People demand health because of its role in facilitating and providing
happiness. Health can be defined along two dimensions: the length of life
(longevity) and the quality of life. A person derives value from the quality of
life directly and indirectly: directly because one’s level of health affects the
enjoyment of goods and leisure and indirectly because one’s level of health
enhances productivity (Box 4-1). Enhanced productivity can be rewarded
in the labor market through higher wages. The indirect effect of health
on productivity suggests that health is an important component of human
capital investment. Consistent with the basic principle of our economic
system, consumers exercise choice in purchasing health care and other goods
and services.
Essay on Definitions of Health
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Why Is Healthcare Important? Healthcare?
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Overview - Health Care IssuesHealth Care IssuesOpposing .docxgerardkortney
Overview - Health Care Issues
Health Care Issues
Opposing Viewpoints Online Collection, 2015
In recent years, the availability and affordability of health insurance in the United States has become
the subject of much debate. The United Nations’ Universal Declaration of Human Rights lists medical
care among the basic human rights to which all people are entitled. In 2011, however, about 17
percent of Americans had no health insurance at all. For many people who are insured, the cost of
coverage is a financial hardship. This situation has led some people to call for the government to
provide health insurance for all citizens. Others, however, are skeptical of government’s ability to
efficiently manage health insurance and oppose any plans that involve government. The issue is made
more urgent by rapidly rising health care costs that threaten to overwhelm the country’s current
system of health insurance, and the national economy in general. Health care reform has become one
of the most important issues in contemporary American politics.
The Basics of Health Care
In most developed countries, health care systems involve government control or sponsorship. For
instance, in Great Britain, Scandinavia, and the countries of the former Soviet Union, the government
controls almost all aspects of health care, including access and delivery. For the most part, health
services in these countries are free to everyone; the systems are financed primarily by taxes. Other
countries, such as Germany and France, guarantee health insurance for almost all their citizens, but
the government plays a smaller role in managing health care. Both systems are financed at least in
part by taxes on wages.
The US government, by contrast, does not pay for most of its citizens’ health care. Generally,
Americans receive health care through employer-sponsored insurance, or they arrange to pay for
insurance on their own. Like all forms of insurance, health insurance operates by pooling the
resources of a group of people who face similar risks. This creates a common fund that members can
draw upon when needed. Each person in the group pays a certain amount, called a premium, every
month. These premiums are used to cover the medical expenses of group members who become sick
or injured.
Health Insurance in the United States
Today, most Americans receive health insurance through their place of work. Employers typically pay
for part of the premiums. Most employer-sponsored plans are administered through payroll
contributions. People who are self-employed and those whose employers do not provide health
insurance must purchase individual health insurance. Individual plans are generally more expensive
than group plans. Certain low-income individuals and families may be eligible for Medicaid, a form of
government-sponsored health insurance. In 1997, the US government introduced the Children’s
Health Insurance Program (CHIP) to assist the children of families who do not qualify f.
A very unique health and wellness movement which has developed a Corporate Wellness Program that can make a huge impact to your bottom line AND make your employees more productive through better health
Essay on Definitions of Health
Healthcare in the United States Essay
Why Is Healthcare Important? Healthcare?
Essay On Healthcare System
Essay On Impact On Health Care
Essay On Home Health Care
Essay On Affordable Health Care
Health Care Persuasive Essay
Essay on Careers in Healthcare
Essay On Health Care
Persuasive Essay On Health Care
Essay On Healthcare In The United States
Inequality in Healthcare Essay examples
Health Care Trends Essay examples
Social Media And Health Care Essay
Essay on Quality Health Care
Essay on Health Care
The Health Of A Health Care System
Essay On Health Care
Persuasive Essay On Health Care
Overview - Health Care IssuesHealth Care IssuesOpposing .docxgerardkortney
Overview - Health Care Issues
Health Care Issues
Opposing Viewpoints Online Collection, 2015
In recent years, the availability and affordability of health insurance in the United States has become
the subject of much debate. The United Nations’ Universal Declaration of Human Rights lists medical
care among the basic human rights to which all people are entitled. In 2011, however, about 17
percent of Americans had no health insurance at all. For many people who are insured, the cost of
coverage is a financial hardship. This situation has led some people to call for the government to
provide health insurance for all citizens. Others, however, are skeptical of government’s ability to
efficiently manage health insurance and oppose any plans that involve government. The issue is made
more urgent by rapidly rising health care costs that threaten to overwhelm the country’s current
system of health insurance, and the national economy in general. Health care reform has become one
of the most important issues in contemporary American politics.
The Basics of Health Care
In most developed countries, health care systems involve government control or sponsorship. For
instance, in Great Britain, Scandinavia, and the countries of the former Soviet Union, the government
controls almost all aspects of health care, including access and delivery. For the most part, health
services in these countries are free to everyone; the systems are financed primarily by taxes. Other
countries, such as Germany and France, guarantee health insurance for almost all their citizens, but
the government plays a smaller role in managing health care. Both systems are financed at least in
part by taxes on wages.
The US government, by contrast, does not pay for most of its citizens’ health care. Generally,
Americans receive health care through employer-sponsored insurance, or they arrange to pay for
insurance on their own. Like all forms of insurance, health insurance operates by pooling the
resources of a group of people who face similar risks. This creates a common fund that members can
draw upon when needed. Each person in the group pays a certain amount, called a premium, every
month. These premiums are used to cover the medical expenses of group members who become sick
or injured.
Health Insurance in the United States
Today, most Americans receive health insurance through their place of work. Employers typically pay
for part of the premiums. Most employer-sponsored plans are administered through payroll
contributions. People who are self-employed and those whose employers do not provide health
insurance must purchase individual health insurance. Individual plans are generally more expensive
than group plans. Certain low-income individuals and families may be eligible for Medicaid, a form of
government-sponsored health insurance. In 1997, the US government introduced the Children’s
Health Insurance Program (CHIP) to assist the children of families who do not qualify f.
A very unique health and wellness movement which has developed a Corporate Wellness Program that can make a huge impact to your bottom line AND make your employees more productive through better health
Comparing Magazine or Online Nutrition Information with Published.docxbartholomeocoombs
Comparing Magazine or Online Nutrition Information* with Published Research.
Scientific research sometimes contraindicates nutrition information in Health and Fitness magazines or from retail supplement stores. The information may not be completely false, but the information could be exaggerated, embellished, or simply not based on research. However, the information could be very accurate.
1. Select an article about a specific nutrition recommendation or a specific nutrition supplement from a Health and Fitness magazine or website. Most Health and Fitness magazines and websites now hire a Nutrition and/or Fitness professional to write their nutrition related articles. Thus, instead of an article, you can choose information from a retail website, an online advertisement, or information listed on a supplement container.
Please note: supplements that are very new (so new that research has not yet been conducted) would not be a good choice for this assignment. Also, do not select Creatine, as its proposed benefits are well documented.
2. Research the same nutrition recommendation or supplement using sources such as published research, scientific journals, textbooks, or reliable websites (commonly ending with .edu, .gov, or .org).
Instructions
1. List your selected Nutrition Recommendation or Supplement.
2. List the exact source of the claims or proposed benefits (magazine, website, advertisement, actual supplement container, etc.). If possible, provide a web link. If using a print advertisement or supplement container, submit a picture or photo.
3. List the exact claims and/or proposed benefits from your selected magazine article, website, advertisement, commercial, or supplement container.
4. Using reputable sources, summarize actual research results of the claims or benefits from #3. Two paragraphs minimum.
5. Provide at least 2 references. Our textbook can be used for 1 of the 2 references. Use APA style and format when listing and citing your references. See the Week 2 folder for information on APA style.
6. Compare the information from #3 and #4. One paragraph minimum.
This Assignment must be typed, and please number the various parts of your submitted assignment (as noted in the Instructions above: 1, 2, and so on).
