Being a Wise Consumer; Being a Wise Consumer; Insurance & Medical CostsInsurance & Medical Costs

Ch. 26Ch. 26

What do you think this What do you think this means?means?

Social vs. Private Medical Social vs. Private Medical TreatmentTreatment

PrivatePrivateCompetitionCompetitionNeed insurance Need insurance Need moneyNeed money

In an extensive ABCNEWS/In an extensive ABCNEWS/Washington Washington Post Post poll, Americans by a 2-1 margin, poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal 62-32 percent, prefer a universal health insurance program over the health insurance program over the current employer-based system. That current employer-based system. That support, however, is conditional: It falls support, however, is conditional: It falls to fewer than four in 10 if it means a to fewer than four in 10 if it means a limited choice of doctors, or waiting limited choice of doctors, or waiting lists for non-emergency treatments. lists for non-emergency treatments.

Support for change is based largely on Support for change is based largely on unease with the current system's unease with the current system's costs. Seventy-eight percent are costs. Seventy-eight percent are dissatisfied with the cost of the dissatisfied with the cost of the nation's health care system, including nation's health care system, including 54 percent "very" dissatisfied. 54 percent "very" dissatisfied. By Gary By Gary LangerLanger

Social ( Universal )Social ( Universal )Available to allAvailable to allNo competitionNo competitionGovt. foots the billGovt. foots the bill

Simply saying that people have health Simply saying that people have health insurance is meaningless. Many countries insurance is meaningless. Many countries provide universal insurance but deny provide universal insurance but deny critical procedures to patients who need critical procedures to patients who need them. Britain's Department of Health them. Britain's Department of Health reported in 2006 that at any given time, reported in 2006 that at any given time, nearly 900,000 Britons are waiting for nearly 900,000 Britons are waiting for admission to National Health Service admission to National Health Service hospitals, and shortages force the hospitals, and shortages force the cancellation of more than 50,000 cancellation of more than 50,000 operations each year. In Sweden, the wait operations each year. In Sweden, the wait for heart surgery can be as long as 25 for heart surgery can be as long as 25 weeks, and the average wait for hip weeks, and the average wait for hip replacement surgery is more than a year. replacement surgery is more than a year. Many of these individuals suffer chronic Many of these individuals suffer chronic pain, and judging by the numbers, some pain, and judging by the numbers, some will probably die awaiting treatment. In a will probably die awaiting treatment. In a 2005 ruling of the Canadian Supreme 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin Court, Chief Justice Beverly McLachlin wrote that "access to a waiting list is not wrote that "access to a waiting list is not access to healthcare." access to healthcare." By Michael Tanner By Michael Tanner and Michael Cannon, and Michael Cannon,

What you can Expect in What you can Expect in healthcarehealthcare

Primary Care Primary Care PhysicianPhysician

Select the right Select the right doc. For youdoc. For you

SpecialistSpecialist Medical HistoryMedical History Second OpinionSecond Opinion

Patient’s Bill of RightsPatient’s Bill of Rights

Considerate and respectful care.Considerate and respectful care. Complete information concerning your diagnosis in Complete information concerning your diagnosis in

language you can understand.language you can understand. Informed consent before treatment.Informed consent before treatment. Refusal of treatment.Refusal of treatment. Privacy.Privacy. Reasonable response when help is sought out.Reasonable response when help is sought out. Info. Pertaining to conflicts of interest.Info. Pertaining to conflicts of interest. Informed regarding using you in research.Informed regarding using you in research. Itemization of your charges.Itemization of your charges. Rules to follow.Rules to follow. Good follow up care.Good follow up care.

Medical Costs and InsuranceMedical Costs and Insurance

Defensive Medicine:Defensive Medicine: Numerous and sometimes Numerous and sometimes unnecessary tests to avoid unnecessary tests to avoid law suites.law suites.

Premium:Premium: Payment made Payment made to an insurance company to an insurance company for coverage.for coverage.

