quiz 4/29

• The US healthcare system has the highest cost per capita in the world
• The US is unique/distinct from other wealthy nations in not having universal healthcare coverage
• Every other advanced economic wealthy nation can offer universal healthcare
• Private healthcare system


  Doctors and hospitals are in private practice/ownership
• 3rd party coverage


  Private or public, with some uninsured (10%)
• Most get care but many at inappropriate time and location
• Care can be very costly due to lack of insurance
• EMTALA

  Emergency Medical Treatment & Labor Act 1986 - Requires hospitals receiving government money to accept patients with medical emergencies even if uninsured
• Granny dumping

  Hospitals denying care of elderly adults
• The US has the most expensive healthcare system in the world
• Proportion of national economy spent on healthcare

  • 1970: 6.9%
  • 1980: 8.9%
  • 1990: 12.1%
  • 2000: 13.3%
  • 2020: 19.7%
• Other wealthy industrialized nations spend around 12% of their national economy on healthcare
• Drivers of high healthcare costs in the US

  • Supplier induced demand
  • Emphasis on technology (including new medications)
  • Administrative costs, organizational complexity
  • Aging population
  • Corporatization of healthcare (funds for profit, marketing)
  • Culture - action versus inaction
• The US healthcare system leads to more surgeries, more procedures, more drugs which ultimately leads to more spending
• Charity hospitals


  Established by faith-groups, provided care for the poor
• Local public hospitals


  Operated by county government, provided care for those who required it
• Community health centers (FQHCs)


  Federally funded, provide care for uninsured patients
• Charity clinics


  Provided primary care, mostly non-profit, faith based, and staffed by volunteers
• Individual policies pre-ACA


  Expensive, limits on pre-existing conditions
• Individual policies post-ACA


  Government subsidies, standardized benefits
• Private insurance


  Mostly obtained through employer, can also buy individual private insurance
• Private insurance began in the 1930s, expanded in the 1950s with Collective Bargaining
• Rise of Managed Care in 90s

  Health Maintenance Organizations (HMOs) - Have physicians on salaries, opposed by AMA, seen as way of controlling costs
• Political pressure led to easing of managed care controls as patients got mad over HMO incentives
• Medicare


  Federal program covering individuals over 65+ and permanently disabled, financed by payroll tax, premiums, copays/deductibles
• Medicaid & CHIP

  Medicaid: Program for the poor, low income families, disabled, children, elderly, foster care. CHIP: Covers medically indigent children.
• The ACA enacted in 2010 expanded Medicaid to cover childless adults <138% FPL, but some states (like Texas) did not expand Medicaid
• Consequences of being uninsured

  • Lack of preventive services
  • No usual source of care - delay
  • Less care - treatments, medications, specialty care
  • Financial consequences for providers & patients
• Groups lacking health coverage


  • Working poor
  • Undocumented
  • Small business employees
  • Unemployed
  • Self-employed (gig economy)
  • Retired by age 65
  • Young "invincibles"
• Texas had the highest rate of uninsured in the US
• "Spend down"

  Going to a long-term care facility and using up all money to then qualify for Medicaid