APA Format
Due Friday April 5, 2019
Running head: HEALTHCARE POLICY ASSESSMENT
1
HEALTHCARE POLICY ASSESSMENT
2
Healthcare Policy Assessment
Dr. Timothy Smith
Darrin Clanton
PAD 510: Introduction to Public Policy Analysis
January 18, 2019
Healthcare Policy Assessment
Introduction
A presidential administration often works towards the improvement of the society. This is done through the implementation of different federal policies which act as facilitators towards specific objectives. In America, it is possible to trace specific social challenges that have existed since time immemorial. The phenomenon has led to different presidential administrations instituting the same federal policy as an effort to r.
Comparing Magazine or Online Nutrition Information with Published.docxannette228280
Comparing Magazine or Online Nutrition Information* with Published Research.
Scientific research sometimes contraindicates nutrition information in Health and Fitness magazines or from retail supplement stores. The information may not be completely false, but the information could be exaggerated, embellished, or simply not based on research. However, the information could be very accurate.
1. Select an article about a specific nutrition recommendation or a specific nutrition supplement from a Health and Fitness magazine or website. Most Health and Fitness magazines and websites now hire a Nutrition and/or Fitness professional to write their nutrition related articles. Thus, instead of an article, you can choose information from a retail website, an online advertisement, or information listed on a supplement container.
Please note: supplements that are very new (so new that research has not yet been conducted) would not be a good choice for this assignment. Also, do not select Creatine, as its proposed benefits are well documented.
2. Research the same nutrition recommendation or supplement using sources such as published research, scientific journals, textbooks, or reliable websites (commonly ending with .edu, .gov, or .org).
Instructions
1. List your selected Nutrition Recommendation or Supplement.
2. List the exact source of the claims or proposed benefits (magazine, website, advertisement, actual supplement container, etc.). If possible, provide a web link. If using a print advertisement or supplement container, submit a picture or photo.
3. List the exact claims and/or proposed benefits from your selected magazine article, website, advertisement, commercial, or supplement container.
4. Using reputable sources, summarize actual research results of the claims or benefits from #3. Two paragraphs minimum.
5. Provide at least 2 references. Our textbook can be used for 1 of the 2 references. Use APA style and format when listing and citing your references. See the Week 2 folder for information on APA style.
6. Compare the information from #3 and #4. One paragraph minimum.
This Assignment must be typed, and please number the various parts of your submitted assignment (as noted in the Instructions above: 1, 2, and so on).
APA Format
Due Friday April 5, 2019
Running head: HEALTHCARE POLICY ASSESSMENT
1
HEALTHCARE POLICY ASSESSMENT
2
Healthcare Policy Assessment
Dr. Timothy Smith
Darrin Clanton
PAD 510: Introduction to Public Policy Analysis
January 18, 2019
Healthcare Policy Assessment
Introduction
A presidential administration often works towards the improvement of the society. This is done through the implementation of different federal policies which act as facilitators towards specific objectives. In America, it is possible to trace specific social challenges that have existed since time immemorial. The phenomenon has led to different presidential administrations instituting the same federal policy as an effort to r.
Running Head APPROPRIATE INTERVENTIONS FOR HEALTHY PEOPLE 20202MalikPinckney86
Running Head: APPROPRIATE INTERVENTIONS FOR HEALTHY PEOPLE 2020
2
APPROPRIATE INTERVENTIONS FOR HEALTHY PEOPLE 2020
Appropriate Interventions for Healthy People 2020
Norys Gil
South University
List of Support Needs for the Participant
1. Assisting the patients to change the lifestyle is one of the primary support needs. According to the participant response, quitting smoking and maintaining a healthy weight are some of the significant challenges. Educating the patient about healthy dietary and the need for vigorous physical exercise will help the patient in maintaining the right body weight. Smoking habits are highly addictive, and quitting becomes challenging and requires significant effort from both the patient and the caregiver.
2. Psychological counseling. The patient has a great concern of wondering if she would leave long to see grandchildren. She also takes medication such as propranolol and diazepam for managing the stress. Counseling will help the patient mitigate the effects of anxiety and possible depression. It will also change the mindset of imminent death as a result of chronic kidney complications. Physical exercise is essential for mental health and manages stress levels.
3. Accurate tests and prescriptions of the medical plan to the patient are essential in chronic disease management. According to the participant, she would like to follow the prescribed medical plan to manage this complication.
4. They are assisting the patient in understanding the various prescribed medical plan. There is a need to educate the patient about how to administer medicines such as insulin.
Objectives Implementation of Healthy People 2020
Healthy people in 2020 policies and laws examined the various opportunities and approaches to achieve their primary goals. Different governments are using different strategies to promote the health wellness of society and public health. These initiatives serve as roadmaps for different countries and their objectives to health promotion (Pykett, 2019). They provide a way for the government and the community in general to understand the current and future health situation for effective planning and policymaking. For effective interventions for healthy nations, the government needs to engage public health stakeholders such as the healthcare providers, practitioners, and the community. This will helps in the identification of effective strategies for interventions and making healthy people 2020 ideas actionable.
Good health begins in our homes, workplaces, schools, and community in general. Social determinants of health directly impact all individuals. The healthy people 2020 determinants are divided into various categories, namely economic stability, education, healthcare, and the neighborhood, built environments as well as the community context (Pykett, 2019). The first step of implementing objectives of Health People 2020 is the identification of the national-wide health improvement priorities ...
Wellness and HealthWellness refers to the state of bein.docxhelzerpatrina
Wellness and Health
Wellness refers to the state of being in good health. Wellness is essential for one to work effectively so that the set goals are met. For the goals to be realized, all the seven areas of health are important because they are connected. The first area of health is education. Education is one of the indicators of life outcomes, for instance, social status, employment, and income and can also be used to predict wellbeing and attitude (Anderson, 2015). Other people apply education as a tool that helps them in shaping their social identity and establishing an understanding of their environment. Education shapes the social identity on how people relate with each other in society. A positive social identity is characterized by positive results, such as increased health status, wellbeing, political engagement, and social trust. Currently, a lot of emphases has been placed on education, and therefore those with lower education find it much challenging to positively identify themselves socially hence negatively affecting their self-esteem and wellbeing (Anderson, 2015).
Individuals with higher education levels tend to develop much interest to vie for political positions than those with lower levels of education. These educated individuals also have got more social trust than their uneducated counterparts — several studies confirmed that there are a number of health benefits of education. Baum &Payea (2013) explains that a more educated person has a higher probability of getting a good job with health-promoting packages such as health insurance. On the other hand, those with low education have higher chances of doing risky jobs. Those individuals who are more educated are subjected to more earnings. A Population Survey conducted by the U.S. Department of Labor and the United States Bureau of Labor Statistics in 2012 confirmed that college graduates registered twice as many average earnings than their colleagues who had dropped out of high school and one and a half higher than those who had graduated from high school (Baum &Payea, 2013).
The families that earn more income are in a position to buy healthy food, can get time to perform exercises and can afford to pay for health services and transport cost. Consequently, low level of education brings about job insecurity, poor pay and the vulnerability of these individuals and their families are much higher during hard times leading to poor housing, malnutrition, and inability to afford medical services. Individuals with higher education levels and therefore, have got higher incomes do not suffer from health-related stress that is attached to chronic social and economic hardships (Baum &Payea, 2013). The category of individuals with lower levels of education has limited resources such as social support, a feeling of control over life, and high self-esteem to counter the stress.
Education from school and outside school enables individuals to acquire skills and foster traits that they w ...
Invest in your workforce, their health, wellness, & safety...and realize ROI and productivity while reducing health care cost, absenteeism, lost-day, (due to WC), and turnover!
CHAPTER 1History of the U.S. Healthcare SystemLEARNING OBJECTI.docxmccormicknadine86
CHAPTER 1
History of the U.S. Healthcare System
LEARNING OBJECTIVES
The student will be able to:
■ Describe five milestones of medicine and medical education and their importance to health care.
■ Discuss five milestones of the hospital system and their importance to health care.
■ Identify five milestones of public health and their importance to health care.
■ Describe five milestones of health insurance and their importance to health care.
■ Explain the difference between primary, secondary, and tertiary prevention.
■ Explain the concept of the iron triangle as it applies to health care.
DID YOU KNOW THAT?
■ When the practice of medicine first began, tradesmen such as barbers practiced medicine. They often used the same razor to cut hair as to perform surgery.
