This preview shows page 1. Sign up to view the full content.
Unformatted text preview: The American Health System Overview: How is American Health Care Organized? How do we pay for health care? Who has health care? G.M. Roybal, M.D., M.P.H. HP 200 Fall 2006 November 28, 2006 How do we pay for health care? Most Health Care is Employer Based For people in the United States:
– 83.9% of all individuals have some form of health insurance Self Work Government
24.8% is government based 70.1% is privately based Employer Based Insurance Favors Those with Higher Incomes Employer Based Insurance Favors Those with Higher Incomes For employers, health insurance premiums are tax deductible. Those employees with higher salaries benefit. In the US income tax is progressive--the more money you make the higher your taxes.
– 15% – 28% – 33% 1 Employer Based Insurance Favors Those with Higher Incomes Employer Based Insurance Favors Those with Higher Incomes Example: Health Insurance costs $350.00 per month.
– For employers this cost is completely tax deductible. – If you were to receive the money in cash and then bought your insurance you would be taxed on that amount as income. Example: Health Insurance costs $350.00 per month.
– For Individuals in 15% tax bracket: If you received the money you would be expected to pay a tax of: 0.15 x $350 = $52.50 Employer Based Insurance Favors Those with Higher Incomes Employer Based Insurance Favors Those with Higher Incomes Example: Health Insurance costs $350.00 per month.
– For Individuals in 33% tax bracket: If they received the money they would be expected to pay a tax of: 0.33 x $350 = $115.50 By receiving the health insurance as a benefit paid for by the employer, the higher income individual benefits from not having to pay taxes on the amount of money used to pay for insurance. Employer Based Insurance Favors Those with Higher Incomes Government Based Insurance Medicare Medicaid (MediCal) CHIP Military
– VA, Active Duty, CHAMPUS Additionally, the premium is a smaller percentage of total income:
– For person with Salary of $60,000/yr Monthly: $5,000 Percent of Total: 350/5000 = 7% Monthly: $2,500 Percent of Total: 350/2500 = 14% – For person with Salary of $30,000/yr 2 Medicare: Medicare: Before its enactment in 1965:
– 50% of Elderly People Had No Health Insurance. Before its enactment in 1965:
– In 1964 there were 190 hospital discharges per 1000 elderly people. After:
– By 1973 that number had increased to 350 discharges per 1000 elderly people Now:
– More than 97% of Senior Citizens are insured through the program Medicare: Medicare: Before its enactment in 1965:
– In 1960 men who survived to 65 could expect to live to 78. In 1992 83% of Medicare spending was on behalf of beneficiaries with annual income of less than $25,000. 20% of beneficiaries are 85y/o or older. In 1993 Medicare accounted for 28% of hospital expenditures. After:
– By 1992 they could expect to live to 81 years of age. Medicare: Medicaid--MediCal Divided into:
– Part A: Hospital Costs – Part B: Outpatient Costs State-Federally funded health insurance program designed to be relief program for the poor in addition to populations determined state by state. States have different proportion of their programs receiving funds from the Federal Government. Does Not Pay for Everything. 3 Military: Active Duty Active Duty Family Members Veterans
– Veterans Hospitals Children’s Health Insurance Program: CHIP Established in 1998 Intended to Provide Health Insurance Coverage for Children Who Do Not Qualify for Medicaid or Have Private Insurance States Can Cover Individuals Above the Federal Limits 4 California Insurance Status Uninsured by Race/Ethnicity United States 58% 5% 10% 11% 16% Employer Individual Medicaid Medicare Uninsured United States White Black Other California White Black Hispanic Other 15% 21% 38% 23% 13% 23% 24% Hispanic 35% California 51% 5% 13% 9% 21% Employer Individual Medicaid Medicare Uninsured 5 6 7 8 9 Longevity in leading “developed” nations
Japan Sweden Australia Italy France UK Ireland USA 75.9 (1) 74.2 (2) 73.2 (3) 72.7 (4) 72.6 (5) 72.4 (6) 71.6 (7) 71.6 (7) 10 The absence of disease and injury and the experience of health are not the same
Country Ireland USA UK Sweden Australia France Italy Japan
* Gallup Poll, 1989, 1990 Percent reporting Life health “very good”* expectancy (years) 48 71.6 (7) 40 39 38 36 19 15 9 71.6 (7) 72.4 (6) 74.2 (2) 73.2 (3) 72.6 (5) 72.7 (4) 75.9 (1) 11 ...
View Full Document
This note was uploaded on 02/28/2010 for the course HP 200 taught by Professor Roybal during the Fall '05 term at USC.
- Fall '05