Chapter 7 The Health Care System

Three Models of Health Care: The Medical Model Focus on diagnosis and cure Care in hospital, doctor’s office, nursing home Drugs, surgery rehabilitation Physicians control most treatment Little focus on prevention or community- based care © 2012 Pearson Education, Inc. All rights reserved.

Three Models of Health Care: The Social Model Focus on person’s ability to function in the social world –Health is more than the absence of disease Focus on functional capacity Health care mostly takes place in community © 2012 Pearson Education, Inc. All rights reserved.

Three Models of Health Care: The Health Promotion Model Focus on disease prevention and reduced disability With support, some can regain lost abilities Improving fitness and well-being © 2012 Pearson Education, Inc. All rights reserved.

Figure 7.1 Hospital Discharge Rates, 2006 © 2012 Pearson Education, Inc. All rights reserved.

The U.S. Health Care System Today History of Health Care for Older People –Few options until mid 1960s About ½ older people had health insurance –Medicare program passed by Congress 1965 –AMA opposed Medicare at the time Called it socialized medicine Feared government control of physicians fees © 2012 Pearson Education, Inc. All rights reserved.

The U.S. Health Care System Today Medicare Part A –Hospital Insurance –Funded by payroll tax –Eligibility –Benefits: 4 kinds of care Part B –Supplemental Medical Insurance © 2012 Pearson Education, Inc. All rights reserved.

The U.S. Health Care System Today Medicare –Funded by –Eligibility –Benefits Part D (2006) –Prescription Drug Discount Card –Has reduced some costs for some older people © 2012 Pearson Education, Inc. All rights reserved.

Figure 7.2 How Is the U.S. Health Care Dollar Spent? © 2012 Pearson Education, Inc. All rights reserved.

Figure 7.3 Number of Medicare Beneficiaries, 1970–2050 © 2012 Pearson Education, Inc. All rights reserved.

Figure 7.4 Total Medicare Expenditures 1970–2008 © 2012 Pearson Education, Inc. All rights reserved.

Figure 7.5 Medicare Costs as a Share of Gross Domestic Product © 2012 Pearson Education, Inc. All rights reserved.

Table 7.1 Medicare Payments, Original Medicare Plan © 2012 Pearson Education, Inc. All rights reserved.

The U.S. Health Care System Today Medicaid Began 1965 Serves low income Americans, all ages Funded by federal and state governments Eligibility –Income and asset limits –Income and asset limits different for each state © 2012 Pearson Education, Inc. All rights reserved.

Figure 7.6 Where the Medicaid Dollar for the Elderly Goes, 2002 © 2012 Pearson Education, Inc. All rights reserved.

Figure 7.7 Funding for Long-Term Care, 2004 © 2012 Pearson Education, Inc. All rights reserved.

The U.S. Health Care System Today Other Health Care Plans Employer Sponsored Plans Medigap –Intended to reduce out-of-pocket costs due to gaps in Medicare coverage Long Term Care Insurance –Vary widely in coverage and services Strong interest in buying LTC insurance © 2012 Pearson Education, Inc. All rights reserved.

Figure 7.8 Total Health Expenditures as a % of Gross Domestic Product © 2012 Pearson Education, Inc. All rights reserved.

The Cost of Care Since 1960 US leads developed nations in health care spending Costs expected to increase Federal, state, local governments paid nearly half the total health care bill in 2000 Rising health care costs explain most government spending on older people © 2012 Pearson Education, Inc. All rights reserved.

Figure 7.9 Out-of-Pocket Health Care Costs © 2012 Pearson Education, Inc. All rights reserved.

The Rising Personal Cost of Health Care Amount paid by individuals has increased, despite federal payments Older people pay high out-of-pocket costs About 9% no coverage except Medicare Few have long term care insurance Results © 2012 Pearson Education, Inc. All rights reserved.

Public Dissatisfaction & Health Care Reform Cost of care is high; weak return on cost Health Care Reform: National Legislative Action 2010 Gains & Losses for Medicare Beneficiaries Summary of the Legislation Structural Flaws in the System © 2012 Pearson Education, Inc. All rights reserved.

Institutional Care Insurance does not provide substantial nursing home benefits –Medicare –Medicaid Must spend down to qualify –Private Long Term Care Insurance Only pays about 45% of costs © 2012 Pearson Education, Inc. All rights reserved.

Table 7.2 Long-Term Care Expenditures for the Elderly © 2012 Pearson Education, Inc. All rights reserved.

Long Term Care: Community-Based Services In-Home care and Assisted Living Better community-based care accounts much of the decline in nursing home placement Olmstead Decision (1999) Types of HCBS © 2012 Pearson Education, Inc. All rights reserved.

Long-Term Care Long-Term Care Insurance: A Good Bet? Adult Day Care Respite Services Home Health Care Programs Changes in Funding to Control Costs © 2012 Pearson Education, Inc. All rights reserved.

Long Term Care: Managed Care Medical Care Settings –Some cost control –Capitated payments –Interdisciplinary approach –Early LTC planning –Keeps track of health records –Some focus on rehabilitation © 2012 Pearson Education, Inc. All rights reserved.

Disease Prevention & Health Promotion Prevention catching on in United States! Examples –No smoking in restaurants –Magazines on fitness –Salads and low fat items in fast food restaurants –Water and air quality standards © 2012 Pearson Education, Inc. All rights reserved.

Beyond Fitness and Personal Health Promotion Typical health promotion efforts: Should also –Account for the social and economic contexts of sickness –Account for environmental contexts Promotion and prevention must have impact on the production of illness © 2012 Pearson Education, Inc. All rights reserved.

Future Issues in Health Care Availability –Existence of services; “no-care zones” Accessibility –Can people get the services that do exist? Coordination –Case management needed –Need for integrated system © 2012 Pearson Education, Inc. All rights reserved.