■ In 2014, the United States spent 17.5% of the gross domestic product on healthcare spending, which is the highest in the world.
■ As a result of the Affordable Care Act, the number of uninsured is projected to decline to 23 million by 2023.
■ The Centers for Medicare and Medicaid Services predicts national health expenditures will account for over 19% of the U.S. gross domestic product.
■ The United States is the only major country that does not have universal healthcare coverage.
■ In 2002, the Joint Commission issued hospital standards requiring them to inform their patients if their results were not consistent with typical care results.
▶ Introduction
It is important as a healthcare consumer to understand the history of the U.S. healthcare delivery system, how it operates today, who participates in the system, what legal and ethical issues arise as a result of the system, and what problems continue to plague the healthcare system. We are all consumers of health care. Yet, in many instances, we are ignorant of what we are actually purchasing. If we were going to spend $1,000 on an appliance or a flat-screen television, many of us would research the product to determine if what we are purchasing is the best product for us. This same concept should be applied to purchasing healthcare services.
Increasing healthcare consumer awareness will protect you in both the personal and professional aspects of your life. You may decide to pursue a career in health care either as a provider or as an administrator. You may also decide to manage a business where you will have the responsibility of providing health care to your employees. And last, from a personal standpoint, you should have the knowledge from a consumer point of view so you can make informed decisions about what matters most—your health. The federal government agrees with this philosophy.
As the U.S. population’s life expectancy continues to lengthen—increasing the “graying” of the population—the United States will be confronted with more chronic health issues because, as we age, more chronic health conditions develop. The U.S. healthcare system is one of the most expensive systems in the world. According to 2014 statistics, the ...
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Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Comparing Magazine or Online Nutrition Information with Published.docxbartholomeocoombs
Comparing Magazine or Online Nutrition Information* with Published Research.
Scientific research sometimes contraindicates nutrition information in Health and Fitness magazines or from retail supplement stores. The information may not be completely false, but the information could be exaggerated, embellished, or simply not based on research. However, the information could be very accurate.
1. Select an article about a specific nutrition recommendation or a specific nutrition supplement from a Health and Fitness magazine or website. Most Health and Fitness magazines and websites now hire a Nutrition and/or Fitness professional to write their nutrition related articles. Thus, instead of an article, you can choose information from a retail website, an online advertisement, or information listed on a supplement container.
Please note: supplements that are very new (so new that research has not yet been conducted) would not be a good choice for this assignment. Also, do not select Creatine, as its proposed benefits are well documented.
2. Research the same nutrition recommendation or supplement using sources such as published research, scientific journals, textbooks, or reliable websites (commonly ending with .edu, .gov, or .org).
Instructions
1. List your selected Nutrition Recommendation or Supplement.
2. List the exact source of the claims or proposed benefits (magazine, website, advertisement, actual supplement container, etc.). If possible, provide a web link. If using a print advertisement or supplement container, submit a picture or photo.
3. List the exact claims and/or proposed benefits from your selected magazine article, website, advertisement, commercial, or supplement container.
4. Using reputable sources, summarize actual research results of the claims or benefits from #3. Two paragraphs minimum.
5. Provide at least 2 references. Our textbook can be used for 1 of the 2 references. Use APA style and format when listing and citing your references. See the Week 2 folder for information on APA style.
6. Compare the information from #3 and #4. One paragraph minimum.
This Assignment must be typed, and please number the various parts of your submitted assignment (as noted in the Instructions above: 1, 2, and so on).
APA Format
Due Friday April 5, 2019
Running head: HEALTHCARE POLICY ASSESSMENT
1
HEALTHCARE POLICY ASSESSMENT
2
Healthcare Policy Assessment
Dr. Timothy Smith
Darrin Clanton
PAD 510: Introduction to Public Policy Analysis
January 18, 2019
Healthcare Policy Assessment
Introduction
A presidential administration often works towards the improvement of the society. This is done through the implementation of different federal policies which act as facilitators towards specific objectives. In America, it is possible to trace specific social challenges that have existed since time immemorial. The phenomenon has led to different presidential administrations instituting the same federal policy as an effort to r.
Comparing Magazine or Online Nutrition Information with Published.docxannette228280
Comparing Magazine or Online Nutrition Information* with Published Research.
Scientific research sometimes contraindicates nutrition information in Health and Fitness magazines or from retail supplement stores. The information may not be completely false, but the information could be exaggerated, embellished, or simply not based on research. However, the information could be very accurate.
1. Select an article about a specific nutrition recommendation or a specific nutrition supplement from a Health and Fitness magazine or website. Most Health and Fitness magazines and websites now hire a Nutrition and/or Fitness professional to write their nutrition related articles. Thus, instead of an article, you can choose information from a retail website, an online advertisement, or information listed on a supplement container.
Please note: supplements that are very new (so new that research has not yet been conducted) would not be a good choice for this assignment. Also, do not select Creatine, as its proposed benefits are well documented.
2. Research the same nutrition recommendation or supplement using sources such as published research, scientific journals, textbooks, or reliable websites (commonly ending with .edu, .gov, or .org).
Instructions
1. List your selected Nutrition Recommendation or Supplement.
2. List the exact source of the claims or proposed benefits (magazine, website, advertisement, actual supplement container, etc.). If possible, provide a web link. If using a print advertisement or supplement container, submit a picture or photo.
3. List the exact claims and/or proposed benefits from your selected magazine article, website, advertisement, commercial, or supplement container.
4. Using reputable sources, summarize actual research results of the claims or benefits from #3. Two paragraphs minimum.
5. Provide at least 2 references. Our textbook can be used for 1 of the 2 references. Use APA style and format when listing and citing your references. See the Week 2 folder for information on APA style.
6. Compare the information from #3 and #4. One paragraph minimum.
This Assignment must be typed, and please number the various parts of your submitted assignment (as noted in the Instructions above: 1, 2, and so on).
APA Format
Due Friday April 5, 2019
Running head: HEALTHCARE POLICY ASSESSMENT
1
HEALTHCARE POLICY ASSESSMENT
2
Healthcare Policy Assessment
Dr. Timothy Smith
Darrin Clanton
PAD 510: Introduction to Public Policy Analysis
January 18, 2019
Healthcare Policy Assessment
Introduction
A presidential administration often works towards the improvement of the society. This is done through the implementation of different federal policies which act as facilitators towards specific objectives. In America, it is possible to trace specific social challenges that have existed since time immemorial. The phenomenon has led to different presidential administrations instituting the same federal policy as an effort to r.
Running Head APPROPRIATE INTERVENTIONS FOR HEALTHY PEOPLE 20202MalikPinckney86
Running Head: APPROPRIATE INTERVENTIONS FOR HEALTHY PEOPLE 2020
2
APPROPRIATE INTERVENTIONS FOR HEALTHY PEOPLE 2020
Appropriate Interventions for Healthy People 2020
Norys Gil
South University
List of Support Needs for the Participant
1. Assisting the patients to change the lifestyle is one of the primary support needs. According to the participant response, quitting smoking and maintaining a healthy weight are some of the significant challenges. Educating the patient about healthy dietary and the need for vigorous physical exercise will help the patient in maintaining the right body weight. Smoking habits are highly addictive, and quitting becomes challenging and requires significant effort from both the patient and the caregiver.
2. Psychological counseling. The patient has a great concern of wondering if she would leave long to see grandchildren. She also takes medication such as propranolol and diazepam for managing the stress. Counseling will help the patient mitigate the effects of anxiety and possible depression. It will also change the mindset of imminent death as a result of chronic kidney complications. Physical exercise is essential for mental health and manages stress levels.
3. Accurate tests and prescriptions of the medical plan to the patient are essential in chronic disease management. According to the participant, she would like to follow the prescribed medical plan to manage this complication.
4. They are assisting the patient in understanding the various prescribed medical plan. There is a need to educate the patient about how to administer medicines such as insulin.
