GROUP MEDICAL EXPENSE BENEFITS: THE CHANGING ENVIRONMENT CHAPTER 9.

GROUP MEDICAL EXPENSE BENEFITS: THE CHANGING

ENVIRONMENT

CHAPTER 9

Development of Medical Expense Coverage

Before the 1930s: families or charity

The Blues: started by hospitals, big in the 40s

Early HMOs-- started in the late 1920, but remained small until 1970s

Early ins : 1930s, major med in late 40s

The 1960s: governmentThe 1970s--reactions to

spiraling costs: HMO Act of 73, self-funding

The 1980s and 1990s--continued change: health care = 15% GDP; 15% population uninsured, more cost-containment focus.

HMOs and Self-funding

1980: 90% of workers in a traditional plan

1999: 85% of workers in managed care50% of workers covered by self-funded plans80%+ if >20,000 ees

Cost Containment and Managed Care

Reasons for increasing costsMeasures for cost containment

plan design with cost shifting and cost containment

alternative providers: HMOs, PPOs, and point of service

alternate funding methods (ch 14)claims review

Cost Containment and Managed Care (cont)

Health education and preventive careEncouragement of external cost-control

systemsManaged care

Characteristics of managed care

controlled access to providerscomprehensive case managementpreventive carerisk sharinghigh-quality care

State ReformsStates continue to take the lead in health care

reform, and there is some support in Congress to allow this to continue.

NAIC Small Employer Health Insurance Availability Model Act

Other state reformsTortStandardized claims administrationHealth Insurance Purchasing Cooperatives (HIPCs)

National Health Insurance Basic questions

Does national health care exist?role of medicaid and medicare

Is the objective affordability or availability?Universal coverage or universal access?

Do Americans want reform? - politicsWho should pay? employer mandate?What benefits should be available?Trade-off between cost containment and

quality?

National Health Care: Approaches

Managed competitionSingle payer plans (Canadian style)Medical Savings Accounts (MSAs)State owned programsModest reform of current system

Increase availabilityPortabilityContinuation

increased portabilityeliminate preexisting conditions

(nondiscrimination)better child coverage (CHIPs)Tax breaks for MSA and self-employedGuaranteed renewableGuaranteed issue for small employers

GROUP MEDICAL EXPENSE BENEFITS: THE CHANGING ENVIRONMENT CHAPTER 9.

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