Problems with Health Care. Sociology 230 Dr. Babcock Chapter 2b

Transcription

1 Problems with Health Care Sociology 230 Dr. Babcock Chapter 2b

2 U.S. Health Care From 1987 through 2014 a growing number of Americans had no medical insurance

3 Health Insurance one in four adults (49.5 million) were uninsured Adding uninsured and underinsured adults together, an estimated seventy-five million adults 42% of the under-sixty-five adult population had either no or inadequate insurance in 2007, up from 35% in In 2007: 27.8% of Americans were covered by government health insurance plans (Medicare, Medicaid, and military insurance) 67.5% were covered by private insurance, most often employment-based In 2009, 50.0 million nonelderly Americans (or 18.9 percent) were uninsured. The hope is that the Affordable Care Act will remedy these inadequacies

4 Coverage by Type of Health Insurance

5 Health maintenance organizations (HMOs) Prepaid group plans in which a person pays a monthly premium for comprehensive health care services. HMOs attempt to minimize hospitalization costs by emphasizing preventive health care.

6 Preferred provider organizations (PPOs) Health care organizations where employers agree to send employees to certain health care providers or hospitals in return for discounts. Health care providers get more patients but charge lower fees to buyers of group insurance.

7 Managed Care Any medical insurance plan that controls costs through monitoring and controlling the decisions of health care providers. Doctors must call a utilization review office to receive approval before they can hospitalize a patient, perform surgery, or order an expensive diagnostic test.

8 Medicare Medicare is a federal program that reimburses elderly and disabled for some costs of health care Employees contribute to Medicare in every pay check with a match from employers Medicare s medical insurance program is not free; a copayment for services is required Medicare does not cover long-term nursing home care, dental care, eyeglasses, and other types of services, requiring seniors to pay for additional (gap) insurance

9 Medicaid Provides health care coverage for the poor, and is jointly funded by the federal and state governments Medicaid does not cover all poor people Eligibility rules and benefits vary from state to state, and in many states Medicaid provides health care only for the very poor who are well below the federal poverty level Medicaid eligibility is limited

10 The High Cost of Health Care Health care spending in the United States rose from $ per person in 1970 to $6,697 in 2005 and is expected to rise to $12,320 by U.S. health care spending as a share of gross domestic product grew from 7.2% in 1970 to 16% in 2005 and is expected to reach 20% of GDP by The US spends more on health care than any nation in the world

11 Factors in Escalating Medical Costs Contributing to escalating medical costs: Increased longevity. Excessive and inappropriate medical care. administration, drugs, (r & d & advertising) doctors fees, hospital services, medical technology, and health insurance.

12 Strategies for Improving Health and Health Care Selective primary health care focuses on using specific interventions to target specific health problems, such as promoting condom use to prevent HIV infections Comprehensive primary health care focuses on the broader social determinants of health, such as poverty and economic inequality, gender inequality, environment, and community development Preventative health care focuses on keeping people from needing expensive treatment later

13 U.S. Health Care Reform The U.S. is the only country in the industrialized world that does not guarantee health care to its citizens. That is changing now with the Affordable Care Act

14 Socialized Medicine In all systems of socialized medicine the government: 1. Directly controls the financing and organization of health services. 2. Directly pays providers. 3. Owns most of the medical facilities. 4. Guarantees equal access to health care. 5. Allows private care for individuals who are willing to pay for their medical expenses. End