Older adults, chidlren, racial and ethinc minorties, poor, uninsured, chronically ill, disabled, terminally ill, mentally ill, aids victims, alchol and substance abuse people, homeless, rural areas, non english speakers, communicaiton difficulties, low levels of education
US 75 for males, 80 for females
World Health Organization (WHO)
objective is to influence health opportunities and outcomes for all people so that they can attan the highest possible level of helth. Six goals: 1. promoting development 2. fostering health security 3. strenghitng health systems 4. harnessing reasrch, infomration,a nd evidence, 5. enhacing partnerships, 6. improve performacne
Institute of medicine
Non profit organizaton that conducts reaearch from a systems approach to imprve health care of the nation.
group of providers come together and develop IPA. Contract with insruance comapny on behalf of providers they represent. Insurance company works with IPA to get contracts. Insurance company pays IPA, IPA pays doctors, etc.
HMO- least expensive plan, least amount of providers in network, more for younger healthier persons who dont go to the doctor frequently. PCP is gatekeeper, has to approve specialists
Pay more than HMO, has larger number of providers in network. Do not have to approve specialist.
Largest network. Most expensive. Unlimited access to large variety of specialists.
Primary care provider
Doctor who serves at the gatekeeper and foundation of a managed care organization.
A system such as an HMO in which each provider reacieves a flat annual fee for each participant regardless of how often the services are used.
formed to control hospital costs. Physicians whose professional focus is caring for the hospitalized patient.
Federallu funded health insurance program for persons over 65, disabled persons who are entitled to social securty benefits, and people with end stage renal disease requiring dialysis or kidney transplant. Also known as Title XVIII of the SSA. Part A
Inpatient care in hospitals, skilled nursing facilities, home health care, hospice
Supplementary voluntary coverage
Pays doctor's visits
Pharmaceutical costs—multiple plans available
Growth in elderly population
Depletion of Medicare resources (trust fund)
Uncovered services (glasses, hearing aids)
Federally funded insruance progam available to certain low income families who fit into an eligibility program that is recognized by federal and state law. Commonly known as welfare. Also called Title XIX of the ammednments to the SSA. Assistance program managed jointly by federal and state funds
Costs up to 50% of state budgets—open-ended program
Benefits vary by state
Certain low-income individuals
No age requirements
Families with children: 5-year lifetime limit
Private health insurnace
Traditional insurance companies (BC/BS)
PPOs—"brokers" between insurers/providers
POS—combination of HMOs and PPOs
Medicare and Medicaid
Health insurance portability and accountability act. Individuals with health insutance who lose or leave a job can maintain coverage even when they are sick. No cost provisions so it can be costly.