Objectives Implementation of Healthy People 2020
Healthy people in 2020 policies and laws examined the various opportunities and approaches to achieve their primary goals. Different governments are using different strategies to promote the health wellness of society and public health. These initiatives serve as roadmaps for different countries and their objectives to health promotion (Pykett, 2019). They provide a way for the government and the community in general to understand the current and future health situation for effective planning and policymaking. For effective interventions for healthy nations, the government needs to engage public health stakeholders such as the healthcare providers, practitioners, and the community. This will helps in the identification of effective strategies for interventions and making healthy people 2020 ideas actionable.
Good health begins in our homes, workplaces, schools, and community in general. Social determinants of health directly impact all individuals. The healthy people 2020 determinants are divided into various categories, namely economic stability, education, healthcare, and the neighborhood, built environments as well as the community context (Pykett, 2019). The first step of implementing objectives of Health People 2020 is the identification of the national-wide health improvement priorities ...
Wellness and HealthWellness refers to the state of bein.docxhelzerpatrina
Wellness and Health
Wellness refers to the state of being in good health. Wellness is essential for one to work effectively so that the set goals are met. For the goals to be realized, all the seven areas of health are important because they are connected. The first area of health is education. Education is one of the indicators of life outcomes, for instance, social status, employment, and income and can also be used to predict wellbeing and attitude (Anderson, 2015). Other people apply education as a tool that helps them in shaping their social identity and establishing an understanding of their environment. Education shapes the social identity on how people relate with each other in society. A positive social identity is characterized by positive results, such as increased health status, wellbeing, political engagement, and social trust. Currently, a lot of emphases has been placed on education, and therefore those with lower education find it much challenging to positively identify themselves socially hence negatively affecting their self-esteem and wellbeing (Anderson, 2015).
Individuals with higher education levels tend to develop much interest to vie for political positions than those with lower levels of education. These educated individuals also have got more social trust than their uneducated counterparts — several studies confirmed that there are a number of health benefits of education. Baum &Payea (2013) explains that a more educated person has a higher probability of getting a good job with health-promoting packages such as health insurance. On the other hand, those with low education have higher chances of doing risky jobs. Those individuals who are more educated are subjected to more earnings. A Population Survey conducted by the U.S. Department of Labor and the United States Bureau of Labor Statistics in 2012 confirmed that college graduates registered twice as many average earnings than their colleagues who had dropped out of high school and one and a half higher than those who had graduated from high school (Baum &Payea, 2013).
The families that earn more income are in a position to buy healthy food, can get time to perform exercises and can afford to pay for health services and transport cost. Consequently, low level of education brings about job insecurity, poor pay and the vulnerability of these individuals and their families are much higher during hard times leading to poor housing, malnutrition, and inability to afford medical services. Individuals with higher education levels and therefore, have got higher incomes do not suffer from health-related stress that is attached to chronic social and economic hardships (Baum &Payea, 2013). The category of individuals with lower levels of education has limited resources such as social support, a feeling of control over life, and high self-esteem to counter the stress.
Education from school and outside school enables individuals to acquire skills and foster traits that they w ...
Invest in your workforce, their health, wellness, & safety...and realize ROI and productivity while reducing health care cost, absenteeism, lost-day, (due to WC), and turnover!
CHAPTER 1History of the U.S. Healthcare SystemLEARNING OBJECTI.docxmccormicknadine86
CHAPTER 1
History of the U.S. Healthcare System
LEARNING OBJECTIVES
The student will be able to:
■ Describe five milestones of medicine and medical education and their importance to health care.
■ Discuss five milestones of the hospital system and their importance to health care.
■ Identify five milestones of public health and their importance to health care.
■ Describe five milestones of health insurance and their importance to health care.
■ Explain the difference between primary, secondary, and tertiary prevention.
■ Explain the concept of the iron triangle as it applies to health care.
DID YOU KNOW THAT?
■ When the practice of medicine first began, tradesmen such as barbers practiced medicine. They often used the same razor to cut hair as to perform surgery.
■ In 2014, the United States spent 17.5% of the gross domestic product on healthcare spending, which is the highest in the world.
■ As a result of the Affordable Care Act, the number of uninsured is projected to decline to 23 million by 2023.
■ The Centers for Medicare and Medicaid Services predicts national health expenditures will account for over 19% of the U.S. gross domestic product.
■ The United States is the only major country that does not have universal healthcare coverage.
■ In 2002, the Joint Commission issued hospital standards requiring them to inform their patients if their results were not consistent with typical care results.
▶ Introduction
It is important as a healthcare consumer to understand the history of the U.S. healthcare delivery system, how it operates today, who participates in the system, what legal and ethical issues arise as a result of the system, and what problems continue to plague the healthcare system. We are all consumers of health care. Yet, in many instances, we are ignorant of what we are actually purchasing. If we were going to spend $1,000 on an appliance or a flat-screen television, many of us would research the product to determine if what we are purchasing is the best product for us. This same concept should be applied to purchasing healthcare services.
Increasing healthcare consumer awareness will protect you in both the personal and professional aspects of your life. You may decide to pursue a career in health care either as a provider or as an administrator. You may also decide to manage a business where you will have the responsibility of providing health care to your employees. And last, from a personal standpoint, you should have the knowledge from a consumer point of view so you can make informed decisions about what matters most—your health. The federal government agrees with this philosophy.
As the U.S. population’s life expectancy continues to lengthen—increasing the “graying” of the population—the United States will be confronted with more chronic health issues because, as we age, more chronic health conditions develop. The U.S. healthcare system is one of the most expensive systems in the world. According to 2014 statistics, the ...
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Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
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There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
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Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
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Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
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Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
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Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
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Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
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1. 97
C H A P T E R 4
The Importance of Health and
Health Care
The American health care system is an engine for innovation that develops
and broadly disseminates advanced, life-enhancing treatments and offers
a wide set of choices for consumers of health care. The current health care
system provides enormous benefits, but there are substantial opportunities
for reforms that would reduce costs, increase access, enhance quality, and
improve the health of Americans.
An individual’s health can be maintained or improved in many ways,
including through changes in personal behavior and through the appropriate
consumption of health care services. While there is substantial health care
spending in the United States, the importance of health does provide a strong
rationale for this level of spending. But because health care financing and
delivery are often inefficient, there are opportunities to advance health and
access to health care services without further growth in spending. To improve
the efficiency of health care financing and delivery, the Administration has
pursued policies that would increase incentives for individuals to purchase
consumer-directed health insurance plans. The Administration has also
worked to link provider payments to performance, thus rewarding efficient
delivery of health care. In the President’s State of the Union Address,
he proposed changing the tax treatment of health insurance, offering all
Americans a standard deduction for buying health insurance. Such a change
could play an important role in increasing the efficiency of the American
health care system and expanding health insurance coverage.
The key points in this chapter are:
• Health can be improved not only through the consumption of health
care services, but also through individual behavior and lifestyle choices
such as quitting smoking, eating more nutritious foods, and getting
more exercise.
• Health care has enhanced the health of our population; greater efficiency
in the health care system, however, could yield even greater health for
Americans without increasing health care spending.
• Rapid growth in health care costs and limited access to health insurance
continue to present challenges to the health care system.
• Administration policies focus on reducing cost growth, improving
quality, and expanding access to health insurance through an emphasis
on private sector and market-based solutions.
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2. 98 | Economic Report of the President
Health and the Demand for Health Care
The demand for health care is unlike the demand for most consumer
products and services because while the desire for consumer products
and services comes from direct consumption, the desire for health care
is not derived directly from the consumption of the medical procedures
themselves; rather, it comes from the direct value of improved health that is
produced by health care. For example, demand for an MP3 player is based
on the enjoyment that an MP3 player brings to a consumer, but few would
choose to get a laparoscopic cholecystectomy for the same reason. Rather, a
consumer’s desire to have her gallbladder removed is directly related to the
positive impact the operation is likely to have on her health. Understanding
how health is produced, demanded, and valued is a useful starting point for
evaluating the health care system and health care policy.
