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Faculty of MedicineHealth Economics and Policies 31505391 The Market for Health InsuranceHatim Jaber.
MD MPH JBCM PhD25 27 02 2019 Course Content 31505391 Week 1 Introduction to Course introduction to Health health value health determinants Week 2 Introduction to Health care management Health Policy and Healthcare Delivery .
Week 3 The scope of Economics and Health Economics Week 4 Demand and Supply Demand for Medical Care Supply of public health Week 5 The Market for Health Insurance Week 6 Financing health care Economic in Health Policy Cost and price Week 7 Health systems performance analysis Measurement and evaluation in health care .
Week 8 Midterm assessment Exams 21 3 2019 Week 9 Public Goods Market Failures and Cost Benefit Analysis Week 10 Economic evaluation Economics and efficiency cost analysis and cost effectiveness Week 11 Economic effects of Bad habits including smoking and alcohol consumption Week 12 Quality Improvements in healthcare delivery Methods to improve health care.
Week 13 Human resources in Healthcare delivery Week 14 Health Markets and Regulation and Economic regulation of health markets Week 15 16 Final assessment Exams 5 Why It Exists How It Influences Care Delivery The role of public policy in health insurance market .
How does inequality of incomes affect public policy related to healthinsurance The characteristics of the insurance market The role of and implications of employer based insurance The trends in insurance markets .
Economics and the market for health insurance Governmental health insurance programs What should public policy do about the price insurance affordability ... access conundrum in health care Health market outcomes Market failures Regulations and Institutional.
Expenditures on health and Uninsured Presentation outlineFinancing and insurance definitions types 08 00 to 08 20and impact How does inequality of incomes affect 08 20 to 08 30.
public policy related to health insurance The characteristics of the insurance 08 30 to 08 40market The role of and implications ofemployer based insurance The trends in insurance markets 08 40 to 08 50.
Uninsured Health policy and financing policyHealth policy and financing policy are inseparablebecause financing policy determines who has access to basic health care.
how much is available who controls the funds and how they are used the technical allocative and distributive efficiency of resource in use social protection .
what financial incentives are given to patients and providers and whetherhealth care cost inflation can be controlled Why should doctors be concerned withhealth care financing Rising health care costs in all nations leading to .
Government cost control measures e g regulation ofInsurance company scrutiny of actionsof doctorsLoss of clinical autonomy for doctors e g doctors cannotprescribe expensive drugs or order expensive procedures.
without getting permission from other parties first Reasons for rising costs1 New technology e g MRI organ transplants renal dialysis patenteddrugs to treat HIV AIDS2 Population ageing.
3 Epidemiological transition4 Medicalisation of social problems5 Rising expectations of the publice g expect better hotel services in hospitals6 Systems of health care financing without proper cost control.
mechanisms7 Unwise spending by government e g building more and more hospitals8 Inefficient privatisation e g privatisation of Government How do we pay for health care 1 Out of pocket i e patient and family pays.
2 Employer pays e g employer reimbursesthe employee who sees the doctor3 Private insurance scheme4 Charity or PVOs private voluntary organisations 5 Government i e through money raised from taxes.
Britain s National Health Service or through aNational Health Insurance scheme South Korea and6 Medical Savings Accounts Singapore s Medisave 7 Foreign aid important in poor countries Definition of Insurance.
A social device where a group of personstransfers risk to an insuring entity in orderto combine loss experience This theoretically permits the ability toactuarially predict these losses and to calculate.
the premium payments that will need to becontributed by all members of the risk pool What is insurance Meant to insure us against random uncertainty Club of 100 members .
On average each year one member gets sick itcosts 20 000 It is random who gets sick This is a lot of money for one person to pay Aim of insurance is to reduce the variability inone s income by pooling risks with a large.
number of people What is insurance Outlays for health may be variable for oneperson they are fairly predictable for the Health insurance would not be necessary if.
everyone had average needs But we do not itis variable What is insuranceDesirable characteristics for insurance 1 The number of insured should be large and.
they should be independently exposed topotential risk2 Losses covered should be definite in time place and amount3 The chance of loss should be measurable.
4 The loss should be accidental from viewpoint of person who is insured Basic Insurance TermsYour monthly cost for insurance coverageSet cost per visit that you pay out of pocket at the time of.
DeductibleTotal amount you pay out of pocket before insurance willpay for servicesCoinsurance of costs you pay out of pocket for services.
Basic Insurance Terms Coinsurance A form of medical cost sharing in ahealth insurance plan that requires an insured personto pay a stated percentage of medical expenses afterthe deductible amount .
Copayment A form of medical cost sharing in a healthinsurance plan that requires an insured person to paya fixed dollar amount when a medical service isreceived The insurer is responsible for the rest of thereimbursement .
Basic Insurance Terms Deductible A fixed dollar amount during the benefitperiod usually a year that an insured person paysbefore the insurer starts to make payments for coveredmedical services Plans may have both per individual and.
family deductibles Premium Agreed upon fees paid for coverage ofmedical benefits for a defined benefit period Premiumscan be paid by employers unions employees or sharedby both the insured individual and the plan sponsor .
