Health Care Economic Issues Outline Abdel, Susan Erin, Irma September19, 2011 I. Introduction Providing health care service for uninsured and underinsured individuals in the United States is an ongoing concern. A report released by the U. S. Census Bureau reveals the number of uninsured Americans under age 65 rose from 45. 7 million in 2008 to 50. 0 million in 2009 and an estimated 25 million American’s were reported to be underinsured in 2007 (Gould, 2010). Uninsured are individuals not covered by any type of health insurance.

Underinsured are individuals who have health coverage that does not adequately protect them from additional costs of care. From an economic perspective, the weight of this concern falls heavily on the leaders and citizens of the nation. II. How has the evolution of health care affected the financial decision-making process among the uninsured and the underinsured? a) Tradition-understanding tradition through historical research allows a basis for comparison, critique, and ultimately for decision making, which allows change and ensures ulnerable patient populations are served (Pape, 2010) b) Evidence-based decision making c) Policy and Regulation d) Market demand: Demand curve, Supply Curve III. Evolution of health care and the financial decision-making process. a) Evolution of health care. b) Expansion of the health care system. c) Use of evidence in decision making. IV. Uninsured/Underinsured and the financial decision-making process. a) Utilization and the decision making process. b) Shifting the cost / billing adjustments. c) Resources. d) Quality of care implications / liabilities. ) Patient input. V. Policy and regulatory impacts on decision making 1) EMTALA: not federally funded thus causing financial burden to health care providers 2) ERISA preemption provisions-difficult to predict making it hard for states to craft health initiatives for the uninsured 3) State legislations-passing the burden to state residents 4) Hospital policy- affecting organization’s approach to provision of care 5) Hospital billing-provide discounted services or not VI. Recommended Improvement Strategies a) Key Players 1) Federal Regulators:

Federal legislators are responsible to providing health reform initiatives, as well as policy proposals involving health system reform. ( U. S. Department of Health & Human Services, 2008). 2) State legislators and insurance commissioners: i) Are responsible for implementing the fastest growing form of health insurance- Health Savings Accounts (HSAs) and HSA-eligible high-deductible health plans (HDHPs), which can increase an individual’s involvement in making health and healthcare decisions (Bachman, 2007). i) State legislatures advance laws supporting healthcare 3) Insurers, employers and other health service vendors: i) Insurers, employers, and other health service vendors operate businesses within the allowed parameters set by federal and state legislation. ii) Insurance serves a number of functions: assisting in pooling risks, facilitating commercial transactions, and managing risks. 4) Health care providers: i) Shift from traditional medicine to evidence-based medicine (EBM): promoting a scientific attitude. i) The vision of EBM vision highlights the importance of potential benefits of a proposed course of treatment against the potential costs, including medical risks and financial costs b) Microeconomic/macroeconomic tools to help the under/uninsured 1) Microeconomics i) Make insurance products more attractive to consumers. ii) Commit more money to preventative measures 2) Macroeconomics i) Lowering health care expenditures nation-wide ii) Decrease labor-market fluctuations c) Tools supporting best practices 1) Opportunity cost ) Measuring the value of services 3) Evaluating the scarcity of products d) Benchmarking 1) Laws prohibiting discrimination of individuals with pre-existing conditions. 2) Government containment of health care costs 3) Tax break for purchasing health insurance 4) Monetary incentives for using preventative service 5) Universal health care plan e) Policy and regulatory environment impacts on financial management of health care 1) Federal and state legislators are striving to develop policies, regulations, and reform to improve quality and constrain costs ) Economic incentives and competition 1) CMS is the major spender on health care and provides the most reimbursements 2) Incentives are essential to promote quality of care i) Electronic Medical Records: Financial incentives from the government ii) Health care consumers need to be more cost-conscious iii) Competition provides incentives g) Global Implications 1) Health Care reform: What does it look like? 2) Is universal health care the answer VII.

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