Session 4
Chapter 7
Major Themes
- Evolution of health care payment sources from out-of-pocket expenditures and charitable resources to a complex array of personal, private-third party, and government sources
- Comparisons of U.S. health care spending and health outcomes with 28 other Organization for Economic Cooperation and Development member countries
- Factors influencing the historical growth of health care costs; magnitude of health care cost growth compared with growth in the general economy; shifting trends of medical expenditure growth and the underlying reasons.
- The impact of government support on the development of the U.S. hospital industry and on the health care delivery system; the contrast of expanded Medicare coverage in the 1960s and 1970s with contraction of coverage in the late 1970s and 1980s
- The evolution of private health insurance and its effects on costs and access to services.
- History of cost control efforts: legislation and regulation; the development of prospective payment and its impact on hospitals and consumers
- The Medicare Prescription Drug, Improvement and Modernization Act of 2003 reformed Medicare managed coverage first enacted by the BBA of 1997, added a prescription drug benefit and significantly expanded preventive care and diagnostic services for the Medicare population.
- The Child Health Insurance Program (CHIP) continues a successful outreach track record to enroll eligible children in Medicaid.
- Emergence of managed care concepts and the HMO movement; the population perspective; implications for physicians, hospitals and consumers
- Measurements of the quality and accessibility of managed care services.
- Effects of Medicare and Medicaid managed care enrollment and quality initiatives.
- Implications of the Patient Protection and Affordable Care Act of 2010.