1. Being a Wise Consumer; Insurance & Medical Costs Ch. 26

2. What do you think this means?

3. Social vs. Private Medical Treatment Private PrivateCompetition Need insurance Need money In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system. That support, however, is conditional: It falls to fewer than four in 10 if it means a limited choice of doctors, or waiting lists for non-emergency treatments. In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system. That support, however, is conditional: It falls to fewer than four in 10 if it means a limited choice of doctors, or waiting lists for non-emergency treatments. Support for change is based largely on unease with the current system's costs. Seventy-eight percent are dissatisfied with the cost of the nation's health care system, including 54 percent "very" dissatisfied. By Gary Langer Support for change is based largely on unease with the current system's costs. Seventy-eight percent are dissatisfied with the cost of the nation's health care system, including 54 percent "very" dissatisfied. By Gary Langer Social ( Universal ) Social ( Universal ) Available to all No competition Govt. foots the bill Simply saying that people have health insurance is meaningless. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year. In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year. Many of these individuals suffer chronic pain, and judging by the numbers, some will probably die awaiting treatment. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that "access to a waiting list is not access to healthcare." By Michael Tanner and Michael Cannon, Simply saying that people have health insurance is meaningless. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year. In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year. Many of these individuals suffer chronic pain, and judging by the numbers, some will probably die awaiting treatment. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that "access to a waiting list is not access to healthcare." By Michael Tanner and Michael Cannon,

4. What you can Expect in healthcare Primary Care Physician Primary Care Physician Select the right doc. For you Select the right doc. For you Specialist Specialist Medical History Medical History Second Opinion Second Opinion

5. Patient’s Bill of Rights Considerate and respectful care. Considerate and respectful care. Complete information concerning your diagnosis in language you can understand. Complete information concerning your diagnosis in language you can understand. Informed consent before treatment. Informed consent before treatment. Refusal of treatment. Refusal of treatment. Privacy. Privacy. Reasonable response when help is sought out. Reasonable response when help is sought out. Info. Pertaining to conflicts of interest. Info. Pertaining to conflicts of interest. Informed regarding using you in research. Informed regarding using you in research. Itemization of your charges. Itemization of your charges. Rules to follow. Rules to follow. Good follow up care. Good follow up care.

6. Medical Costs and Insurance Defensive Medicine: Numerous and sometimes unnecessary tests to avoid law suites. Defensive Medicine: Numerous and sometimes unnecessary tests to avoid law suites. Premium: Payment made to an insurance company for coverage. Premium: Payment made to an insurance company for coverage. Deductible: Amount an insured person pays before the insurance company begins paying. Deductible: Amount an insured person pays before the insurance company begins paying. Co-Pay: Small payment made when visiting with a physician. Co-Pay: Small payment made when visiting with a physician.

7. Insurance Coverage Any physician? Any physician? Deductible? Deductible? Lost income insurance provided? Lost income insurance provided? Full coverage? Full coverage? Pregnancy covered? Pregnancy covered? Group policy available? Group policy available? Mental health covered? Mental health covered? Dental Care? Dental Care? Dependents? Dependents? Pre-existing conditions covered? Pre-existing conditions covered? Quit or lose job Quit or lose job

8. Insurance Policies HMO’S: Subscribers receive complete medical care for a fixed monthly fee. PPO’S: When using pre- selected health care providers the subscriber receives discounted service. Traditional: Covers costs accrued through any doctor or hospital. Subscribers are Reimbursed the charges.

9. Free Health Services For disadvantaged members of society. For disadvantaged members of society. Medicaid Medicaid Health department Health department Free clinics Free clinics

10. Quiz 1. What information makes up a medical history? 2. What is a second opinion? 3. What is the purpose of the patients bill of rights? 4. What are two approaches being considered to make medical care affordable to everyone? 5. Name an advantage and disadvantage of traditional health insurance. 6. What is an HMO? 7. What kind of treatment do free clinics provide? 8. When selecting a primary care physician what would you look for in that individual? 9. What is defensive medicine? 10. What is a co-pay?

11. Quiz Answers 1. What information makes up a medical history? Previous illnesses, Surgery, Medications, Allergies. 2. What is a second opinion? The recommendation of another doctor. 3. What is the purpose of the patients bill of rights? To protect the patient. 4. What are two approaches being considered to make medical care affordable to everyone? Socialized Medicine & Shared cost programs. 5. Name an advantage and disadvantage of traditional health insurance. Advantage: choose any doctor. Disadvantage: Reimbursed charges.

12. Quiz Answers Continued 6. What is an HMO? Complete medical care for a monthly fee. 7. What kind of treatments do free clinics provide? Medicaid, Immunization, STI’s, Health services, Maternal services. 8. When selecting a primary care physician what would you look for in that individual? Qualifications, Caring, Experience. 9. What is defensive medicine? Use of numerous and sometimes unnecessary tests to avoid a lawsuit. 10. What is a co-pay? A small fee paid to receive healthcare services.