What is Health Insurance Health insurance like other forms ofinsurance is a form of collectivism by meansof which people collectively pool their risk inthis case the risk of incurring medical.
Why should I consider purchasinghealth insurance Ten Essential Health Benefit Categories1 Ambulatory services 6 Prescription drugs2 Emergency services 7 Rehabilitative and.
habilitative services and devices3 Hospitalization 8 Laboratory services4 Maternity and newborn 9 Preventive and wellnesscare services and chronic diseasemanagement.
5 Mental health and 10 Pediatric services includingsubstance use disorder oral and vision careservices including behavioralhealth treatment Insurance .
Individual view Risk Aversion Social view Risk Pooling way.
Cross Subsidy Insurance Pools the risksbut don t vanish or decreased it How does insurance work A contract .
1 Insured pays a premiumand transfers his financial risk2 Insurer pays the financiallosses suffered by the insured indemnity in case of.
unforeseen events Bilateral Exchange Model for GoodsConsumers ProvidersMoney HospitalsPhysicians.
Exchange Model for Goodsxe s GovernmentGovernmentConsumers ProvidersService 26.
Trilateral Exchange Model for GoodsTaxes PaymentsOrganizationConsumers ProvidersUser fees Hospitals.
Physicians 27 Types of health care provider arrangements Exclusiveproviders Enrollees must go to providersassociated with the plan for allnon emergency care in order for the costs to be.
Any providers Enrollees may go to providers oftheir choice with no cost incentivesto use a particular subset of providers Mixture of providers Enrollees may go to anyprovider but there is a cost incentive.
to use a particular subset of providers The Demand for Health Insurance Why do consumers value health insurance 1 Illness injury and disability are to a large extentrandom events.
2 Hospitalizations serious injury andrehabilitation and other advanced moderntreatments can be very expensive3 Most households are averse to risk Demand for health insurance.
Results of uncertainly Illness and medical expenditures are unpredictable Hospitalizations serious injury and rehabilitation and otheradvanced modern treatments can be very expensive Can save for possible medical expenditures.
Most households are averse to risk Insurance companies pool risk Don t take on risk spread risk among many consumersWhat is risk aversion Risk Aversion .
The desire to replace an uncertain loss with asteady certain premium payment Demand for insuranceFactors affecting demand for health insurance 1 Probability of illness.
2 Loading fee3 Magnitude of loss relative to income cost of4 Degree of risk aversion5 Price Higher price reduces likelihood that anindividual will insure against a given event.
Demand for insurance Probability of Illness evidence Increases with age Affected by availability of public health insurance programs Medicare .
Differs by gender Result of women responsible for child birth Affected by availability of public health insurance programtargeting pregnant women Differs by type of care needed.
Chronic vs acute vs preventive Elasticity of demand will differ Medical VS Health Medical In order to cover the costs Have to increase.
Health Decrease costs Decrease Invalidity or disease so increasequality of life productivity Changing Vision toward.
RISK REDUCTIONMedical INSMedical INSHealth INSHealth INS.
So Can reduce the risk 34 WHAT IS MEDICAL INSURANCE System of assurance to makecontingencies of health care To provide protection against.
financial loss by unforeseen To meet cost of good medical care Relieves anxiety and tension WHY MEDICAL INSURANCE REQUIRED Medical expenses have increased Common man.
has to stretch to uncomfortable financiallimits to get proper treatment for himselfand his family Covers the individual and family against any financialconstraints arising from medical emergencies In.
case of sudden hospitalization illness oraccident health insurance takes care of theexpenses on medicines oxygen ambulance blood hospital room various medical testsand almost all other costs involved.
What does health insurance coverBasic CoverageA health insurance plan should provide cover forhospital rooms doctor or surgeon fees medicaltests medicines and related expenses .
It provides you with essential protection plus a rangeof optional extensions that can be selected to suityour specific insurance requirements Health Insurance Cover Specific Health Plans.
It provides covers for critical illnesses or diseases suchas heart attack kidney failure etc most insurers offercritical illness plans Another set of specific insurance plans targetailments such as diabetes and cancer These plans.
offer cash on hospitalization reimbursement forexpenses incurred on surgical treatments andsuch like Patterns of Insurance CoverageType of Health Variance of of People.
Care Financial Under 65Risk InsuredHospital Care Highest 80Surgical in High 78hosp medical.
Outpatient Medium 40 50Dental Low 40 Comprehensive healthTotal coverage for health care relatedThis coverage is after deductibles and.
co insurance are applied to anyhospital or physician s office visit A Good Health Insurance Plan Should Provide quality care at a reasonable cost Offer basic coverage for doctor and hospital bills.
Cover 120 days hospital room and board Provide at least 1 000 000 lifetime maximum per Pay 80 of out of hospital expenses after thedeductible is met Have no unreasonable exclusions.
Limit out of pocket expenses HEALTH INSURANCE FUNDAMENTALS Health insurance pays for some or all of a person shealth care costs The covered person will pay a premium which is a monthly amount paid in.
advance in order to receive health insurance Course Content 31505391 . Week 1 Introduction to Course introduction to Health: health value, health determinants. Week . 2 Introduction to: Health care management Health Policy a

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