| A | B |
|---|
| Health Care Consumerism | • making decisions about health providers, hospital, health plans, prescriptions, prevention strategies, quality of care, treatment choices and reliable health information |
| Employment-Based Health Insurance | employer pays part of the premium |
| direct purchase health insurance | you pay premium |
| medicaid | for low income families. o A. state and federally administered o B. for state determined by low income o C. pays medical provider not the patient o D. usually covers doctors, hospitals, diagnostic services, dental, long term care and possibly others as determined by each state |
| medicare | • Medicare: over age of 65 and have contributed to social security • II. Medicare o A. available to all who qualify for social security benefits o B. Options |
| SCHIP | State Children’s Health Insurance Program (SCHIP) o A. a state-by-state run program • B. for children whose parents do not qualify for Medicaid but have a low enough income that they cannot afford private insurance |
| option part A medicare | a. pays a % of hospital visits, in-home health care, and inpatient skilled nursing care and hospice b. does not pay for physician c. most do not pay a premium |
| option part B Medicare | a. covers out patient care, doctor’s services, physical or occupational therapy and additional home health care; b. most pay a premium for this option |
| option part C medicare | A combination of parts A and B |
| option part D medicare | a. is for prescription drug coverage b. have a variety of drug coverage options c. has a premium to be paid |
| #employer insured, uninsured, medicaid or SCHIP 2010 | #employer insured-150million, uninsured-50million, medicaid or SCHIP-40 million |
| #employer insured, uninsured, medicaid or SCHIP 2020 | #employer insured-159million, uninsured-22million, medicaid or SCHIP-51million |
| current conditions for uninsured | o The uninsured: immediate access thru high risk pools if excluded before for pre-existing conditions; children remain on parents’ plans until age 26 |
| current conditions for employers | o Employers: small businesses (N<25) receive tax credits to purchase insurance; (N>50) pay for or receive a fine—should keep worker costs down |
| current conditions for health insurers | o Health insurers barred from: • a. removing coverage when a person gets sick; • b. denying coverage to children with pre-existing conditions • c. imposing lifetime coverage caps |
| current conditions for medicare prescription drug beneficaries | o Medicare prescription-drug beneficiaries: • a. receive a $250.00 rebate when drug costs exceed $2,700 • b. eliminates “the doughnut hole”—costs between $2700-$6154 where currently there is no coverage |
| 2011 conditions (health insurers/medicare prescription drug beneficaries) | • a. Health Insurers o health insurers: required to spend 80% of premiums on medical services • b. Medicare Prescription Drug Beneficiaries o Medicare prescription-drug beneficiaries: receives a 50% discount on brand-name drugs while in the “doughnut hole” |
| In 2013, what will be the conditions for Taxpayers? | • taxpayers: Medicare payroll taxes increase and expand to include unearned income for individuals making >$200,000 and families making >$250,000 |
| 2014 conditions (uninsured, insurers, employers) | • a. The Uninsured o The uninsured: most required to purchase insurance or pay a penalty • b. Insurers o . Insurers: prohibited from refusing to sell policies and limited in setting prices based upon health status • c. Employers o Employers: N>50 workers must provide coverage or pay a penalty |
| In 2018, what will be the conditions for Taxpayers? | • taxpayers: high cost employer-provided policies ($27,500 for a family $10,200 for an individual) are subject to a 40% excise tax • sum: expected to encourage purchasing of lower cost coverage |
| . In 2020, what will be the conditions for Medicare Prescription-Drug Beneficiaries? | • Medicare prescription-drug beneficiaries: the prescription-drug coverage gap is eliminated |
| What has been the effect of Health Care Reform in Massachusetts since 2006? | • The Massachusetts model-2006 o 1. In 2006-600,000 were uninsured o 2. 2010-160,000 are uninsured o 3. 2006—health care costs aprox 5% state budge o 4. Currently the costs are stabilized at about 1% of state budget |
| Describe Important Criteria for Choosing a Doctor | • 1. Check education and accreditation • 2. Assess communication style • 3. Able to answer ?s regarding tests, test outcomes and test results • 4. Culture, gender and language factor • 5. Hospital privileges • 6. Use internet resources (WEBMD) |
| Describe Important Criteria for Utilizing Medical Self-Help Programs | • 1. Info must be authorized • 2. Should support the doctor patient relationship-not replace it • 3. Confidentiality is stated to be secure • 4. Info backed by referenced research and dates • 5. Include working links to additional resources • 6. Provides a valid email address for a webmaster • 7. Provides disclosure of funding sources • 8. Clear division between editorial content and any advertising |
| quakery | • any treatment which shows no effect, becomes harmful and/or deadly acceptable and effective treatment • 1. Tends to target specific individuals • 2. Promises quick solutions to complicated problems |
| quackery alters | • 1. Relief or cures for multiple conditions • 2. Prompt and painless cures • 3. Secrete formulae from only one source • 4. Promise cures for disease with no known cure • 5. Testimonial w/o medical references • 6. Money-back guarantees if not satisfied • 7. Require advanced payments, offer additional products or bonuses with purchase or have a limited supply • 8. Use terminology such as scientific breakthrough or miracle cure • sum: contact federal trade commission and or state attorney general and or www.ftcomplaitassistant.gove |
