政府和医疗保健市场.docxVIP

政府与医疗保健市场 1 SOURCE: Centers for Medicare and Medicaid Services [2005a]. 2 SOURCE: Centers for Medicare and Medicaid Services [2005a]. 3 Private Health Insurance The Implicit Subsidy for Employer-Provided Insurance World War II era price controls Federal tax subsidy 4 The Advantages of Employer-Provided Health Insurance Increase the risk pool Reduce adverse selection Lower administrative costs 5 Employer-Provided Health Insurance and Job Lock Job lock Health Insurance Policy Portability and Accountability Act of 1996 (Kennedy-Kassenbaum Act) 6 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) 7 Medicare: Overview SOURCE: Centers for Medicare and Medicaid Services [2005a]. Real expenditures on Medicare Expenditures on Medicare as a Share of GDP 8 How Medicare Works Benefits Part A – Hospital insurance (HI) Part B – Supplementary medical insurance (SMI) Financing Payroll tax funds HI General revenues fund SMI 9 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 11 Medicare: Impacts on Spending and Health Expenditures on health care for the elderly Health outcomes 12 Medicaid: Overview Medicaid State Children’s Health Insurance Program 13 SOURCE: Centers for Medicare and Medicaid Services [2005a]. 14 Financing and Administration Joint Federal-State financing State administration 15 Benefits States obligated to offer minimum package of benefits States may offer more generous benefits State administrative flexibility 16 Medicaid: Impacts on Health Take-up rate Crowding out Empirical evidence: