Health Care Cost Containment
Measures designed to lower health care costs
3 categories of health care systems
voluntary nonprofit
proprietary institutions
government institutions
Health care facilities provide what services
emergency room treatment
community health education classes and materials
health screening services
clinical services
medical education for physicians, nurses and other health professionals
financial contributions to community organizations
coordination o
Ranking of U.S. infant mortality rate in 2006
33rd
Voluntary Nonprofit Institution
Community facility that receives federal, state, and local tax exemptions in exchange for providing a community benefit, such as services to Medicaid patients and those who are unable to pay. Operates for a charitable purpose. No net profit
Poprietary Institution
For-profit health care facility usually owned by a corporation. Usually owns a chain. Run like any other corporation and must pay local, state and federal taxes.
Government Institution
Public health care facility that receives most of its funding from local, state or federal sources.
Health care payment methods
Private insurance
Direct Payment
Government plans
Private insurance
Employment-based health insurance system
Direct payment
Patients pay for their health care with their own money
Government plans
Health care plan funded by a government agency. Active military, dependents and veterans, Medicaid and Medicare.
Premium
The monthly amount paid to an insurance company for health insurance coverage
Deductible
The money a person pays before the insurance policy provides benefits
Co-Insurance
Describes plans that require the insured to share a portion of the costs for health care services
Co-pay
Flat fee required by health insurance company each time they receive a health care service
Medicare
Federally-funded health care program for older Americans and permanently disabled workers
Medicaid
Government program that offers health insurance to many low-income and disabled people
TRICARE
Government health care plans for military personnel and their families
SCHIP (State Children's Health Insurance Program)
Provides states with matching funds to help expand health care coverage to uninsured children
CHIRPA (Children's Health Insurance Program Re-authorization Act)
Added $33B in federal funds for children's coverage
Managed Care
Puts health care providers in the position of managing a patient's use of health care
HMO (Health Maintenance Organization)
Provides coverage only if the care is delivered by a member of its hospital, physician or pharmacy panel
PPO (Preferred Provider Organization)
Allows patients to receive care from a non-plan provider, but requires them to pay a higher out-of-pocket price if they do so
POS (Point-of-Service)
Physician co-ordinated plan that combines characteristics of both HMO and PPO plans
In-Network Providers
Providers in the plan
Out-of-Network Providers
Providers not in the plan
Managed care plans characteristics
Consist of a select group of primary care providers
Provide a broad range of services
Eliminate duplicate services
Encourage cost containment
Provide a profit for both health care providers and ins co's
Include utilization review
Utilization Review
Process in which an insurer review decisions by a physician and other providers about how much care to provide
Gatekeeper
A physician who delivers primary care services by also makes referrals for specialty care
DRG
Diagnostic Related Group
DRG
Classification system. Patients with similar medical conditions are assigned to a DRG. Used by Medicare and Medicaid to determine payment for health services.
Resource Utilization
Health care facilities expect their employees to make efforts to cut costs