national health care expenditure
2.8 trillion dollars in 2012
17.2% of GOP
national health expenditures by category
hospital care: 31% (2011)
nursing home facilities and continuing care retirement communities: 5.5% (2011)
physician and clinical services: 20% (2011)
prescription drugs: 9.7% (2011)
who pays for health care?
self pay
employee insurance
government (VA, medicare, medicaid)
private vs public
households: 28%
federal government: 26%
private business: 21%
state and local: 18%
private revenues: 7%
10% of population account for __________ percent of all healthcare spending
63
1% of population account for ____________ of all healthcare spending
21
50% of population account for ___________ of all healthcare spending
3
40% of medicare costs occur in the last ___________ of life
month
dept of health and human services
public health service
center for medicare and medicaid services
administration for children and families
administration on aging
office for civil rights
public health service
agency for health care research and quality
center for disease control and prevention
food and drug administration
national institutes of health
health resources and services administration
indian health services
substance abuse and mental health services
social security act--1935
amendments:
old-age and survivors insurance
unemployment compensation
disability insurance
medicare
medicaid
old age and survivors insurance
provides monies to workers or family upon retirement, disability, or death
2 components (social security and disability)
federal insurance contributions act (FICA)
FICA rate (2014)
2014--benefits sent to 55 million
amount based on avg earnings and length
FICA rate 2014
7.65% up to max of $117,000
self employed 15.3%
retirement age
62 with partial benefits
avg amount is based on avg earnings and how long you worked
disability insurance
8 million receiving benefits
qualifications: covered by social security 5-10 yrs, physical or mental disability, unable to work
5 month waiting period
paid to worker or dependents
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
supplemental security income
provides direct cash benefits to aged or disabled with decreased income
amount based on need, not on contributions
500 million people per yr
medicare
established in 1965
funds 20% of all health services
provides health insurance to citizens or permanent residents over 65 who have worked at least 10 yrs (part a)
can purchase supplemental insurance (part b) for additional cost
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
medicare part b
after $147 deductible, part b pays 80% of allowable expenses (2014)
physician services
labs
durable medical equipment
outpatient services
prescription drugs not self-administering
cost: $104.90 per month (2014)
medicare part c
medicare advantage plans
available 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
medicare part d
prescription drug coverage
complex regulations
monthly fee purchased from private plans
cost- $0-50 per month with $310 deductible, patient pays 25% up to $2850
then patient pays 47.5% brand name and 72% generic up to $4550 (gap donut hole)
after that , p
medicaid
pays for medical services for low income
program designed by each state
majority in managed care plans
does not voter all poor
major financial support for persons in nursing homes
medicare/medicaid legislation
quality improvement organizations
the health care quality improvement act
early 1980's:
drastic cuts to medicare and medicaid
prospective payment system developed
diagnostic related groups (DRG)
results of PPS-DRGs
shorter length of stay
increased patient acuity
nursing home admissions increased x3
increased demands on family, community, and home care provider resources
past 10-20 years in medicare/medicaid
reimbursement for certified nurses-midwives, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists
nursing home care standards
child health
health economic stats for 2009
46,000,000 uninsured americans
86.7 million uninsured over past 2 yrs
medical bills account for >60% of bankruptcies
uninsured have a 40-50% higher risk of death
100,000 lives could be saved yearly with universal primary care
family health insurance cost
health economic stats for 2014
approximately 30,000,000 uninsured americans
medical bills account for >60% of bankruptcies
family health insurance cost $15,473/yr
concerns about healthcare
is health care a right or privilege?
if a right, whose jurisdiction?
is equity of care an entitlement?
president clinton-health security act
increasing trend to universal coverage with combination of public/private sectors
healthcare reform 2010
provides coverage to 32 million currently uninsured
creates interstate health insurance exchanges
closes medicare part d donut hole
expands medicaid to 133% of poverty level ($29,327/family of 4)
insurance companies may no longer deny _________ coverage with preexisting conditions
children
in 2014, insurance companies may no longer deny __________ coverage with preexisting conditions
anyone
children stay on parent's plan until age _____
26
in 2014, no _______ limit caps
lifetime
in 2014, everyone must purchase health insurance or face a _________ annual fine (low income exceptions)
$695
tax credits for _______ businesses
small
by 2018, all plans must cover ________ care
preventative
in 2010, ______ tanning tax
10%
in 2013, 3.8% investment income tax for families making ____________
>$250,000/yr
in 2013, increase medicare tax to 9% on families making _________
>$250,000
in 2018, 40% excise tax on high-end health insurance plans ________
>$27,500
paying for healthcare reform between 2011 and 2019
drug companies will pay 16 billion
insurance companies will pay 47 billion
medical device manufacturers pay 2.9% excise tax on sale of walls
medicare part c reductions over 10 yrs
home health care reductions over 10 yrs
nursing healthcare costs
difficult to determine actual cost of nursing care
about 20-28% of hospitalization costs are related to nursing care
economic value of RN nursing care
economic value of RN nursing care
decreased patient complications
decreased length of stay
decreased patient deaths
managing healthcare costs
be aware of costs
provide evidence based care
higher level degrees
lifelong learning
patient education
political professionalism in nursing
political activism is part of the role of a registered professional nurse
know your legislators and how they vote on issues important to you
contact legislators about issues
participate in political campaigns
vote
know legislator's voting record
legislator influence
interest groups
political action committees (PACs)
lobbysists
grassroots lobbying
grassroots lobbying
individuals write/email/call a legislator
writing to legislator
address correctly
identity self as nurse and constituent
be brief and specific
use reasoning, good sense, and facts
include bill number, author, title, status
use correct grammar and spelling
political professionalism in nursing
participate in organizations concerned with legislative issues
give testimony at hearing
participate on advisory committees
originate and encourage specific legislation
becoming politically savvy
know your nurse practice act
join ANA
read american journal of nursing
awareness of specialty organizations
legislative issues
read newspapers or web
nursing and politics
nurses becoming more politically involved
ANA and other organizations update nurses on important issues
individual nurses are encouraged to become acquainted with legislators
identify voting records especially health care policies and nursing issues