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Employer-paid contributions to employee health costs are basically a substitute for cash wages. Bythere were Source Book of Health Insurance Data. Physicians, the vast majority of whom are in private practice and paid on an FFS basis, see their patients in their offices, and admit them to hospitals where they can continue to serve them.

There is no single nationwide system of health insurance. Competition proposals Proposals for a tax cap, advanced in the early s by the Reagan Administration, called for limiting the amount of health insurance an employer could provide tax-free to a fixed amount per employee per month. Municipal, State, and local governments pay for long-term care or home care only in rare and limited cases.

A layman’s guide to the U.S. health care system

Annual Survey of Hospitals, Medicare peer review activities assess the medical necessity, appropriateness, and quality of care in the hospital setting.

In fact the majority of fhe uninsured 75 percent are employees or their dependents Short, Monheit, and Beauregard, Also, physicians are free to establish their practice where they choose.

Studies have documented high variation across geographic areas in the performance of certain surgical procedures Wennberg, ; Chassin et al. In the s and s, several States, including Maryland, New Jersey, New York, and Massachusetts, started all-payer ratesetting systems for hospital services. These expenditures are financed by a complex mixture of public payers Federal, State, and local governmentas essentia,s as private insurance and individual payments: Proponents for the State model argue that State budgets are constrained by the inability to run deficits or print money, so States may have a greater stake in restraining cost growth than the Federal Government.


First, advocates of competition encourage HMOs and similar entities to compete for members on the basis of quality and premiums as an effective way to control health care inflation. The Institute of Medicine of the National Academy of Sciences has issued several reports calling for more health outcomes research and improved data systems, including computerized patient records Institute of Medicine, essentias Twenty-five States have legislatively approved risk-pool legislation to provide insurance to essentialw who, because of an expensive pre-existing health condition, cannot purchase insurance in the private market.

Inabout Employers now have a large stake in the ERISA Federal pre-emption because many have structured their health benefit plans to take advantage of its provisions and exemptions.

Employers may become ambivalent about aggressive cost-containment strategies if the result is potential labor unrest there have been several recent strikes 3 over employer health benefit reductions. Congressional Budget Office, Moreover, coordinated care itself may have difficulty in controlling utilization in a system whose basic structure continues to reward increased FFS billings.

National Medical Expenditure Survey: Moreover, Medicare patients must also pay coinsurance and deductibles: There were 5 workers for each beneficiary inthere will be 3 workers per beneficiary inand 1.

Twenty years of Medicare and Medicaid: Although Federal and State mortgage loan guarantee programs assist some hospitals to secure financing for and renovation projects, it is more common for hospitals to secure private mortgage insurance when floating a construction bond.


Chapter Quizzes

Open in a separate window. It can also be argued that Congress and the President are less likely to propose expanded health benefits for those without insurance coverage paid for by taxing or reducing the benefits and tax advantages of those esssntials with insurance coverage. The ERISA pre-emption provided further incentives to employers to convert their employee health benefit plans to self-insurance.

Are physicians trained to practice medicine differently?

Nevertheless, persons without health insurance are not entirely without health care. Current Population Survey File.

Welcome to Essentials of the U.S. Health Care System

Because health insurance in the United States is primarily employer-based, cost containment must be a high priority for employers if cost-control goals are to be attained.

However, the Massachusetts play or pay plan was not implemented because of the State’s recent fiscal crises, election of a new governor who campaigned, in part, on a platform opposing the program Kronick, Medicare is an inter-generational transfer program primarily funded by taxes from working to provide services to aged beneficiaries.

PPS was successful in reducing Medicare’s rate of increase in inpatient hospital spending, and in increasing hospital productivity although the effect on overall cost growth is not clear Coulam and Gaumer,