Health Economics & Policy 2 nd Edition James W. Henderson Chapter 13 Policies That Enhance Access Copyright 2002, South-Western, a division of Thomson Learning, James W. Henderson, Health Economics and Policy, 2e

Medicare l Institutional features –Part A—Hospital insurance –Part B—Physicians’ insurance –A flawed insurance system l Who pays? l Who benefits? l Economic consequences

Medicare Spending

Medicare Payment Allocations, 1997

Medicare Assignment l Graphical presentation (see p. 427) l Impact on non-Medicare patients l Impact on the elderly l Impact on medical practitioners

Medicaid l Institutional features –State administered –Federal cost-sharing –Eligibility standards l SCHIP expansion l Economic consequences

Medicaid Spending

Spending by Eligibility Categories, 1997

Other Economic Issues l Health outcomes l Enrollment in private insurance l Labor supply l Family structure l Savings

Other Government Programs l FEHBP l Defense Department –Direct care –Civilian Health and TriCare Standard l Veterans’ Administration

Summary and Conclusions l Fulfilled stated goals—improving medical care access for poor, elderly, and disabled l Medicare’s structural deficiency—poor coverage for catastrophic illness l Medicare’s limited benefit package— lacks outpatient prescription drug coverage and long-term care coverage