Chapter 10 - Government and the market for health care. The following will be discussed in this chapter: Private health insurance, the advantages of employer-provided health insurance, employer-provided health insurance and job lock, cost control and private insurance,. | GOVERNMENT AND THE MARKET FOR HEALTH CARE Chapter 10 Uses of Health Care Funds in the . (2010) Source: Centers for Medicare and Medicaid Services [2012c]. 10- Sources of Health Care Funds in the . (2010) 10- Source: Centers for Medicare and Medicaid Services [2012c]. Private Health Insurance The Implicit Subsidy for Employer-Provided Insurance World War II era price controls Federal tax subsidy 10- The Advantages of Employer-Provided Health Insurance Increase the risk pool Reduce adverse selection Lower administrative costs 10- Employer-Provided Health Insurance and Job Lock Job lock Health Insurance Policy Portability and Accountability Act of 1996 (Kennedy-Kassenbaum Act) 10- Cost Control and Private Insurance Cost-based reimbursement (fee-for-service) Managed care Capitation-based reimbursement Health Maintenance Organizations (HMOs) Preferred Provider Organizations (PPOs) Point-of-service (POS) 10- Medicare . | GOVERNMENT AND THE MARKET FOR HEALTH CARE Chapter 10 Uses of Health Care Funds in the . (2010) Source: Centers for Medicare and Medicaid Services [2012c]. 10- Sources of Health Care Funds in the . (2010) 10- Source: Centers for Medicare and Medicaid Services [2012c]. Private Health Insurance The Implicit Subsidy for Employer-Provided Insurance World War II era price controls Federal tax subsidy 10- The Advantages of Employer-Provided Health Insurance Increase the risk pool Reduce adverse selection Lower administrative costs 10- Employer-Provided Health Insurance and Job Lock Job lock Health Insurance Policy Portability and Accountability Act of 1996 (Kennedy-Kassenbaum Act) 10- Cost Control and Private Insurance Cost-based reimbursement (fee-for-service) Managed care Capitation-based reimbursement Health Maintenance Organizations (HMOs) Preferred Provider Organizations (PPOs) Point-of-service (POS) 10- Medicare Expenditures (1966-2010) Expenditures on Medicare as a Share of GDP Real expenditures on Medicare Source: Centers for Medicare and Medicaid Services [2012c]. 10- How Medicare Works Benefits Part A – Hospital insurance (HI) Part B – Supplementary Medical Insurance (SMI) Financing Payroll tax funds HI General revenues fund SMI 10- Prescription Drug Benefit Part C – Medicare Advantage Part D – Prescription Drug Benefit Monthly premium Low deductible Donut hole Generous coverage for high costs 10- Cost Control Under Medicare Medicare’s retrospective payment system Medicare’s prospective payment system Diagnosis related groups Resource-based relative value scale system Medicare Managed Care 10- Medicare: Impacts on Spending and Health Expenditures on health care for the elderly Health outcomes 10- Medicaid: Overview Medicaid State Children’s Health Insurance Program 10- Medicaid Expenditures (1966-2010) Source: Centers for Medicare and Medicaid Services [2012c].