Deductible:Deductible: Amount an Amount an insured person pays before insured person pays before the insurance company the insurance company begins paying.begins paying.

Co-Pay:Co-Pay: Small payment Small payment made when visiting with a made when visiting with a physician.physician.

Insurance CoverageInsurance Coverage

Any physician?Any physician? Deductible?Deductible? Lost income insurance provided?Lost income insurance provided? Full coverage?Full coverage? Pregnancy covered?Pregnancy covered? Group policy available?Group policy available? Mental health covered?Mental health covered? Dental Care?Dental Care? Dependents?Dependents? Pre-existing conditions covered?Pre-existing conditions covered? Quit or lose jobQuit or lose job

Insurance PoliciesInsurance Policies

HMO’S:HMO’S: Subscribers Subscribers receive complete medical receive complete medical care for a fixed monthly care for a fixed monthly fee.fee.

PPO’S:PPO’S: When using pre- When using pre-selected health care selected health care providers the subscriber providers the subscriber receives discounted receives discounted service.service.

Traditional:Traditional: Covers costs Covers costs accrued through any accrued through any doctor or hospital. doctor or hospital. Subscribers are Subscribers are Reimbursed the charges.Reimbursed the charges.

Free Health ServicesFree Health Services

For disadvantaged For disadvantaged members of members of society.society.

MedicaidMedicaid Health departmentHealth department Free clinics Free clinics

QuizQuiz

1.1. What information makes up a medical history?What information makes up a medical history?2.2. What is a second opinion?What is a second opinion?3.3. What is the purpose of the patients bill of rights?What is the purpose of the patients bill of rights?4.4. What are two approaches being considered to make What are two approaches being considered to make

medical care affordable to everyone?medical care affordable to everyone?5.5. Name an advantage and disadvantage of traditional Name an advantage and disadvantage of traditional

health insurance.health insurance.6.6. What is an HMO?What is an HMO?7.7. What kind of treatment do free clinics provide?What kind of treatment do free clinics provide?8.8. When selecting a primary care physician what would you When selecting a primary care physician what would you

look for in that individual?look for in that individual?9.9. What is defensive medicine?What is defensive medicine?10.10. What is a co-pay?What is a co-pay?

Quiz AnswersQuiz Answers

1.1. What information makes up a medical history?What information makes up a medical history? Previous Previous illnesses, Surgery, Medications, Allergies.illnesses, Surgery, Medications, Allergies.

2.2. What is a second opinion? What is a second opinion? The recommendation of The recommendation of another doctor.another doctor.

3.3. What is the purpose of the patients bill of rights? What is the purpose of the patients bill of rights? To To protect the patient.protect the patient.

4.4. What are two approaches being considered to make What are two approaches being considered to make medical care affordable to everyone? medical care affordable to everyone? Socialized Socialized Medicine & Shared cost programs.Medicine & Shared cost programs.

5.5. Name an advantage and disadvantage of traditional Name an advantage and disadvantage of traditional health insurance. health insurance. Advantage: choose any doctor. Advantage: choose any doctor. Disadvantage: Reimbursed charges.Disadvantage: Reimbursed charges.

Quiz Answers ContinuedQuiz Answers Continued

6.6. What is an HMO? What is an HMO? Complete medical care for a Complete medical care for a monthly fee.monthly fee.

7.7. What kind of treatments do free clinics provide? What kind of treatments do free clinics provide? Medicaid, Immunization, STI’s, Health Medicaid, Immunization, STI’s, Health services, Maternal services.services, Maternal services.

8.8. When selecting a primary care physician what When selecting a primary care physician what would you look for in that individual? would you look for in that individual? Qualifications, Caring, Experience.Qualifications, Caring, Experience.

9.9. What is defensive medicine? What is defensive medicine? Use of numerous Use of numerous and sometimes unnecessary tests to avoid and sometimes unnecessary tests to avoid a lawsuit.a lawsuit.

10.10. What is a co-pay? What is a co-pay? A small fee paid to receive A small fee paid to receive healthcare services.healthcare services.