Managed_care_08_a - A History of Managed Care PAM 435...

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A History of Managed Care PAM 435 February 21, 2008
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Federal Tax Subsidy by Family Income, 2004 Source: Sheils and Haught, 2004; U.S. Census Bureau. $102 $292 $725 $1,231 $1,448 $2,134 $2,640 $2,780 < 10 10 - 19 20 - 29 30 - 39 40 - 49 50 - 74 75 - 99 100+ ($000) % of Population 5% 9% 11% 10% 10% 19% 14% 22%
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17.9% 17.5% 6.8% 62.2% Source of Health Insurance Among the Non-Elderly, 2006 100% = 260 million Source: Current Population Survey. Uninsured Employer-Provided (“group market”) Public (Medicaid, Medicare, VA) Individually purchased Note : percentages sum to more than 100% due to double coverage. Why is 18% of the Non-elderly U.S. Population Uninsured?
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The U.S. is one of the few developed countries that does not have universal health insurance Two (economically) equivalent statements Our government does not provide us all with health insurance. Our government does not compel or mandate that we all pay for health insurance.
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% of Firms Offering Health Insurance by Firm Size, 2005 45 76 83 94 99 3-9 Workers 10-24 Workers 25-49 Workers 50-199 Workers 200+ Workers 60% All firms 69% in 2000 Source: Kaiser Family Foundation Employer Survey, 2000-2007.
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% of the % with PRIVATE Family Poverty Level Uninsured health insurance < 100% 35.8% 20.8% 100% – 149% 15.9% 35.2% 150% - 199% 13.5% 51.8% 200% - 299% 16.3% 70.4% 300% - 399% 7.5% 83.5% 400% + 11.1% 91.3% Non-elderly U.S. Population, 2006
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Comparing the Uninsured (U) and the Insured (I) U use about 50-75% fewer MD visits and hospital days. U health costs are about 50% lower than for insured people. U get fewer high tech hospital procedures U report greater frequency of problems in access and untreated symptoms (e.g., recent cancer study) Punch line 1: Real cost of covering U is only about 8% of NHE (0.16 X 0.50 = 0.08). Punch line 2: Financial help is needed but hard to target (i.e., crowd out).
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Summary of 2/19 Lecture Are several problems related to health insurance: adverse selection moral hazard: low price spurs demand for medical care purchasing too much health insurance due to tax exclusion policy (i.e., covering high-probability events) Health insurers try to control moral hazard with cost sharing and “utilization management” (topic of today’s lecture) Uninsured rate is relatively high among people with low income, low education, Hispanics, and blacks.
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Managed_care_08_a - A History of Managed Care PAM 435...

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