U.S. HealthCare System Economic Structure
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The U.S. health care system is fractured and complex, with costs driven by high facility construction spending despite low utilization rates. Medicare provides coverage for citizens aged 65+ and some younger adults with disabilities, while costs vary based on income levels. Medicaid covers over 60 million low-income Americans. Spending comes from federal, state, local, and household sources. One proposed solution is a health care advisor model to help consumers navigate options and reduce wasteful spending. The Affordable Care Act aims to curb costs through prevention and this advisor role.
U.S. HealthCare System Economic Structure
- 1. Fractured Structure The U.S. Health Care System and it’s Economics
- 2. U.S Health Care: Public Sector Economics Medicare is a entitlement program funded by the Federal Government for U.S. Citizens. Legal residents must have been living in the U.S. for at least 5 years. Citizens must be 65 years of age or older, younger than 65 with a qualifying disability or any age with end stage Renal disease.
- 3. Medicare Costs Medicare Part A Hospital Stay $1,184 deductible per benefit period $0 for the first 60 days of each benefit period $296 per day for days 61-90 of each benefit period $ 592 per “Lifetime Reserve Day” after day 90 of each benefit period
- 4. Medicare Part B (Health Insurance) You pay a Part B premium each month. Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.
- 5. Medicare Part B premium vs Tax income Individual Tax Return Individual Tax Return If your yearly income was $85,000 or less, you pay $104.90 per month. If your yearly income was above $214,000, you pay $335.70 per month.
- 6. Medicaid Medicaid provides health care to 60 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities. To participate in Medicaid, federal law requires states to cover specific population groups and gives them flexibility to cover other population groups. Many states have expanded coverage , particularly for children, above the federal
- 7. Spending in a Nutshell Health Care Spending Costs Federal State and Local private households
- 8. So what’s Driving Costs? Believe it or not, Health Care facility construction has been the main factor involving rising health care costs to patients. Utilization of these facilities has not grown with overall real estate utilization within the U.S. One of the largest health systems in the U.S only operate at 53% of its capacity. This is a major problem.
- 9. The Solution Patients paying into the health care system must be made aware of wasteful spending at the expense of their quality of care. One solution is access to a Health Care Advisor that’s analogous to a financial advisor or stock broker on wall street. There primary function is to guide consumers through the system helping them find the highest quality of care for their money.
- 10. Our Future Health Care System The Affordable Care Act will be fully implemented in October 2013 with the promise of a Preventative Approach in curbing “Out of Control” healthcare costs. The Health Advisor Model can also assist in this effort; tackling the high costs of infrastructure spending at the expense of a patients overall quality of care.
- 11. References Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System. (2013). Medical Benefits, 30(3), 11. Webb, Rob. Guiding Consumers Through the Complex Health Care System. (2013). OptumHealth Care Solutions, 20-23. National Health Care Expenditures Highlights 2011. www.cms.gov/...Data.../NationalHealthExpendData/.../highlight s.pdf Reed, R. W. (2013). Coordinated Care--Fix for a Fractured System. Benefits Magazine, 50(3), 36-41.
- 12. QUESTIONS