care Model  What are the strengths and weaknesses of this model  How might this address issues in health care costs? U.S. Healthcare Policy Concept Checks