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Class 507 Unit 3 Overview and Outcomes
Markets, Funding, And Financial Models
The United States spends more per capita on health care than any other country, relative to our gross domestic product (GDP). If we compare the infant mortality rates, the United States is twenty per thousand live births, where other countries, such as Sweden and Japan are seven per a thousand live births. The United States is spending more money, per capita in relationship to the GDP and yet, the results are often worse than other industrial countries (Nickitas, Middaugh & Aries, 2016).
The United States leads the world in other areas of medicine, such as biomedical research. In areas of primary care and general practice, our programs have high standards, yet other countries treat patients with more psychological and socially sensitive methods and a reduced number of invasive surgical procedures (Nickitas et al., 2016).
Examining other countries is interesting, in how they approach health care. In the German healthcare system, they pay for up to one week at a spa for their citizens, as part of their managed care plan. In the United States, managed health care plans may give a modest discount for a club membership fee.
Financing health care is done mostly through insurance agencies or third parties. The insured pay a monthly premium, either through their employer or out of pocket. Many times, pharmacy, eye care, and dental care are not included in any of these packages. Understanding how insurance companies do a risk analysis is important for understanding financing of health care. Managed care is a concept that was brought about in the 1920s, and its precepts are about holding down costs.
Medicaid is actually fifty different programs that were established by each state and funded by the federal government. This program takes poor, indigent people; persons who are disabled; patients with end-stage renal disease; blind persons; and long-term care for nursing homes.
Medicare was designed for the elderly. Anyone sixty-five and older is eligible for Medicare, Part A and B. There are high deductibles and co-pays in the Medicare program, so people enrolled may have to take out other insurance plans.
The process of financing healthcare is a complex one. The advance practice nurse should have an overall understanding of the process.
Nickitas, D. M., Middaugh, D. J. & Aries, N. (2016). Policy and Politics for Nurses and Other Health Professionals: Advocacy and Action (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
http://www.thesoftedge.com/products-services/congress-web/?gclid=CIiCrLDh684CFQYPaQodYG8IcQ
After completing this unit, you should be able to:
· Distinguish between Medicare and Medicaid.
· Summarize ways in which health insurance fails the elderly.
· Examine financial models of health insurance.
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