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.

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