Presented by Janki Shah and Ella Teplitsky

Background/Evidence• In 2008, the U.S. spent $2.4 trillion or

16% of gross domestic product (GDP), on health care, approximately $6,500, per person, annually.

• U.S. spending on health care is greater than any other industrialized nation.

•There are approximately 45 million uninsured Americans due to the high cost.

Percent of population eligible for hospitalization insurance for US is 46%, Compared to United Kingdom which is 100.0%

Percent of population eligible for hospitalization insurance for US is 46%, Compared to United Kingdom which is 100.0%

Negative Effects for High Cost of Health Care

• 1.5 million families lose their homes due to foreclosure high medical costs

• Uninsured put pressure on public resources because when patients seek care in the ER and public clinics, taxpayers ultimately foot the bill.

• Uninsured more likely to avoid routine preventative care. (Skipping checkups)

• Patients relying on over the counter drugs that may or may not help them

Negative Effects for High Cost of Health Care• Employers decrease

wages due to the high costs of coverage for their employees.

• Families are burdened with high medical bills because the price of coverage (premium) increases

• foreclosures

• Physician doctors earn 2-3 times as much as physicians in other industrialized countries

• High tech surgical treatments, prescription drugs, diagnostic device

• Higher prices for the same health care goods and services

• “defensive medicine”- application of tests and procedures mainly as a defense against malpractice litigation

• Administrative costs (marketing, billing)

Causes of the Societal Problem

• State program in operation since 2001, authorized by the New York State Health Care Reform Act of 2000. Insurance Department

• For uninsured, sole proprietors and small business employers and their employees

• available in all NY counties, premiums vary by county, family size

• NYS makes “stop‐loss” reimbursement payments to health plans that cover 90 percent of all annual claims b/w $5,000 and $75,000 per member.

HEALTHY NY

Healthy NY Eligibility •For small businesses and

employers, they have to employ 50 or fewer employees in order to participate

•For 2008, uninsured individuals and sole proprietors with monthly incomes less than $2,167

• Is one of the nation’s leaders in health care • Aetna puts information and helpful resources

to work for its members to help them make better-informed decisions about their health care

• Offers wide array of programs and services that help control rising employee benefits costs while improving the quality of health care (ex. case management; disease management and patient safety programs; integrated medical, dental, pharmaceutical, behavioral health and disability info)

Business Corporation- Aetna

• CHCS works directly with state and federal agencies, health plans, providers, and consumer organizations to design and implement cost-effective strategies that improve care for people with complex and high-cost needs.

Non-profit Organization: The Center for Health

Care Strategies (CHCS)

Policy Alternative #1• mandate coverage to all citizens. • The source of the policy was from MA health

care reform bil. • Governor Mitt Romney signed a health care

legislation to provide coverage for about 515,000 of the state's 550,000.

• Requires that those people who can afford insurance and do not buy it will be penalized on their state income taxes.

• expands some Medicaid coverage, including coverage for children.

• Commonwealth Health Insurance Connector Authority.

Effectiveness/Feasibility for Policy #1

Effectiveness• Medium • Residents of MA required

to have health care insurance, regardless of status of health or income levels of the family

• Reduced # of the uninsured Not only will this policy increase the quality of health care but also there will be an increase in life expectancy.

Feasibility• The policy has medium

feasibility because the cost of the health care still remains high for the individual and the state for complete coverage. The policy has already become law in the state of Massachusetts, however, the state is experiencing problems with financing and enforcing due to high cost of health insurance.

Policy Alternative #2• Under the policy, there will be several

boards and commissions, each designated to a specific task.

• With the division of work between the boards, each problem can be solved simultaneously and efficiently

• "Much of the high cost of health care can be attributed to high administrative costs, unnecessary tests and services…”

•

Policy Alternative #2

• Dirigo Health Reform Act, was passed on June 2003 by Governor Baldacci.

• The act aims to provide every citizen with access to quality health care statewide, lower costs, cost containment to make health care more affordable to the public.

• DrigoChoice: provides discounted health insurance coverage and operates on a sliding scale

Effectiveness/Feasibility for Policy #2

Effectiveness

• High- Maine has saved the health care system over $110 million since its inception

• make health insurance more affordable by providing discounted health insurance coverage to Maine businesses with 50 or fewer employees

Feasibility • Medium- DirigoChoice

operates on a sliding scale, which means that an individual pays what he/she can afford according to an income index, this can make the problem worse because the state has to cover the rest.

• Dirigo tax to fund the health care system- people unwilling to pay.

Policy Alternative #3• Universal Healthcare-every citizen will

have health insurance and there will be governmental regulation of funds and budgets.

• Health programs like Medicaid, Medicare, and others will be terminated- for program

• To save money, a hot-line will be created, where people can call and a doctor or a nurse practitioner will answer. This will prevent overcrowding in hospitals

Effectiveness/Feasibility for Policy #3

Effectiveness

• High• With Universal

healthcare the # of the uninsured will be non-existenedt

• by having one body that regulates and provides healthcare will bring more organization .

• policy will also decrease the health care cost and # of the uninsured.

Feasibility

• Low• Universal Health care is

considered a socialist policy, and since the United States is built on capitalistic ideas the chances the a universal health bill will be passed are low. Although the cost of health care will decrease the quality will decrease too.

Preferred Policy

• Policy Alternative #2-Maine’s Dirigo Health reform

• The bill "Expressing the sense of Congress that national health care reform should ensure that the health care needs of women and of all individuals in the United States are met" ensures women to have affordable health care at any age, and appropriate care of infants

Bill A01518• An act to amend the insurance law, in

relation to actions by health care providers against patients

• The bill protects patients from health care providers to recover from large bills, and this is related to our topic because it deals with the health care provider’s responsibility to protect the patient in any case that they fail to provide an insurance claim.