Health System Reform 2015

7/26/2019 Health System Reform 2015

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Health System Reform

Allen C. Goodman, 2015


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Goals

A health safety net for all residents,irrese!ti"e of a#e, health stat$s, oremloyment stat$s

%e!hanisms that romote !ost!ontainment

Choi!e for atients and ro"iders

&ase in administration


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Reso$r!e Costs

B

+HA

-G

Health

Goods

Non-Health Goods

Efficient Care

H0

G0

B

Inefficient Care

Figure 23-1 The Resource Costs

of Health Reform

H1

P

B''

P'

P''

G1

Ass$me so!iety determines toro"ide a safety net for allresidents, in!reasin# theamo$nt of health #oodsro"ided from H0to H1.

Economic costof ro"idin#H = H1 H0of health is

the amo$nt of G#i"en $,orG = G0 G1.

'f (e !o$ld !ontrol !osts, orro"ide health more

effi!iently, so!iety mi#htla$si)ly rea!h a oint li*eBor e"en B, on theeffi!ient art of the frontier.


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+ne of the $nderlyin##oals of reform(o$ld mo"e to moreeffi!ient rod$!tion of

health from health!are.

A related iss$e is(hether there (ill )e!ostsharin# for

!o"ered ser"i!es and'f so, (hat tye of !ost

sharin# arran#ement(ill o!!$r.

B

+HA

-G

Health

Goods

Non-Health Goods

Efficient Care

H0

G0

B

Inefficient Care

Figure 23-1 The Resource Costs

of Health Reform

H1

P

B''

P'

P''

G1


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Costs of 'n!remental Care

-he tr$ly in!remental !osts stem fromse"eral so$r!es.

/irst, the maor reason for s(it!hin# to a H'lan is to etend !o"era#e to the 50 million$nins$red. 't sho$ld )e $nderstood that the$nins$red already !ons$me health !are.

3ero ins$ran!e does not ne!essarily mean4ero !are.


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Hadley et al 20067

8sed data from the 20022009 %edi!al&endit$re :anel S$r"eys %&:S7, a nationallyreresentati"e s$r"ey of the !i"ilian,

noninstit$tionali4ed o$lation. &stimated that $nins$red Ameri!ans !ons$med

;6< )illion (orth of health !are in 2006. -histotal !onsisted of ;=0 )illion in o$tofo!*et!osts and ;5< )illion in $n!omensated !are.Go"ernments i!*ed $ a)o$t ;9= )illion of thelatter.


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Hadley 2

-he a$thors then roe!ted that the in!remental !ost ofro"idin# f$llyear !o"era#e for all $nins$red (o$ldamo$nt to ;12= )illion, so that total sendin# of those!$rrently $nins$red (o$ld rise from ;6< to ;20> )illion.

-his in!remental !ost reresented 5.1? of total health!are sendin# in the 8nited States and sli#htly less than1? of its G@:. -he a$thors )ase their estimates on the$tili4ation atterns of lo(erin!ome and lo(ermiddlein!ome indi"id$als.

%ore or less #enero$s lans as (ell as hi#her or lo(erayment rates to ro"iders (o$ld raise or lo(erestimated !osts a!!ordin#ly.


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Hadley =

'ns$red o$lation (ill !ost more to the etent that anH' lan ro"ides #reater tyi!al !o"era#e than eolealready !hoose to )$y or ha"e ro"ided to them )y otherso$r!es.

Also, any tas$orted system of finan!in# !areotentially entails a dead(ei#ht loss to so!iety, astaayers resond to the !han#ed in!enti"es. -hedead(ei#ht losses that a!!omany ta in!reases meanthat some effi!ien!y loss (ill res$lt, !a$sed )y the

disin!enti"es to (or* and in"est. -his is tr$e e"en if the ro#ram is of the emloyer

mandated tye, )e!a$se a la( for!in# emloyers toin!$r eense is really a ta.


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o(

'f yo$ $sh $ n$m)ers )y a)o$t 22? 9?er year7, sin!e 2006 yo$ #etB 6< 1.25 109..1>-rillion.

-his in!remental !ost reresented 6.D? oftotal health !are sendin# in the 8nitedStates and a)o$t 1.5 ? of its G@:.


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&mloyer %andate Eho ays

Ee ha"e demand F

F and s$ly.

-hey lead to a la)or mar*et

e$ili)ri$m.Ehat haens if (e ro"ide

;4 er ho$r of ins$ran!e,that is (orth ;4 to (or*ers

Eho aysEhat haens if ins$ran!e

!osts rise

Ea#e, E

a)or %*t

@S

E

@

S

4 4


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Ienefits

's there no (elfare loss

Ee ha"e demand F

F and s$ly.

-hey lead to a la)or mar*et

e$ili)ri$m.Ehat haens if (e ro"ide

;4 er ho$r of ins$ran!e,that is (orth ;0to (or*ers

Eho aysEhat haens if ins$ran!e

!osts rise

Ea#e, E

a)or %*t

@S

E

@

4

E

@E oss


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Cometiti"eness


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@eends on &lasti!ity

'n re"io$s dia#ram, (ho ays, deendson ho( elasti! the demand is.

'n ast, demand for !ars, for eamle, (asrelati"ely inelasti!.

As 8S !arma*ers #ot more !ometition,(hat haened


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&"al$ation of ::ACA Safety et

CI+ noted that aroimately =2 million eole(o$ld #ain !o"era#e )y 201>.

:redi!ted in!reases of 1< million thro$#h

%edi!aid and CH':, and 29 million thro$#h thee!han#es, (ith small de!reases of those inemloyer and non#ro$ ins$ran!e.

-his (o$ld lea"e a)o$t 2= million nonelderlyresidents $nins$red a)o$t onethird of (hom(o$ld )e $na$thori4ed immi#rants7.


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&"al$ation of ::ACA Costs

Red$!in# !ons$mer demand thro$#h the so!alledCadilla! ins$ran!e taJ

C$ttin# ro"ider ayments )y aointin# a deoliti!i4ed)oard to ma*e $ordo(n re!ommendations to

Con#ress on !han#es to %edi!areKs ro"ider aymentsJ R$nnin# ilot ro#rams to test "ario$s aroa!hes to

re"amin# ro"iderayment in!enti"es andor#ani4ational str$!t$reJ

'n"estin# h$ndreds of millions of dollars in ne(!omarati"eeffe!ti"eness resear!hJ and

a$n!hin# ilot ro#rams to assess the ima!t of "ario$sreor#ani4ations of the medi!al malra!ti!e ro!ess.


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&ssential Health Ienefits &HI7&HI m$st in!l$de items and ser"i!es (ithin at leastthe follo(in# 10 !ate#oriesB

1. Am)$latory atient ser"i!es

2. &mer#en!y ser"i!es=. Hositali4ation9. %aternity and ne()orn !are5. %ental health and s$)stan!e $se disorder

ser"i!es, in!l$din# )eha"ioral healthtreatment


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&ssential Health Ienefits &HI7&HI m$st in!l$de items and ser"i!es (ithin at leastthe follo(in# 10 !ate#oriesB


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-h$s /ar F


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Some Ii# Chan#es


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Documents

Health System Reform 2015