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Healthcare Business Related Issues

1. How does health insurance risk differ from other types of insurance risk (e.g., automobile or homeowners insurance)?

2. Is retiree health insurance likely to become increasingly important as the baby boomer population reaches retirement age? Why or why not?

3. What is the difference between cost sharing and cost shifting?

4. Even though the Medicaid program is included in the discussion of social insurance programs, it is not a true insurance program. Explain how Medicaid differs from a health insurance program.

Chapter 7

5. The total expenditure for health services in 2007 was 83 times the total expenditure in 1960, increasing from $26.9 billion to $2.2 trillion. What factors account for this increase? How much did each factor contribute to this increase?

6. Exhibit 7.9 shows that the sources of financing for select services vary considerably. What services are supported in large part by private health insurance? By the federal government? By out-of-pocket expenditures? What do these funding sources suggest about the population utilizing these services? About other population or system factors?

7. Health expenditures in 2007 totaled $2.2 trillion and absorbed 16.2 percent of the gross domestic product. Should we be concerned about the amount of the gross domestic product that is absorbed by the health sector? Why or why not?

8. Discuss some of the key initiatives to contain or control or reduce health expenditures in recent years (Exhibit 7.16). How successful has each initiative been? What factors influenced the success (or failure) of each initiative?

Chapter 8

9. The ability to accurately predict the number of needed healthcare workers, train the required workforce, and ensure appropriate distribution are not hallmarks of the U.S. system. What are some reasons for the difficulty of these tasks? How and to what extent does a market economy influence the supply of healthcare workers?

10. How would the physician workforce be affected if the Medicare program changedâ?"or eliminatedâ?"its payment of GME expenses? What would be the effect of charging tuition for residency training, as some countries (e.g.,Canada) are doing or proposing to do?

11. To what extent should the government (federal and state) be involved in the training of the healthcare work force? Are there other professions that receive a comparable amount of training support from the government?

Chapter 9

12. The number of short-stay, nonfederal hospitals in the United States reached a high of more than 6,300 in the early 1970s and has since decreased to slightly more than 5,747 as of 2006. What accounts for this reduction? What are some of the potential effects of this reduction on patient access?

13. A decade ago, one might have heard reports of the occasional hospital that refused to take Medicare or Medicaid patients because their payments were too much smaller than those of privately insured patients. To what extent do you think hospitals might refuse to accept Medicare and Medicaid patients? What are some reasons hospitals would not refuse such patients?

14. Discuss some of the differences between not-for-profit and proprietary hospitals, including the types of patients who utilize them, hospital financing, financial viability, and anticipated future direction.

Chapter 10

15. The federal government is a major financier of biomedical research. Congress continues to increase the NIH budget when most other health related federal budgets are declining. Suggestions have been made to target some funds to major initiativesâ?"for example, to renew the War on Cancer, attack Alzheimer's disease, annihilate AIDS, or demolish diabetes. What, in your view, is the appropriate governmental role regarding biomedical research? Why isn't it a private sector responsibility, as was proposed during the Reagan administration? (Reagan proposed the privatization of NIH.)

16. If the randomized clinical trial (RCT) is the gold standard for assessing new technologies, why isn't it universally required before a new technology is disseminated?

17. The regular increase in health expenditures has been attributed, in some part, to the development and utilization of new technologies. Compared to other factors that influence expenditure growth, how significant is the technology factor? What efforts have been made to control the use of technologies and limit their effect on expenditure growth?

Solution Preview

1. Health insurance risk differs from other types of insurance risks, due to the fact that the older that an individual gets, the more risk that the individual will have increasing numbers of health issues, which will require the use of insurance coverage, and the amount of financing that the individual will need for receiving health care will also increase as the likelihood of health care issues rise, as the nature of the health issues intensify.

2. Retiree health insurance is very likely to become more important as the baby boomers reach retirement age, largely due to the fact that the older that the baby boomer population gets, an increasing number of these individuals will need health care services, and as more and more of these individuals need health services, it is more important that these individuals have adequate retiree health insurance.

3. The major difference between cost-sharing and cost shifting, is the fact that cost-sharing involves the sharing of the associated costs involved with receiving some form of service, such as health service, this cost-sharing is usually equitable between individual organizations, whereas cost shifting, involves removing all of the cost from individuals or organizations, and transferring them entirely to other individuals or organizations.

4. Medicaid differs from actual insurance program, due to the fact that Medicaid is a government subsidized program that offers free assistance to individuals that are in need of medical services, and while insurance programs, are programs in which individuals independently purchase medical insurance from private organizations, that offer such insurance to individuals for an agreed upon fee.

5. The rise in the population of the nation attributed to approximately 20% of health care expenditure increases ,due to the fact that more people ...