Econ Lec. 3

  1. Health and Human Services
    • Cabinet section
    • Medicare, Medicaid and FDA
    • 35% of expenditures
  2. FDA
    • drug approval
    • otc and entry of generic drugs into market
  3. 1906
    Original food and drugs act passed
  4. 1938
    • federal food, drug and cosmetic act
    • elixir sulfanilamide
  5. 1962
    • kefauver-harris drug amendments passed to ensure safety and efficacy
    • thalidomide
  6. 1995
    • FDA declares cigarettes to be drug delivery devices
    • restrictions of sale and marketing
  7. 2009
    regulation of tobacco
  8. Senate Funding commities
    • Health, Education, Labor and pensions committee
    • Finance committee
  9. House funding authorizing comittees
    • house committee on energy and commerce
    • house ways and means committee
  10. HRSA
    • analysis of health professional needs
    • 340B program => funding for teaching hospitals
  11. State roll in health policy
    • regulation: boards, inspections
    • Purchaser
    • Provider
  12. State roll as healthcare regulators
    • professional licensing
    • health facility licensing
    • insurance company and managed care organization regulation
  13. State role as health care provider
    • Facilities for developmentally disabled
    • State operated nursing homes and veteran's homes
    • prisons
    • public and population health
    • medical schools and teaching hospitals
    • programs for targeted populations
  14. Public Health Service provided by the state
    • Disease surveillance
    • statistics and record keeping
    • operation of pathology labs
    • injury prevention and public safety
    • protection from environmental hazards
    • medical research
  15. Our Health care system is a mixture of
    • public segments
    • third party payers
    • private entities
  16. Medicare
    solely financed by the US Federal Government
  17. Medicaid
    Jointly financed by the federal and state governments
  18. Government sponsored health insurance
    Pt. doesn't pay to enroll
  19. Types of prescription drug plans
    • ~53 plans in MO
    • stand alone rx drug plans
    • medicare advantage plans < 10 in each state, more common in urban areas
  20. Pharmacy Networks
    the pharmacies that can fill rx drugs in your medicare part D plan
  21. Part D Coverage
    • formulary restrictions
    • one aspect of each class is covered, but not all drugs in the class
    • six classes of drugs must be covered by all plans
  22. Part D Eligibility
    • 7 month window around age 65 (initial enrollment period)
    • those with limited income may be automatically signed up
  23. Drugs not covered by Part D
    • OTC
    • Barbiturates
    • Benzodiazepines
    • Vitamins
    • Weight loss drugs
    • Cosmetic Drugs
    • ED drugs
  24. Medicare Part D Benefit
    • Administered by private regional plans
    • Plans are medicare advantage or stand alone plans
    • At least 2 plans per region
    • 50+ plans in MO
  25. Formulary Exceptions
    • Patient can petition with documentation from their physician that a non-covered drug is needed.
    • Pt. can request drug change teir
    • A response is expected within 72 hours.
  26. Deductible for Part D
    Plan pays 3/4 for the first year
  27. Donut Hole
    • pt pays 100%
    • phasing out 10/10 pt receives $250
  28. Ways to reduce healthcare costs at hospitals and specialists
    • Improved in-patient care process
    • use of lower cost treatments
    • reduction in adverse events
    • reduction in preventable readmissions
  29. ways to reduce healthcare costs at primary care practices
    • improved prevention and early diagnosis
    • improved practice efficiency
    • reduction in unnecessary tests and referrals
    • reduciton in preventable ER visits and admissions
  30. Ways to reduce health care costs at all providers
    • improved management of complex patients
    • use of lower cost settings and providers
  31. Medicare Part A
    • Hospital Insurance
    • Inpatient Hospital, Skilled Nursing Facillities, Home Care
    • Automatically eligible at age 65
    • No premiums
  32. Medicare Part B
    • Supplemental Medical Insurance
    • Office Visits
    • outpatient services
    • drugs administered at an outpatient clinic
    • Must sign up
    • premiums vary per month and increase each year
  33. Medicare Part C (Medicare Advantage)
    • Sign up and it is payed for with taxes and premiums
    • Part A, B and D provided through a privet HMO
  34. Part D
    • Rx drug insurance
    • Premiums vary depending on which plan you choose
    • must enroll
    • penalty of 1% of premium added each year that you didn't enroll after age 65
    • formulary may change at any time
Card Set
Econ Lec. 3
Government involvement in healthcare