Demand for Health
People demand health because of its role in facilitating and providing
happiness. Health can be defined along two dimensions: the length of life
(longevity) and the quality of life. A person derives value from the quality of
life directly and indirectly: directly because one’s level of health affects the
enjoyment of goods and leisure and indirectly because one’s level of health
enhances productivity (Box 4-1). Enhanced productivity can be rewarded
in the labor market through higher wages. The indirect effect of health
on productivity suggests that health is an important component of human
capital investment. Consistent with the basic principle of our economic
system, consumers exercise choice in purchasing health care and other goods
and services.
The Production of Health
Health care is only one of the factors that determine health. Other factors
include individual behaviors, environmental factors, social factors, education,
income, and genetics. If we think of an individual as a producer of health,
the key production inputs are the time and money spent on health-improving
activities and health care. Health-improving activities can include individual
choices regarding exercise, nutrition, and lifestyle. Health care can include
hospital care, outpatient visits to medical providers, nursing home care, and
medication. Because health can deteriorate from accidents, sudden disease,
and the effects of aging, health care inputs are needed not only to maintain
current levels of health but also possibly to restore health following an illness
or injury.
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3. Chapter 4 | 99
Studies of trends in health-improving activities show a mixed picture on
whether Americans are investing more in their health. A recent study finds
that Americans are smoking less and controlling their cholesterol and blood
pressure better (through a combination of health-improving activities and
medical inputs). In contrast, there has been a dramatic increase in obesity in
the United States in both adults and children during the past few decades.
Obesity has more than doubled since the late 1970s, from 15 percent to
34 percent among adults. Among children ages 6 to 19, the incidence of
Box 4-1: Health Effects on Job Productivity
Health can affect job productivity through absenteeism and presen-
teeism. Absenteeism, not being present at the place of work as a result
of injury or illness, prevents an individual from contributing to output,
and may also affect the ability of coworkers to be productive when tasks
require collaboration. Presenteeism is the loss of at-work productivity
caused by a lack of physical or mental energy needed to complete
tasks, increased workplace accidents, and the possible spread of illness
to fellow employees. There is evidence that both of these factors are
costly. According to the Current Population Survey (CPS), 2.3 percent of
workers will have an absence from work during a typical week due to
injury or illness. Several studies estimating the extent to which presen-
teeism affects productivity indicate that, on average, the productivity
loss caused by some of the most common conditions (such as allergies,
depression, musculoskeletal pain, and respiratory disorders) is between
5 and 18 percent.
Investment in improving and managing health offers opportunities
to mitigate some of these costs. An increasing number of employers
are instituting at-work wellness programs that provide targeted health
management. These programs range from monetary penalties for those
with unhealthy lifestyles (such as smoking or uncontrolled diabetes) to
subsidizing access to exercise facilities. The benefits are shared by the
worker (higher earnings, better quality of life) and the employer (enhanced
productivity and decreased health care expenditures). Evidence of the
success of these programs, while incomplete and variable, suggests
that at-work wellness programs can improve worker health outcomes
and provide a positive return to employers. One long-term study of a
particularly comprehensive wellness program shows that health care
expenditures fell by an average of $225 per employee per year (mostly
due to fewer doctor visits and hospital stays), but it took several years
to realize these benefits.
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4. 100 | Economic Report of the President
being overweight has tripled. Obesity is an indicator of unhealthy behavior
because it often reflects a lack of exercise and overconsumption of unhealthy
foods. Also, obesity is associated with a higher risk of many diseases and
health conditions, including hypertension, Type 2 diabetes, coronary heart
disease, and some cancers.
Trends in Health Spending
Americans are investing more in their health as measured by health care
expenditure. In 2006, Americans spent over $7,000 per capita on health care,
up from $2,400 in 1980 and $800 in 1960 (all in 2006 dollars). National
health care spending has grown more rapidly than the economy as a whole,
so health care accounts for an increasing share of the overall economy
(Chart 4-1). National health care spending now accounts for about 16 percent
of gross domestic product (GDP), up from 9.1 percent in 1980 and only
5.2 percent in 1960.
The primary factor that tends to drive health care expenditure growth is
the development and diffusion of new technologies. Knowledge about health
and health care conditions continues to expand over time, generating an
expanding inventory of new or improved products, techniques, and services.
Medical technology may account for about one-half or more of real long-term
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5. Chapter 4 | 101
health care spending growth. Rising incomes are a second important factor
because as income increases, a greater proportion of income is typically spent
on health care. The aging of the population and increasing disease prevalence
is a third important factor contributing to expenditure growth in the United
States. Other cited factors include more rapid wage growth in the health
sector, greater insurance coverage supported by large government subsidies
through both government-sponsored programs and tax subsidies, and the low
share of health expenses paid out-of-pocket by health consumers.
Trends in Life Expectancy
Life expectancy is only one of many outcome measures for health, but
because it has been reliably and consistently measured over time, it offers a
unique historical view of trends in health. United States life expectancy trends
since 1900 both from birth and from age 65 are shown in Chart 4-2. In the
two panels of this chart, we see life expectancy gains throughout the century.
Progress in life expectancy at birth was rapid in the first half of the century,
growing from 48 to 68 years. Between 1950 and 1970, life expectancy at birth
grew gradually, reaching only 71 by 1970. Progress picked up in the 1970s,
with life expectancy reaching age 78 by 2004. There is a contrasting pattern
for the life expectancy among those who live to age 65. Life expectancy at age
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6. 102 | Economic Report of the President
65 showed little progress until the 1930s; in the subsequent 4 decades, life
expectancy at 65 rose 3 years to 15 (meaning that in 1930 a person who was
65 could expect to live to age 77, while in 1970 a 65-year-old person could
expect to live to age 80). Starting in the 1970s, the pace of improvement
accelerated. By 2004, life expectancy at age 65 was 18.5 additional years; a
gain of 3.5 years of life over the past 3.5 decades.
Innovations in health and health care can explain the patterns in longevity.
Changes in the first half of the 20th century came largely through progress
in reducing malnutrition, improving sanitation, and containing infection
through improved public health measures and the use of antibiotic agents such
as penicillin. After about 20 years of gradual improvement in life expectancy,
the rising longevity from 1970 reflects progress in treating life-threatening
ailments prevalent among those over 50. As shown in Table 4-1, the largest
single contributor to increased longevity has been reduced mortality from
heart disease (3.6 years); reduced mortality from strokes added another
1.3 years to life expectancy. Reduced mortality from those two conditions has
thus added nearly 5 years to the life expectancy of Americans.
Research suggests that the lower mortality from heart disease and strokes is
primarily attributable to advances in intensive medical therapies, non-acute
medications to manage high blood pressure and high cholesterol, and changes
in individual behavior to reduce risk factors such as smoking and high-fat
diets. Improvements in medical treatments alone are believed to account
for at least 3 of the 5 years of the life expectancy gain that is attributable to
reduced mortality from heart diseases and strokes.
To put these substantial benefits of extending life into a perspective that
accounts for the increased spending on health care, it is useful to assess the
tradeoff between the cost of the treatments and the benefits of longer life. An
influential study has done this and found the benefits of increased spending
on cardiovascular treatments to be about four times as large as the costs.
Table 4-1.—Additional Life-Years Due to Reduced Mortality
from Selected Causes, for US by Decade, 1950-2000
(years)
1950-1960 1960-1970 1970-1980 1980-1990 1990-2000 Total
Infant Mortality............... 0.47 0.35 0.67 0.22 0.16 1.87
Heart Disease.................. 0.38 0.55 0.96 1.08 0.67 3.63
Cancer ............................. 0.01 -0.05 -0.09 -0.05 0.30 0.16
Stroke.............................. 0.15 0.24 0.52 0.31 0.07 1.29
Accidents......................... 0.14 -0.09 0.27 0.27 0.09 0.66
Other................................ 0.66 0.00 0.55 -0.28 0.40 1.33
Total................................. 1.80 1.00 2.93 1.54 1.68 8.96
Source: Murphy, K.M., and Topel, R.H. The Value of Life and Longevity (2006). Journal of Political Economy, vol. 11, No. 5,
871-904.
