Medicaid and Other Government Programs

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來自 University of Pennsylvania 的課程

The Economics of Health Care Delivery

85 個評分

University of Pennsylvania

The Economics of Health Care Delivery

85 個評分

課程 2（共 4 門，Specialization The Business of Health Care）

In this course, you’ll learn about the key components of health care, and the economics behind their principles and pricing strategies. Professors Ezekiel Emanuel of Penn Medicine and Guy David of the Wharton School have designed this course to help you understand the complex structure of the health care system and health insurance. Through study and analysis of providers and insurance through an economic lens, you’ll learn how basic economic principles apply to both principles and payment methods. By the end of this course, you’ll be able to identify different types of health care providers and understand the dynamic between the providers and patient so you can employ best practices and maximize profit for your health care organization.

從本節課中

Module 1

This module was designed to give you a deeper understanding of the history and structure of the American health care system. You’ll begin by examining the history of health care providers and improvements in health care technology throughout the years. Then you’ll look at the different evolutions of insurance throughout history, the purpose of health insurance, and the inherent issues and solutions within the concept of insurance. You’ll learn key aspects of Medicare, Medicaid, and other government programs that increase access to health care. Then, you’ll evaluate the Iron Triangle of Health Care—quality, cost, and access—and the main areas of focus and tension for health care policy. By the end of this module, you’ll have a richer understanding of the growth of health care providers, insurance, and government programs and their impact on health care access.

History: Providers8:56

History: Health Insurance5:50

History: Government Programs3:31

Introduction to Health Insurance5:57

The Structure of Health Insurance5:45

Medicaid and Other Government Programs4:44

與講師見面

Ezekiel J. Emanuel, MD, PhD
Diane v.S. Levy and Robert M. Levy University Professor
Department of Medical Ethics and Health Policy
Guy David, PhD
Gilbert and Shelley Harrison Associate Professor of Health Care Management
Department of Health Care Management

Last time we looked at Medicare,

that gives health coverage to people who are 65 years and older.

Now we're going to look at Medicaid,

the government program that gives health coverage to people who are poor.

Medicaid passed at the same time was predominantly targeted to the poor people.

Today, about half of the people would get Medicaid,

our children, another quarter our pregnant women and

parents of the children and a quarter our elderly and disabled.

Poor elderly people in Medicaid pays for

those provisions that Medicare doesn't cover.

It turns out while a quarter of the people are elderly and disabled,

they actually use almost two-thirds of all the Medicaid dollars.

The Medicaid dollars predominantly don't flow to children and adults, but

to the disabled and elderly.

Despite being a program to pay for healthcare for poor, it turns

out that there are certain groups which are very largely excluded from Medicaid.

Working parents, only some of them get covered on Medicaid even if they're poor.

Turns out that if you're a childless adult and destitute, you are not eligible for

Medicaid.

You are left out of the health care system if you have no children and

you aren't poor.

It's important to contrast Medicare and Medicaid.

While they were part at the same time, they are very different programs.

In Medicare, once you turn 65, you get the program.

You don't have to file papers, there are no complex eligibility requirements.

In addition, it's exclusively a federal program.

The same rules apply throughout the United States for everyone on the program.

On the other hand, Medicaid is a very different arrangement.

It's conditional, you have to prove you're eligible.

Not everyone who's poor is eligible.

Second, it's a joint federal-state program in two senses.

It's funded jointly between the federal government and the state.

Federal government pays on average 57% of the cost,

it pays more for poor states and less to richer state and states pick up the rest.

It's also a joint federal and state administrative program.

The federal government sets minimum eligibility criteria, minimum criteria for

what needs to be covered, and then the states make the final eligibility

determination, and what's covered, and how it's administered.

In addition to Medicare and Medicaid, the federal government has a program called

CHIP, Children's Health Insurance Program.

After President Clinton's healthcare reform plan was defeated,

he teamed up with Senator Kennedy and passed CHIP in 1997.

It was meant to fill in a gap, provide coverage for

children who were ineligible for Medicaid, cover those children that were uninsured.

Again, like Medicaid states set the eligibility criteria, like Medicaid,

its a joint federal- state finance program.

Today about 6 million children get CHIP and it costs about $13 billion.

One of the consequences of our complex system is that White and

Asian children tend to be insured through private healthcare insurance.

Whereas minority, Hispanic and

Black children, are predominantly covered by public programs, Medicaid and CHIP.

In addition to Medicaid and

Medicare, there are a number of other large public programs.

For example,Veterans Affairs covers veterans.

There are about 150 veteran hospitals in the country.

There are about 800 veteran outpatient facilities.

This is a program which the federal government both owns the hospitals,

employs the doctors.

It is true socialized medicine.

And it cost about $53 billion per year.

The Defense Department has strike year which provides services

to about 9 million active military personnel, retirees and their dependents.

There is the Indian health service which provides services to the native American

populations.

And there are a few other programs around, between the private insurance

market covering employees and individuals who bribe private insurance.

The Public Health Insurance Programs, Medicare and

Medicaid, veterans programs and others.

We have a very complex way of funding health insurance.

That is matched by a complex way of providing coverage between doctors,

hospitals, pharmacies, home health care agencies, and others.

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