Exam #3: Political Activism*** Flashcards Preview

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Flashcards in Exam #3: Political Activism*** Deck (50)
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1

What is the National Health Expenditure?

2.8 trillion in 2012
17% of GDP

2

What is the breakdown of categories within the National Health Expenditure?

Hospital Care: 31.5%
Physician/Clinical services: 20%
Prescription drugs: 9.7%
Nursing home/continuing care retirement communities: 5.5%

3

Who pays for healthcare?

1. Self-pay
2. Employee insurance
3. Government
--> VA, Medicare, Medicaid

*Not guaranteed right to healthcare in US, millions still uninsured, health in US is low

4

What is the distribution between public and private insurance?

Private: 55%
Public: 45%

5

Public vs. Private

Households: 28%
Federal Government: 26%
Private businesses: 21%
State/Local: 18%
Private Revenues: 7%
-31% go to administrative costs (problem)

6

10% of population account for ___% of all healthcare spending.

63%

7

1% of population account for ___% of all healthcare spending.

21%

8

50% of population account for ___% of all healthcare spending.

3%

9

Federal Agencies

1. Department of Health & Human Services
2. Public Health Services

10

Department of Health & Human Services

-Public Health Service
-Center for Medicare & Medicaid Services (formally – Health Care Financing Administration)
-Administration for Children & Families
-Administration on Aging
-Office for Civil Rights

11

Public Health Service

-Agency for Health Care Research & Quality
-CDC
-FDA
-NIH
-Health Resources & Services Administration
-Indian Health Services
-Substance Abuse & Mental Health Services
-Agency for Toxic Substances & Disease Registry

12

When was the social security act initiated?

1935

13

Old Age & Survivors Insurance

--> Provides money to workers or family upon retirement, disability, or death

-2 components: social security and disability
-FICA
-Amount based on avg earnings/length of employment ($1,100-1,200)
-Takes about 5 people to fund for one person, in 2035 we will only have 2 people funding for one person (decreasing!!)

14

FICA (def and rate)

Federal Insurance Contributions Act

--> dedicated payroll tax taken out of our paychecks)

-FICA rate (2014): 7.65% up to max of $117,000, self-employed 15.3%

15

How many people receive social security?

Benefits sent to 55 million (2014)

16

Retirement age/benefits

62 w/partial benefits
→ full benefits at 66 (soon to be 67)

17

Unemployment Insurance

-Protect workers out of work through no fault of their own
-Governed by states

Qualifications:
•No work for >1 week
•Able to work and take job
•Previous job ended through no fault of own (not fired or asked to resigned)

18

Disability Insurance

-8 million receiving benefits (paid to worker or dependents)

Qualifications:
-covered by social security 5-10 years
-physical/mental disability
-unable to work

Downsides:
-5-month waiting period
-strict
-70% are denied
-only $900-1000/month

19

Supplemental Security Income

-Provides direct cash benefits to aged/disabled with decreased income
-Amount based on need, not on contributions
→ $100-200/month

20

Medicare

-Provides health insurance to citizens or permanent residents over 65 who have worked at least 10 years (Part A)
-Can purchase Supplemental Insurance (Part B) for additional cost

21

When was medicare established?

1965

22

What percentage of health services does medicare fund?

20%

23

Medicare Part A

-Hospital room fee covered
-Deductible is $1216 per benefit period (2014)
-Will pay some nursing home costs
-Hospice care covered for 210 days
-Home health services

24

Medicare Part B

-->additional supplement purchased separately

After $147 deductible, Part B pays 80% of allowable expenses (2014):
•Physician services
•Labs
•Durable medical equipment (walker, brace, etc)
•Outpatient services
•Prescription
•drugs not self-administered

Cost: $104.90 per month (2014)

25

Medicare Part C

Medicare Advantage Plans
-in select locations
-managed-care option run by private companies
-provides a few additional services
-higher plan cost paid by all members, not just those in Medicare Part C

26

Medicare Part D (and regulations)

Prescription Drug Coverage
-complex regulations
-monthly fee purchased from private plans

Cost: $0-50/month with $310 deductible (2014)
1. Pt pays 25% up to $2850
2. Then… Pt pays 47.5% (brand name) and 72% (generic) up to $4550 (gap, donut hole)
3. After that… pt pays about 5% for drugs

--> Decreased with Affordable Care Act

27

Medicaid

--> Pays for medical services for low income

-program designed by each state – huge variations
-majority in managed care plans
-does not cover all poor
-major financial support for persons in nursing homes

28

What percentage of nursing home costs does Medicaid cover?

45%

29

Medicare/Medicaid Legislation: Quality Improvement Organizations

Monitors appropriateness of admission/discharge and use of resources of medicare pts (avoid abuse of system)

30

Medicare/Medicaid Legislation: The Healthcare Quality Improvement Act

Monitors healthcare providers and their practice – doesn’t allow a bad physician to continue practice elsewhere in another state