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7. Chapter 4 | 103
While the study focused on spending on cardiovascular disease, the basic
conclusion—aggregate health-spending increases have provided positive
returns—is true more broadly. Using the same framework, the total increase
in health care spending since 1950 can be justified, in monetary terms, by
the life expectancy gains from cardiovascular treatment and neonatal care
alone. Gains from other treatment advances (not to mention benefits other
than life extension, such as a higher quality of life) thus imply that, over the
past half-century, the benefits from greater health care spending in the United
States have exceeded their costs. However, the benefits of greater health care
spending in relation to costs have not been as favorable since 1980, suggesting
potentially diminishing returns from health care spending.
Trends in Health Insurance Coverage
Health insurance helps shield families from the financial risk of the
unanticipated health expenses of serious illness or injury, and facilitates access
to the health care system, thereby improving health outcomes. Given those
benefits, it is a major concern that at any given time, 16 percent of Americans
report that they lack health insurance. The primary driver of declining enroll-
ment in private insurance has been the increasing cost of health care and this
decline contributes to the rising proportion of uninsured (Chart 4-3).
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8. 104 | Economic Report of the President
Addressing Challenges in the
Health Care System
The trends in the U.S. health care system suggest that the rapid growth in
health care costs will persist. Health care costs will pose an increasing challenge
for consumers of health care and health insurance as expenditures in this sector
make up a greater share of household consumption. Taxpayers will also face an
increasing challenge as the budgetary burden of Federal and State health care
programs continues to expand. (See Box 4-2 for an overview of government
health care programs.) Reducing health care cost growth and increasing access
while improving health care quality are the goals of Federal health care policy.
The Administration’s objective has been to develop market-oriented policies to
meet these goals by fostering the innovation, flexibility, and choice that are the
best aspects of the American health care system. Market-oriented policies must
address potential market failures that are at the root of the challenges in the
health care system. These problems include insufficient information available
to patients, health providers, and insurers; access barriers for lower-income
or disadvantaged Americans; and two specific market failures that arise in
insurance markets: moral hazard and adverse selection. Moral hazard is the
tendency for individuals to overuse certain types of health care when insurance
covers a sizable fraction of the costs; adverse selection is the tendency for
insurance to be purchased by those persons who are most likely to need it (and
who thus have higher costs). Policies aimed at mitigating these problems can
enhance the ability of our market-oriented health care system to achieve the
goals of controlled cost growth, improved access to health insurance coverage,
and high-quality health care.
Box 4-2: Government Health Care Programs
About 46 percent of health care spending is funded by Federal and
State Governments through various health programs. The main govern-
ment-funded health programs are designed to serve specific populations
and include Medicare, Medicaid, the State Children’s Health Insurance
Program (SCHIP), and the Veterans Health Administration (VHA).
Medicare was enacted in 1965 and covers nearly all individuals aged
65 and older (as well as some younger individuals with disabilities or
specific illnesses). Medicare today consists of three basic parts. Part A is
hospital insurance, which covers stays in hospitals and nursing facilities.
Part A is primarily funded by a 2.9 percent payroll tax (1.45 percent each
for workers and employers). Part A is generally provided automatically
continued on next page
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9. Chapter 4 | 105
continued on next page
and without premiums for persons age 65 and older who are eligible for
Social Security or Railroad Retirement benefits. Part B is supplementary
medical insurance which covers doctor visits and other outpatient
services. Part B is voluntary and enrollees pay a monthly premium, yet
94 percent of those eligible elect to enroll. Part D, Medicare’s prescrip-
tion drug benefit which started in 2006, is available on a voluntary basis
to individuals who qualify for Medicare Part A, and requires a monthly
premium for those beneficiaries who do not qualify for the low-income
subsidy. Unlike other parts of Medicare, Part D is administered by a
partnership between private insurers and Medicare officials to provide
choice of prescription drug plans to beneficiaries and to allow for price
competition. Part B and Part D are funded by a combination of premiums
from beneficiaries and government revenues (Part D also receives some
resources from the States). In 2007, there were 43.4 million beneficiaries
enrolled in Part A, 40.6 million in Part B, and 24.4 million in Part D.
Under Fee-for-Service Medicare, health care providers are reimbursed
by the Federal Government at predetermined rates for services
provided. However, Medicare beneficiaries can opt to enroll in a private
Medicare plan under Medicare Advantage through local coordinated
care plans offered mostly by local health maintenance organizations
(HMOs) and preferred provider organizations (PPOs), regional PPOs, and
private fee-for-service providers. Local coordinated care plans make up
72 percent, regional PPO plans 3 percent, and private fee-for-service
plans 21 percent of Medicare Advantage plans.
Medicaid was also established in 1965 as a health care program for
low-income individuals, in particular those with children. Medicaid
is administered by the States, and is funded by both the Federal
Government and the States. Like traditional Medicare, Medicaid also
reimburses private providers for services at predetermined rates and
allows recipients to enroll in Medicaid managed care plans in many
States. However, unlike Medicare, these predetermined rates are
determined at the State level. In 2006, there were 45.7 million enrollees
in Medicaid, of whom 65 percent were in managed care plans. The
State Children’s Health Insurance Program (SCHIP) was created in 1997
to cover children from low-income families who do not qualify for
Medicaid. SCHIP is also administered by the States and funded by both
Federal and State Governments, but the Federal contribution towards
spending is higher for SCHIP than for Medicaid. In 2006, there were
6.6 million enrollees in SCHIP.
While Medicare, Medicaid, and SCHIP are publicly funded programs,
most health care services are delivered by private providers not employed
by the government. In contrast, the Veterans Health Administration
Box 4-2 — continued
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10. 106 | Economic Report of the President
Moral Hazard and Cost Control
In most markets, consumers decide what to purchase by comparing the
benefit of a good or service relative to its cost. In the health care sector,
however, consumers often do not learn the prices of goods and services until
bills are received weeks or months later. Because health insurance polices
cover most health care costs, including the costs of routine, predictable health
care services, consumers have little incentive to try to access and act on price
information. This moral hazard effect encourages overuse of certain types of
heath care, gives little incentive for consumers to consider costs in their search
for a provider, and distorts incentives for technological change.
Overuse of health care can occur when the perceived cost of a service is less
than the actual cost and, as a result, the service may be used even when its value
is less than its cost. This happens, for example, with health insurance coverage
that shields consumers from the true cost of a service by having them pay none
or only a portion of its cost. To illustrate, consider a consumer’s decision to
purchase a migraine therapy that costs $100 to produce. If the symptoms are
serious enough and would be relieved by the therapy, the consumer might
be willing to pay more than $100 for the therapy. The consumer would thus
purchase the therapy regardless of how much of the $100 cost was covered by
insurance, and the purchase would not be overconsumption. If the customer
had milder symptoms, however, insurance may induce overconsumption.
Suppose, for example, that the consumer would only be willing to pay $25 to
relieve the symptoms. If insurance covered the entire $100 cost, the consumer
would purchase the therapy since the $25 benefit exceeds the consumer’s
(VHA) delivers health care to veterans through a system that is run by
the Department of Veterans Affairs. The VHA is a truly public health
care system in the sense that the Federal Government owns the VHA
hospitals and employs the health care providers.
Rising health care costs are creating budget pressures for govern-
ment health care programs. Currently, Federal spending on Medicare
and Medicaid totals about 4 percent of GDP, or about 20 percent of the
Federal budget. Rising health care costs, however, will likely raise those
figures in coming decades. If spending grows 1 percent per year faster
than GDP (which is somewhat slower than the historical rate of growth
over the past 40 years), for example, the Office of Management and
Budget projects that in 25 years, spending on these two programs alone
could reach 8 percent of GDP. Such spending growth, if it came to pass,
would require either unprecedented levels of taxation or dramatic reduc-
tions in other government activities.
Box 4-2 — continued
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11. Chapter 4 | 107
effective price of zero. Even if a $10 copayment was required by the insurance
benefit, the purchase would still take place. Because the social cost of $100
exceeds the $25 benefit, this purchase would not be socially beneficial and
would therefore be considered overconsumption.
