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challenges to accomplishing Health Reform
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, 1. Culture:
- lack of consensus
- entrepreneurialism and individualism
- contrasted by belief that gov. does have a role in health reform
2. US Political System:
- Checks and Balances
- States Responsibility
3. Interest groups:
- corporate for profit and non profit entities
- Lots of power- influence policies
-easy to oppose without proposing alternative
4. Path Dependency:
- Hard to accept changes
- Inertia/momentum in a particular direction creates windows of
opportunity
-Issue of "crowd out"
Cost containment tools
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1. Performance based salary, bonuses, and withholds
2.Discounted fee schedules
Lower payments and more patients
3. Capitated payments
Set pay for each member
Health insurance market differences
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, 1. Health insurance transaction w/ insured patient has 3 parties:
- consumer (patient)
- supplier (provider)
- insurers
2. Demand is unknown; supply needed unknown; therefore preferences
unknown- impossible to predict costs
3. Types of markets
Moral hazard
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Once someone is insured, that person is more likely to define a problem as
an illness and more likely to seek care (i.e. hypochondria)
Elasticity Graphs/ equation
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Elasticity= % change in Q demanded / % change in price or income
Pros & Cons of insurance
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, Insurance is GOOD because...
1. Allows consumers to purchase health care service they otherwise
couldn't afford
2. Lowers risks of financial ruin
But it can be COMPLICATED because of...
1. Business model of insurance companies
2. Asymmetric information
3. Adverse selection
LOW INCOME MINORITIES HAVE 6.2X THE PROBABILITY OF HAVING DIABETES.
THIS IS AN EXAMPLE OF A ________________.
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HEALTH DISPARITY
CHIP eligibility
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states may cover children up to 300% Federal Poverty Line
- children must be enrolled in Medicaid if eligible not in CHIP
States may impose waiting periods, enrollment caps, and other measures to
limit expenses
ACOs
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