Download Health Insurance

PowerPoint® Lecture Outlines prepared by
Dr. Lana Zinger, QCCCUNY
16
Savvy Health Care
Consumerism
Copyright © 2011 Pearson Education, Inc.
Taking Responsibility for Your Health Care
 Self-Help or Self-Care
• Know your body.
• Pay attention to body signals.
• Take appropriate action to stop progression of illness or
injury.
• Many common forms of self-care, including
• Diagnosing symptoms/conditions that occur
frequently but don’t require a physician visit
• Using over-the-counter remedies
• Performing home health tests
• Learning minor first aid
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Taking Responsibility for Your Health Care
 When to Seek Help
• Recognize when a condition needs professional help
• See a professional for conditions such as serious
accident or injury, adverse drug reactions, unexplained
sudden weight loss, and any symptom that is unusual
and recurs over time
• Home health tests for many conditions should not be a
substitute for professional diagnosis and care
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Taking Responsibility for Your Health Care
 Assessing Health Professionals
• Identify what type of help you need and where to find it.
• You should feel comfortable with your provider.
• Your provider should explain diagnosis and treatment
options thoroughly and involve you in any patient care
decisions.
• Be sure to understand coverage options.
• Check certifications, affiliations, availability, and
whether provider shows respect and empathy for patient.
• Ask questions.
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Choosing Health Products
 Prescription Drugs
• Prescription drug use has risen by 25 percent over the
past decade.
• 45 percent of Americans report taking at least one
prescription drug in the past month, while 18 percent
report taking three or more.
• Generic drugs—medications sold under a chemical
name rather than a brand name, and contain the same
active ingredients as brand-name drugs but are less
expensive
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Choosing Health Products
 Over-the-Counter (OTC) Drugs
• Nonprescription substances used in the course of self
diagnosis and self-medication
• The FDA has categorized 26 types of OTC preparations
• Those most commonly used are analgesics; cold, cough,
allergy, and asthma relievers; stimulants; sleeping aids
and relaxants; and dieting aids
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Common Over-the-Counter Drugs, Their Uses, and
Potential Side Effects
Continued
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Common Over-the-Counter Drugs, Their Uses, and
Potential Side Effects
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The Over-the-Counter Medicine Label
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Choices in Medical Care
 Conventional Western
(allopathic) Medicine
• Primary care practitioners (PCPs)
• Nurses
• Osteopaths
• Nurse practitioners (NPs)
• Ophthalmologists
• Physician’s assistant
(PAs)
• Optometrists
• Dentists
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Health Insurance
• Insurance allows the patient to pay into a pool of funds
and then the health care provider bills the insurance
carrier for all or part of the heath care charges they
incur.
• 46 million Americans are uninsured.
• 25 million Americans between the ages of 19 and 65 are
estimated to be underinsured.
• Many students are uninsured.
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Health Insurance
 Private Health Insurance
• Fee-for-service or indemnity
• Deductibles, co-payments, and coinsurance
• Preexisting condition clauses
• Waiting periods
• Lifetime limit
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Health Insurance
 Managed Care
• A network of physicians, hospitals, and other providers
and facilities linked contractually to deliver
comprehensive health benefits
• A budget based on an estimate of the annual cost of
delivering health care for a given population
• An established set of administrative rules requiring
patients to follow the advice of participating providers
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Health Insurance
 Medicare and Medicaid
• Medicare covers 99 percent of adults over 65 years of
age.
• Medicaid is a welfare program that includes people with
disabilities and children who do not have health care
coverage.
• Diagnosis-related groups (DRGs)
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Issues Facing Today’s Health Care System
 Cost
• The United States spends more than any other nation;
costs are over $2 trillion annually
• Individuals with preexisting conditions, and those who
are self-employed often find themselves unable to find
or afford health care.
• Health care expenditures are projected to grow by 6.2
percent each year, reaching over $4 trillion annually by
2018—nearly 20 percent of our projected gross
domestic product (GDP).
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Issues Facing Today’s Health Care System
 Factors for High Costs
• Excess administrative costs
• Duplication of services
• Aging population
• Growing rates of obesity and inactivity
• Demand for new diagnostic and treatment technologies
• Emphasis on crisis-oriented care
• Inappropriate use of services by consumers
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Health Care Spending per Person, 2007 (in thousands of
U.S. dollars)
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Where Do We Spend Our Health Care Dollars?
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Issues Facing Today’s Health Care System
 Access
• Access to health care depends on many factors
• Supply of providers and facilities
• Proximity to care
• Health status
• Ability to maneuver in the system
• Insurance coverage
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Issues Facing Today’s Health Care System
 Quality and Malpractice
• Mechanisms for safety
• Education
• Licensure
• Certification/registration
• Accreditation
• Peer review
• Mistakes do happen, and deaths can occur because of
medical errors.
• Outcome measurements access the quality of heath care at
the individual level
 Do you believe the U.S. health care system is safe?
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The Perils of Medical Waste
• Hospitals generate a substantial amount of medical and
pharmaceutical waste.
• This can contaminate groundwater and surface water,
and pollute oceans
• Pharmaceutical drugs have been detected in drinking
water.
• Green ways to manage unused medications
• Send your medicine to those in need.
• Take your drugs back to the pharmacy.
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The Debate Over National Health Insurance
 Proponents of Reform:
• Health care should be available and affordable for
everyone.
• Health care is a right, not a privilege.
 Opponents of Reform:
• The high cost of changing the system is more than the
United States can afford.
• The government should not interfere with market
industry.
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The Debate over National Health Insurance
 Critical Issues
 Many Americans feel:
• We are paying for the most expensive system in the
world without obtaining full coverage.
• We pay for people who don’t have insurance.
• Prevention and early treatment are not emphasized.
 The Institute of Medicine, a nonpartisan organization,
recommends a single-payer, tax-financed scheme.
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The Affordable Care Act of 2010
 Health care rationing?
 Will it cost more?
 What are some important parts of the reform?
• Parent’s insurance until 26
• No discrimination based on pre-existing conditions
• Prohibits dropping coverage when people get sick
• Covers preventive health services
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