This chapter cover health care function and opens with Kissick's equilateral triangle, the triangle has three 60 angles; Cost containment, access, and quality. The United States has trouble keeping this and equilateral triangle. 83% of Americans have health insurance, but 43 million are not covered. 8 of 10 uninsured people are in working families whose jobs do not provide insurance.
Health care is the best in America, but the most costly. Americans pay 17% out of pocket and third parties foot the rest. Third parties are; Private insurance, public/gov, and a small percentage is covered by private parties. People can be covered by fee-for-service or prepaid, fee-for-service people pay back after using services and prepaid people pay a coverage. Prepaid is working better for big business. The book follows and talks about SCHIP and its 40 billion dollar cost and how this cover uninsured children. SCHIP looks at low income children first who are not previously covered. Even with SCHIP working 8.3% of children under 18 are not covered.
Then this chapter moves into the terms of insurance talking about co-payments, deductibles, exclusion, pre-existing condition and fixed indemnity. All of these have different meanings and have to do with what the insurance will give you after you have been treated and what you will pay. There are eight different kinds of coverage for different parts of the body. The ways these different areas are covered is changing every day and fewer companies are covering them. The cost of overage varies on what the people covered do in their life and how much coverage they need.
The governmental agencies covered are Medicare( for people 65 and older with some exceptions for younger people), and Medicaid( for poor). These programs are made to cover people who do not have the finances to cover themselves. Adding on to this the book talks about Medigap which is supplemental coverage that fills the "gap" that Medicare does not cover. There are other supplemental plans which cover different diseases and different hospitals. Long term care is for when people need to be taken care of, these plans set care at home and provide caregivers. Some of these plans can cost up to 4000 dollars a month.
Managed care was brought in by Bill Clinton in 1993 to help stop the soaring costs of insurance. What this does is get groups of providers, deals with amounts of patients, financial incentives for users, and care is looked into by outsiders to provide best means. PPO, EPO, HMO are forms of managed care all of these have different plans and incentives for their consumers. There are lots of advantages and disadvantages in managed care.
National coverage was looked into next. This talked about plans to cover our nation, the US is the only developed nation without national coverage. Coverage would be paid through taxes and people would not pay out of pocket. The Canadian model is a good example of how this works. Even though is is not an example of national care it is on the right wave.
Reflection:
This chapter had a lot to talk about, there was a ton of information. The biggest thing our group got out of the was confusion. There was just so much information and so many term. We all believe there needs to be a change in health care in America. There needs to be reform, it is a burden on people and the money is too much. All people in the United States need to be covered in some way and the big companies should not be the ones deciding peoples fates. I got heated after watching the movie in class and feel like this is a huge issue.
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