Transcript group medical expense benefits: the changing

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: government
The 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 care
50% of workers covered by self-funded plans
80%+ if >20,000 ees
Cost Containment and
Managed Care
Reasons for increasing costs
Measures 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 care
Encouragement of external cost-control
systems
Managed care
Characteristics of managed care
controlled access to providers
comprehensive case management
preventive care
risk sharing
high-quality care
State Reforms
States 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 reforms
Tort
Standardized claims administration
Health 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? - politics
Who should pay? employer mandate?
What benefits should be available?
Trade-off between cost containment and
quality?
National Health Care:
Approaches
Managed competition
Single payer plans (Canadian style)
Medical Savings Accounts (MSAs)
State owned programs
Modest reform of current system
Increase availability
Portability
Continuation
HIPAA
increased portability
eliminate preexisting conditions
(nondiscrimination)
better child coverage (CHIPs)
Tax breaks for MSA and self-employed
Guaranteed renewable
Guaranteed issue for small employers