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CEBS: GBA 2, Module 1 Exam (Changing Dynamics of the U.S. Health Care System)
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CEBS: GBA 2, Module 1 Exam (Changing Dynamics of the U.S. Health Care System)
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CEBS: GBA 2, Module 1 Exam (ChangingDynamics of the U.S. Health Care
System)
Basic assumption of free markets - -Rational consumers will make informed
decisions about value, quality and price, while producers meeting
consumers' demands will be rewarded with market share and profit.
-Benefits of free markets - -People who do not like their provider or health
plan should be able to "vote with their feet" and select other options. The
theory is that choice empowers consumers, regulates producers and, under
the right conditions, drives efficiency.
-Ways in which health care does not function like a free market - -The
health care market has significant asymmetry in information between
consumers, providers and insurers. Additionally, moral hazard is a problem
because
the marginal cost of covered care is zero, causing some to over consume
medical care.
Research also indicates that many consumers choose their doctors initially
by
convenience, accessibility or recommendation from a friend or relative. Cost
has also
been shown to be lower on a priority scale for choosing a provider.
-Bounded Rationality - -the rational consumer is only functional up to a
certain point, in
which their choices are constrained or bound by limited knowledge and an
understanding
of available choices
-Initiatives that purport to use market forces to increase efficiency - -(a)
Employers are offering more high-deductible plans with some as high as
$10,000. These plans, often paired with health savings accounts (HSAs) are
coupled with the idea of transparency, or making more information available
to
the consumer on cost and quality. The idea is that consumers will have more
"skin in the game" and be more prudent purchasers of care with their own
money.
(b) The Affordable Care Act (ACA) is creating marketplaces that employ a
form of
managed competition where standardized health plans compete on cost and
quality.
(c) Public Medicaid and Medicare programs are moving toward requiring or
, making choices available for managed care products that structure care
within
provider networks.
-U.S. Programs for obtaining health insurance & percentage of population
covered - -The largest portion of Americans, 48%, receive health insurance
through an
employer, 16% through Medicaid and 15% through Medicare, and 6%
purchase
insurance on their own. 15% are uninsured
-How did ACA change Medicare? - -ACA expanded Medicare's wellness and
prevention benefits, improved prescription
drug coverage and financed experiments to control health care costs by
testing
alternative payment methods and delivery systems.
-How did ACA change eligibility for Medicaid benefits? - -ACA shifted
program eligibility from a category-based (for example, single parents
with dependents or people with disabilities eligible for cash assistance) to an
incomebased standard. The Medicaid program once covered fewer than half
of low-income
Americans, but now ACA Medicaid expansion has been steadily increasing
enrollment in this program
-National Federation of Independent Business v. Sebelius - -ACA sought to
expand Medicaid coverage to all individuals and families with
incomes below 138% of the poverty level. In the Sebelius case the U.S.
Supreme Court ruled that the states could choose not to
expand Medicaid programs. By January 2015, twenty-five states had chosen
not to
expand coverage.
-How has ACA affected the number of uninsured Americans? - -Prior to ACA,
16.3%, or 49.9 million, Americans were uninsured. By 2014 this
number had been reduced to 13%, and by the first quarter of 2016 to 8.6%.
-Describe private health insurance coverage with regard to :
(a) size of firm
(b) high-deductible health plans (HDHPs) with medical savings accounts and
(c)variability of coverage by states - -(a) In a recent study, 98% of
employers with 200 or more employees offer health
insurance, but fewer than 45% of firms with three to nine employees do so.
Larger employers offer more choice of health plans than smaller employers,
and
smaller firms tend to offer point-of-service (POS) plans that require higher
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