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Course: The Brookings Institution > Unit 1
Lesson 1: Introduction to health care in the U.S.- Introduction to the U.S. health care system
- Medicare
- Medicaid
- The U.S. uninsured population
- Paying for medicines: copays and deductibles
- Paying for medicines: tiering and formularies
- Understanding your medical bill
- Health care costs
- Private health insurance
- Health care for the chronically ill
- Health care exercise
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Health care costs
We all know the US spends a lot on health care, but why are costs so high and what can we do about it? This video explains the reasons why costs have risen so rapidly and various policies proposed to contain costs and improve health care value. Created by Brookings Institution.
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Should we be concerned that Pay for Performance might incentivize hospitals to keep patients away who actually should be readmitted?(7 votes)
For the most part, no, because of a few different reasons.
1 ) The analysts that calculate these metrics are able to differentiate between planned readmissions, and unplanned readmissions. Meaning, if standard appropriate care would require a patient to come back in for a hospital visit after a surgery, that would not be included in the calculation.
2 ) Hospitals cannot turn emergent patients away. If they do, the legal ramifications would be far greater than the reduced payment that would result from higher readmissions.
3 ) The readmission is attributed to the hospital that the person was discharged from, not the one they are readmitted to. So even if a hospital was willing to risk the legal ramifications by turning patients away, a different hospital would have no reason to turn them away.(10 votes)
Shouldn't we be trying to increase the supply of medical providers to increase competition among them and thereby reduce costs? Unfortunately, the barriers to admittance and completion of medical school are enormous. In other words, free market solutions to increasing medical costs are seldom if ever tried.(7 votes)
The barriers to admittance don't end with medical school. Greater problems come from a shortage of residency positions. The American Medical Association is demanding more funding for these residency positions, but they may not actually need it. Residents do valuable work and are not paid very much. Where would the difference go? It's sort of like the residents are paying a "tuition" to train in the hospital, and this tuition acts as a pay deduction for the services they provide. Hospitals may actually be able to add more residency spots if they truly need to.(3 votes)
In the second half of the video, in discussing "Pay for Performance", why is the most critical variable in the process, namely THE PATIENT, left out of the discussion? The MD, RN, and Administrators were all mentioned as having increased "accountability", but how does such a system work if the patient refuses to quit smoking or refuses to lose weight or neglects to take the medication as prescribed (or fails in any other manner of ways) and then requires re-admission to the hospital?(6 votes)- This is a great question. A common complaint I hear from doctors is that they know how to keep their patients healthy, it's just getting the patients to actually comply. Some of the most successful physicians in capitated arrangements aren't necessarily the most medically savvy doctors, but rather the ones that can connect with their patients and engage them in their own health outcomes.
However, it should be noted that patients do inherently have incentives to stay healthy, namely their own well-being, but also any co-pays, deductibles and co-insurance. The problem is people are REALLY bad at making rational decisions about these kinds of things. It takes a lot of will-power for someone to choose the $4.00 healthy meal over the $2.00 unhealthy meal, even if they know there is ~$5.00 worth of unseen healthcare costs associated with the unhealthy meal in the long run. And it gets much more complicated for more grey areas. i.e. smokers should pay a higher premium for their intentionally unhealthy behaviors, but should people that choose to live next to industrial neighborhoods with high air pollution also pay higher rates? If people who neglect to take their medication should be at financial risk, should people that are very forgetful due to mental conditions also be at financial risk?
Some steps are taken to create incentives for people to better manage their own health. Many employers now offer free gym memberships, smoking cessation programs, and disease management programs. Health plans offer rewards programs to essentially pay people for being healthy.(5 votes)
How old should you be to start learning about the US health care?(4 votes)- The sooner the better, but definitly before you get out of higschool. When I went to college, I was clueless about my health insurance situation. Knowing about these kinds of things can help you make much more informed decisions that could easily save you hundreds of dollars and potentially help you avoid bankruptcy if something serious happens.(6 votes)
Are HMO systems an example of Full Capitation?(3 votes)- Yes. In HMO plans there are various levels of "risk" the provider is willing to take. They may just want to act as the member's gatekeeper, and get a small payment from the insurance company for that additional management. They may also be willing to take a full capitation arrangement, where they are fully at risk for all the services their members require, in exchange for a much larger financial payment to cover those services.(1 vote)
- Who uses these different type of service within the accountable spectrum? As to who uses p4p or episodic care and so on? is it dependent on the insurance plan?(2 votes)
As we go towards full capitation, won't this mean that you're capping the maximum price given to the hospital? So they earn less as they are forced to do more each time a patient returns to the hospital? So a patient with a really complex problem that requires multiple surgeries and long hospitalization stay will hit the hospital really hard in terms of the excess of expenses over DRG or capitation per person, wouldn't he?(2 votes)- Full capitation refers to how physicians are paid. Hospitals can still choose to charge whatever they like, but when the physician that's ordering the service is the one that has to pay for it, they are less likely to pay higher prices or pay for frivolous tests. It really just shifts the roll of the insurance company over to the physician (except for processing claims).(1 vote)
- "Full Capitation Act" is it part of the Affordable Care Act?(1 vote)
- is there global care rigth now(1 vote)
- When I receive my hospital bill, none of the services charged for are defined, other than by a code number. This is not very helpful in determining whether I actually received all the services I was charged for. How do I find out what those code numbers mean?(1 vote)