Because consumers are less sensitive to the prices of the health care services
they consume, the competitive forces that typically keep prices down are
weakened. Imagine two hospitals that provide the same service, but hospital
A charges $1,000 and is located in an older facility, while hospital B charges
$2,000 but is located in an updated facility with a wide array of amenities
and equipment on site. Given these choices, a consumer facing the actual
price may prefer hospital A, but in a world where few costs are shared with
the patient, most people would choose hospital B. This gives hospital B few
incentives to control costs given that convenience or amenities have a greater
influence on consumer choice than price.
New technological innovations enter a market in which consumers rarely
pay more than 10 to 20 percent of the market price out-of-pocket. This influ-
ences the value of the innovations that are developed and marketed. If a new
product is only slightly more effective than an existing product, for example,
it may be highly demanded even if it is priced well above existing alternatives.
Because there is a market for new technology with little additional benefit
over existing treatments, innovators have sufficient incentive to create new
technologies with little marginal value.
Health insurers and their sponsors (employers) recognize that insurance
reduces consumer incentives to be responsive to costs. Insurers use a variety
of cost-control mechanisms such as utilization review, pre-approval, and drug
formularies to attempt to manage costs and, in part, counteract the lack of cost
consciousness by consumers. But those mechanisms can only partly offset the
problem. In addition, insurance benefits are designed to limit moral hazard
by sharing the costs of services received with the beneficiary. Design features
to accomplish this goal include deductibles, copayments, and coinsurance.
Deductibles, the dollar amount that a consumer will have to pay before the
insurer pays for any medical expenses, are often less than $500. Copayments
are a fixed fee paid per visit or per prescription. Coinsurance is a percentage of
the cost of the service that is the responsibility of the consumer.
These cost sharing mechanisms are underutilized because of a bias created
by the tax code. The health insurance premium of employees paid by
employers is exempt from income and payroll taxes, but individual spending
through deductibles, copayments, and coinsurance is taxable. As a result, there
is a tax incentive for employers to compensate employees through generous
health insurance plans that limit cost sharing. Thus, the tax code reduces
the incentive for optimal health insurance design and ultimately encourages
individuals to purchase more health care services than they would otherwise.
Health Savings Accounts (HSAs), enacted into law by this Administration
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12. 108 | Economic Report of the President
in 2004, and the standard deduction for health insurance first proposed by
this Administration in 2007, both provide a mechanism for eliminating the
tax bias against greater cost sharing. These policies are intended to offer the
private sector more opportunities to control costs through greater consumer
awareness of the cost of health insurance premiums and health care services.
Health Savings Accounts
Health Savings Accounts are savings accounts of pre-tax dollars, funded
by individual or employer contributions, that can be used toward current
and future out-of-pocket medical expenses. HSAs are designed to be used
in conjunction with high-deductible health plans, reducing reliance on
insurance for routine health expenses. The funds in the HSA can be used to
pay these routine health expenses directly. Because unspent funds belong to
the individual and can accumulate over time, HSAs lead the individual to
play a more active role as a health care consumer. In January 2007, HSAs
covered 4.5 million people, which is an increase of 1.3 million since January
2006, and 3.5 million since March 2005.
As the consumer plays a greater role and becomes more aware of routine
health expenses, provision of inefficient care should be reduced; incentives for
providers to adopt cost-effective therapies should increase; and possibly, some
health care prices may decline, which may even benefit consumers in tradi-
tional insurance plans. Yet the benefit of moving to a high-deductible policy
with an HSA will vary in that chronically ill individuals with persistently high
spending may find these policies less desirable because their out-of-pocket
spending would be consistently high. Consumers in lower tax brackets will
derive a smaller tax benefit from HSAs because the value of tax exemption
depends on a consumer’s marginal tax rate (the tax paid on the next dollar a
worker earns).
A Standard Deduction for Health Insurance to Replace the
Tax Exemption
The lack of consumer sensitivity to health care prices occurs not just
through the consumption of health care services, but through the consump-
tion of health insurance as well. The tax exemption of employer-sponsored
health insurance premiums is inefficient because, by providing a larger tax
break to families with more-generous employer-sponsored health insurance
policies, there is an incentive for health insurance to cover more services than
employees would otherwise demand. This occurs because employees can
increase after-tax compensation by accepting more of their compensation in
the form of health insurance.
The President has proposed to replace the current open-ended tax exclusion
for employment-based health insurance with a flat $15,000 standard
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13. Chapter 4 | 109
deduction for health insurance to all families (or $7,500 for individuals),
whether that insurance was obtained through their employer or on their own.
The amount of this standard deduction would be independent of the actual
amount spent on the premium, so families who obtain insurance policies for
less than $15,000 (but whose policy satisfies a set of minimum requirements
for catastrophic coverage) would still have an exemption for the full $15,000
of compensation from income and payroll taxes. The annual increase in
the standard deduction for health insurance would be linked to inflation as
measured by the Consumer Price Index.
This policy has two key effects: 1) It would reduce the inefficiency of the
current tax treatment of employment-based health insurance and would allow
individual consumers to benefit from reducing the cost of their insurance;
and 2) it would provide for equitable tax treatment for health insurance
purchased inside and outside of employment. The first effect can be shown
in the following example. Consider a family of four with an annual income of
$50,000 and a health insurance policy worth $10,000 that is sponsored by an
employer. Because the marginal tax rate of this family is roughly 30 percent,
the current tax exemption for the cost of this insurance policy provides a
$3,000 tax break to the family. Another family with the same income and an
employer-sponsored health insurance policy worth $20,000 currently receives
a tax break of $6,000. One advantage of the proposed standard deduction is
that it provides the same tax treatment to all types of health insurance plans.
Under the proposed plan, both families would qualify for the flat $15,000
standard deduction and receive the same tax savings of $4,500. The flat tax
break provides a strong incentive to obtain health insurance coverage, and it
would allow families to reap the tax benefits of health insurance policies with
optimal cost-sharing features. Because the tax break is not more generous
for those who choose expensive health insurance plans (unlike the tax
exemption), consumers will become more conscious of cost when purchasing
health insurance and health care.
Healthinsurancepurchasesbyfamiliesandindividualswithorwithoutaccess
to employment-based health insurance would receive the same tax benefits
under this policy. Currently, tax treatment of health insurance premiums
is inequitable because it does not offer the same tax break to families and
individuals without access to employment-based insurance, who must instead
purchase a private plan in the individual health insurance market. The family
considered above with an annual income of $50,000 receives a $3,000 tax
break for a health insurance policy worth $10,000 sponsored by an employer,
but no tax break for a similar health insurance policy purchased through the
individual insurance market. Under the Administration’s proposal, those who
are currently insured in the individual health insurance market would see a
reduction in taxes commensurate with those insured in the group market. As
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14. 110 | Economic Report of the President
a result, those who are currently uninsured because they have no access to
employment-based insurance, would be given a strong incentive to purchase
coverage. An uninsured family of four earning $50,000, for example, would
receive a tax benefit of $4,500 if they purchased health insurance in the
individual market (the value of the $15,000 standard deduction if the family
faces a 30 percent marginal tax rate). That tax break would cover nearly half
the cost of a family health insurance plan costing $10,000.
The availability of a tax deduction for the purchase of health insurance for
individuals and families who are not offered employer-sponsored coverage
will make health insurance more affordable for millions of Americans. The
Administration estimates that the standard deduction would provide 3 to
5 million individuals with health insurance who did not have it previously.
Even with a standard deduction, challenges for affordable coverage remain
for individuals with low incomes or with substantial risk of high health
expenditures. The Administration’s Affordable Choices Initiative addresses
these remaining challenges. The initiative facilitates State efforts to make
health insurance more affordable for individuals with persistently high
medical expenses or limited incomes. Currently, subsidies and payments from
the Federal Government are funneled through providers; the objective is to
redirect funding toward individuals.
Controlling Costs Through Competitive
Insurance Markets
The effective functioning of a competitive marketplace for health insurance
requires addressing adverse selection. Adverse selection arises when insurance
is most attractive to those persons most likely to need it. If the premium is
based on the population average and the policy disproportionately attracts
those who spend more than the average, the policy will lose money for the
insurer. The policy will then either increase in price or not last in the market.
In the extreme, some consumers do not purchase insurance because the only
policy available to them is priced for the most expensive consumers.
