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Health Economics

Terms in this set (9)

eligibility for medicaid
-Low-income women and children who do not qualify for TANF
-Medically needy and low-income
-Low income elderly who cannot afford medicare co-payments
-People receiving SSI(supplemental security income)
Why did Number of Medicaid enrollees increase under affordable care act
-Expanded by making people eligible at higher income levels (federal poverty level increased)
-states had a choice of whether or not to expand
-33 states and Washington DC have expanded Medicaid under ACA (Maine has not)
-medicaid has grown significantly since ACA
Medicaid in maine
-Did not expand under ACA
-Higher percentage of population on medicaid than national average
-Average spending per enrollee is higher than national average
-Maine had a lower percentage of state contribution
Publicity posted physician ratings are available
-physician ratings are intended to provide consumers with more information about how to choose a physician, and thus make physicians more responsible to consumers
-The current physician data, at least for Maine, is minimal and difficult to find easily. Thus, it seems unlikely to be helpful to patients at the current time
What are conditions that facilitate price competition occurring in U.S. market
-Need to have several hospitals in close proximity
-Price competition usually occurs through insurance companies negotiating rates with hospitals rather than more direct competition in prices quoted to patients
-Need high percentage of population with commercial health insurance for competition to occur
Impact of tax exemption for health insurance
-Employees are incentivized to offer employees health insurance coverage rather than higher wages
-Individuals are incentivized to spend money on healthcare or health insurance because they do not pay taxes on money spent on healthcare or health insurance
-with current health care insurance structure, people purchase more healthcare than they would if they had to pay full cost at time of service
-People dont feel the economic burden of healthcare spending due to only paying co-pay
-Lost federal tax revenue
-Healthcare providers more likely to order medical tests/treatment with small marginal benefit
How do insurance companies determine premiums
-Cost of claims
-Types of benefits in insurance plans
-State mandates about what must be in health insurance plans
-Average age of insured group
-Region of country
-Rate of medical inflation
How ACA addressed problems with risk pool and adverse/preferred selection
-Created online insurance exchange to make a larger pool of potential enrollees
-Eliminated exclusion for pre-existing conditions
-Created individual mandate
-Set criteria for medical loss ratio
Managed care appears to have
-Decreased number of inpatient hospital days
-Decreased number of hospital admissions
-Temporarily reduced growth in healthcare spending
-HMO's had backlash due to restrictive approval policies for people getting healthcare
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