Texas Health and Human Services Chapter Twelve Texas Health and Human Services Presentation by Eric Miller. © 2005 Houghton Mifflin, all rights reserved. No part of this presentation may be reproduced in any form without the express written consent of the publisher.

Health Care Reforms The federal government brought health care reform to the top of the agenda in 1994. It was not significantly changed at the federal level, but states have made changes to their programs. Presentation by Eric Miller. © 2005 Houghton Mifflin, all rights reserved. No part of this presentation may be reproduced in any form without the express written consent of the publisher. Copyright © Houghton Mifflin Company. All rights reserved.

Terms Other than those mentioned in your textbook, there are five terms that are used when reform of a health care system comes up. Managed Care Managed Competition Universal Coverage Portability Single Payer Presentation by Eric Miller. © 2005 Houghton Mifflin, all rights reserved. No part of this presentation may be reproduced in any form without the express written consent of the publisher. Copyright © Houghton Mifflin Company. All rights reserved.

Managed Care Different types of plans seek to contain costs in different ways. Health Maintenance Organizations (HMOs) Preferred Provider Organizations (PPOs) Each seeks to restrict physicians and services, and cap payments. HMOs are usually contained in one place, while PPOs maintain a “network” of acceptable doctors. Presentation by Eric Miller. © 2005 Houghton Mifflin, all rights reserved. No part of this presentation may be reproduced in any form without the express written consent of the publisher. Copyright © Houghton Mifflin Company. All rights reserved.

Some would say the United States currently uses this system. Managed Competition Some would say the United States currently uses this system. Private insurance companies compete for customers. Insurance companies negotiate fees, coverage, etc. as competition. Presentation by Eric Miller. © 2005 Houghton Mifflin, all rights reserved. No part of this presentation may be reproduced in any form without the express written consent of the publisher. Copyright © Houghton Mifflin Company. All rights reserved.

This would take most healthcare out of the hands of the states. Universal Coverage This would take most healthcare out of the hands of the states. Other countries have this plan. Every person would be afforded some basic medical and health care. Presentation by Eric Miller. © 2005 Houghton Mifflin, all rights reserved. No part of this presentation may be reproduced in any form without the express written consent of the publisher. Copyright © Houghton Mifflin Company. All rights reserved.

Portability Portability refers to health plans that will follow the citizen where ever they go– even if it is to another state. As Texans move from place to place, their health insurance may or may not move with them. Presentation by Eric Miller. © 2005 Houghton Mifflin, all rights reserved. No part of this presentation may be reproduced in any form without the express written consent of the publisher. Copyright © Houghton Mifflin Company. All rights reserved.

This often goes with the idea of universal coverage. Single Payer This often goes with the idea of universal coverage. Under the single payer idea, there is only one health insurance source for the entire country (or state). Medicare comes close to this idea. Presentation by Eric Miller. © 2005 Houghton Mifflin, all rights reserved. No part of this presentation may be reproduced in any form without the express written consent of the publisher. Copyright © Houghton Mifflin Company. All rights reserved.

State Programs Several states have worked on providing universal coverage for their residents. Hawaii has come closest, with Oregon rationing healthcare for Medicaid recipients. Tennessee has a statewide network of insurance providers with costs varying by income level. Presentation by Eric Miller. © 2005 Houghton Mifflin, all rights reserved. No part of this presentation may be reproduced in any form without the express written consent of the publisher. Copyright © Houghton Mifflin Company. All rights reserved.

State Programs (Cont’d) States continue to look for ways to cut costs, yet meet federal and public expectations about levels of service. The terms will help you better understand the debate about healthcare here in Texas so you can get involved. Presentation by Eric Miller. © 2005 Houghton Mifflin, all rights reserved. No part of this presentation may be reproduced in any form without the express written consent of the publisher. Copyright © Houghton Mifflin Company. All rights reserved.