致用英语报刊阅读unit 4. employment.pptVIP

LOGO LOGO * unit 4. Employment Passage A. GM ends strike, tries health plan Passage B. The 10 worst mistrakes career changers can make Passage A. GM ends strike, tries health plan 1. American retiree health care system 2. the text(main idea, vocabulary) 3. What is the ostensible reason for the strike? what is the real reason for the strike? 1. US Health Care System US Health Care Spending Three Main Parties in Health Care Payer 支付方 Service Provider 服务提供方 Patient 患者 Providers Doctors Hospitals Laboratories Pharmacies Pharmaceutical Companies (formularies) Home care and other specialty care What Do Providers Do? Family doctors: one-to-one relationship Specialists: specialty care Hospitals: inpatient and emergency care Drug stores: drug prescriptions Pharmaceutical companies: drugs under a “formulary” arrangement Patient Choose health insurance programs. People over 65 are covered by Medicare. People under a certain poverty line are covered by Medicaid. Enroll annually (with some exceptions). Still left 15% of the population “uninsured.” What Do Patients Do? Uninsured: seek emergency care or Medicaid Insured: Choose a family doctor Family doctor becomes the “care manager” Family doctor must make referral to hospitals Make co-pay as defined by payers (office visits, generic / brand name drug, out-of-pocket maximums, etc.) Payers Government: Medicare and state Medicaid programs Health insurance programs / HMO Patients What Do Payers Do? Pay claims submitted by providers. Establish “reasonable and customary” fee schedule. Provider contracting based on price and quality. Manage care through pre-authorization, referrals, case management, and preventive care. People stay healthy Diseases are diagnosed early Minimize disease complications What benefits health insurance companies Health Insurance Companies Keep Provider Costs Down Physician contracting Hospital contracting Formulary This removes all “extra benefits” from providers an