The problems can be most severe in insurance markets involving small
firms and individuals without access to group coverage, because large risk
pools mitigate many of the forces that can lead to adverse selection. (However,
adverse selection can arise in broad risk pools when competing health plan
choices are made available.) To varying degrees, States can minimize adverse
selection by permitting providers in the market for individual insurance to
rate each individual on the basis of his or her medical risk and past health care
expenditure. As a consequence, individuals with chronic illnesses have to pay
higher premiums, be denied coverage altogether, or be denied coverage for
the condition which is making them ill.
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15. Chapter 4 | 111
To reduce the extent to which high-risk individuals face higher premiums
and to improve the availability of certain health insurance benefits, States
have imposed a range of restrictions on insurance underwriting practices
as well as coverage mandates on nongroup (and in many cases on group)
health insurance plans. These regulations generally include guaranteed issue
laws that require insurers to issue insurance to any eligible applicant without
regard to current health status or other factors, and community rating laws
that prohibit insurers from varying premium rates based on health status and
restrict the amount by which insurers are allowed to vary rates based on char-
acteristics such as age or gender. Although these regulations tend to reduce
insurance premiums for high-risk individuals, they also increase premiums
for lower risk individuals. Those premium increases can have the unintended
consequence of encouraging people to wait until they have a health problem
before enrolling. If such adverse selection reduces participation of healthier
people, premiums will increase and the voluntary insurance market may cease
to operate effectively. The result may be less insurance coverage and only
limited premium reductions for those who are chronically ill, as those who are
healthier choose to forgo coverage entirely rather than pay higher premiums.
The approach of the Administration is one that encourages lower premiums
particularly in the individual and small group markets, where adverse
selection poses the greatest challenges for competitive insurance markets.
The Administration supports a national market for health insurance rather
than State-specific markets. This would effectively make insurance available
to individuals and small groups under conditions that resemble those now
available to employees of many large corporations, which, by self-insuring,
are exempt from State insurance regulations and instead operate under the
Federal insurance law provisions of the Employee Retirement and Income
Security Act (ERISA). Health insurance policies with lower premiums would
be more readily available because health insurance policies would not be
subject to costly State mandates and regulations. The Administration also
supports Association Health Plans—plans that allow small groups to band
together to purchase insurance subject to Federal rather than State regula-
tions—because they would reduce adverse selection problems encountered by
small employers, achieve economies of scale in negotiating lower rates with
participating insurers, and allow for greater participation in a competitive
choice system of health insurance plans.
Improving Quality and Costs Through Information
and Reimbursement
Because of the complexities of medicine, patients must often rely on experts
to determine their diagnosis and select treatments. If the incentives for the
expert are different from those that would produce the greatest benefit for the
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16. 112 | Economic Report of the President
patient, however, the services delivered by the expert may not always be of
the greatest benefit to the patient. For example, doctors may have incentives
to overstate the value of expensive tests, and most patients lack the expertise
to assess these claims.
Physicians determine needed services for patients. Because these decisions
are in part subjective, diagnoses and treatments often differ across physicians,
sometimes in ways that are not in the patient’s or society’s best interest.
For example, the frequency of spinal surgery is almost eight times higher in
some parts of the United States than in others, even though the percentage
of people who have back problems does not vary widely between regions.
These types of geographic variations in quantity of care exist across a wide
range of treatments, yet few differences in outcomes can be detected. Overuse
of health care services is one problem, and underuse is another. A classic
study evaluated the rate at which clinicians followed processes of care widely
recommended through national guidelines and the medical literature. When
averaged across all phases of care for the most common or lethal conditions,
it was determined that nearly half of patients who met conditions for effective
clinical care failed to receive appropriate care.
There is great potential to improve quality and/or reduce costs through
reforms that improve information on quality and costs, and align provider
payments so that providers are rewarded for the health outcomes of the
patients rather than just for the services they perform.
Information on Effectiveness
One of the key impediments to more effective health care delivery is a
lack of relevant information—for patients, providers, and payers—on the
comparative effectiveness and efficiency of health care options. Such informa-
tion would be particularly useful for services that are in common practice,
generate high costs, employ rapidly changing technologies for which multiple
alternative therapies exist, and are in areas with substantial uncertainty.
The wide geographic variations in the use of procedures suggest that better
information on the effectiveness of different styles of medical practice could
result in substantial cost savings.
Health Information Technology
Health information technology (health IT) allows comprehensive manage-
ment of medical information and the secure exchange of medical information
between health care consumers and providers. Broad use of health IT has the
potential to help dramatically transform the delivery of health care, making it
safer, more effective, and more efficient. While a number of large health care
organizations have realized some of these gains through the implementation
of multifunctional, interoperable health IT systems, to date, experimental
evidence supporting the broad benefits from health IT is more limited. The
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17. Chapter 4 | 113
Administration supports broad adoption of health IT as a normal cost of
doing business, including policies that will encourage physicians and others to
adopt electronic health records and through furthering technologies for safe,
secure health information exchange.
Value-based Purchasing
Pay for performance or value-based purchasing is a payment model that
encourages health care providers to meet certain performance measures for
quality and efficiency. A recent example is eliminating payments for negative
consequences of care. The Centers for Medicare and Medicaid Services
(CMS) implemented a provision of the Deficit Reduction Act of 2005, which
prevents Medicare from giving hospitals higher payment for the additional
costs of treating certain “hospital-acquired conditions”—conditions that
result from medical errors or improper care and that can reasonably be
expected to be averted. Now big insurers are following Medicare’s lead and
are moving to ban payments for care resulting from grave mistakes. These
changes remove a perverse incentive for hospitals: improving patient safety
could reduce revenues and profits. As a result, these reforms should trigger
safety improvements and enhance the efficiency of the health care system.
Transparency of Price and Quality Information
Transparency of information on price and quality has been a priority of
this Administration. Medicare has provided incentives to providers to submit
performance information to CMS and many of these performance measures
have been made available on the CMS website so that consumers can compare
the quality of providers as they seek care. The administrators and sponsors of
Medicare and other Federal health insurance programs have been directed to
share with beneficiaries information about prices paid to health care providers
and the quality of the services they deliver. The commitment is to transform
Medicare by always seeking to improve the connection between expenditures
and positive health outcomes without increasing Medicare spending.
Promoting Healthy Behavior
Encouraging healthy behaviors, such as exercising more, eating better,
controlling weight gain, and quitting smoking, may be a cost-effective alter-
native to increased spending on health care. One way to encourage healthy
behavior is through health education. For example, much of the beneficial
effect of prenatal care is simply related to education about healthy behavior
while pregnant. A better understanding of the risks of high cholesterol and
blood pressure (and how to reduce those risks through healthy behavior) is
credited with being a very highly efficient way to improve health outcomes.
Administration policies that aim to increase consumer sensitivity to health
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18. 114 | Economic Report of the President
care costs have a positive indirect consequence in that they may induce an
increase in healthy behaviors.
Conclusion
The health care system in the United States has helped improve the health
and well-being of Americans. As health care costs continue to rise, enormous
opportunities exist to increase the value of health care and improve health
insurance coverage. Addressing these fundamental problems and fulfilling
the potential of our health care system will require innovative polices to help
Americansgetthecarethatbestmeetstheirneeds,andtocreateanenvironment
that rewards high-quality, efficient care. While Federally sponsored health
insurance for the most vulnerable Americans through Medicare, Medicaid,
and SCHIP remains a priority, private markets offer the best opportunities
for controlling costs and providing innovative policies to enhance efficiency,
quality, and access. Efficiency of health spending would be improved if tax
code reforms were enacted. Reforms could level the playing field between
employer-provided and individual health insurance, thus boosting insurance
coverage. At the same time, reforms could reward consumers for purchases of
higher deductible plans with reasonable copayments that provide insurance
for costly medical necessities, but do not encourage unwarranted procedures.
By addressing concerns of adverse selection, insurance markets can become
more competitive, thereby promoting innovation, choice, access, and
efficiency. Finally, health care quality can be addressed by improving the
transparency of health care information and by tying reimbursement to the
performance of providers.
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