GROUP MEDICAL EXPENSE BENEFITS: THE CHANGING ENVIRONMENT CHAPTER 9.
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GROUP MEDICAL EXPENSE BENEFITS: THE CHANGING ENVIRONMENT CHAPTER 9
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HMOs and Self-funding 1980: 90% of workers in a traditional plan 1999: 85% of workers in managed care 50% of workers covered by self-funded plans 80%+ if >20,000 ees
Transcript of 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
HIPAA
increased portabilityeliminate preexisting conditions
(nondiscrimination)better child coverage (CHIPs)Tax breaks for MSA and self-employedGuaranteed renewableGuaranteed issue for small employers
