HSEM 380 Lecture Notes - Lecture 1: Medigap, Health Informatics, Health Insurance Coverage In The United States
22 May 2018
School
Course
Professor
Health Information Technology (IT)
the application of information processing involving both computer hardware and software that deals
with the storage, retrieval sharing and use of health care information, data, and knowledge for
communication and decision making
Biomedical informatics
the interdisciplinary field that studies and pursues the effective uses of biomedical data, information,
and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to
improve human health
The infogineering model
Data-> information and knowledge -> decisions
Data
Facts
Information
Captured data and knowledge
Knowledge
our map of the world
Decisions
informed actions
Examples of Health Technologies
FDA
Health information technology
Office of the national coordinator for health information technology (ONC); CMS
Health informatics
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CDC, AHRQ, VA
Expenditures are increased by
expansion of health insurance, and increase in health insurance premiums
Expenditures can be reduced by
restricting insurance, restricting reimbursement to providers, having fewer specialists, spending less on
R&D, utilization control, and designating certain services as noncovered
Insurance
Protects against risk
Risk
the possibility of substantial financial loss from some event, where probability of occurrence is small
Insured
an individual protected by insurance
Insurer
An insurance agency that assumes the risk
Underwriting
Evaluation, selection, classification, and rating of risk
Four principles of insurance
1. risk is unpredictable, 2 risk can be predicted with some accuracy in a large group, 3. insurance can
transfer risk from the individual to group through pooling of resources, 4. losses are shared by all
members
Premium
amount charged by insurer to insure against risk; employer-employee cost sharing
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Experience rating
premiums can be unaffordable for high-risk groups
Community taing
good risks subsidize poor risks
Adjusted community rating
overcomes some of the above drawbacks
Examples of Cost sharing
Deductible, Copayment, and coinsurance
Deductible
amount the insured pays first before benefits are paid by the plan; applied annually
Copayment
Flat amount payed per service
Coinsurance
set proportion of medical costs
Why cost sharing?
Reduces moral hazard; lowers utilization, without any significant negative health consequences
Covered services
Benefits
Benefits
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find more resources at oneclass.com
Document Summary
Health information technology (it) the application of information processing involving both computer hardware and software that deals with the storage, retrieval sharing and use of health care information, data, and knowledge for communication and decision making. Biomedical informatics the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health. Office of the national coordinator for health information technology (onc); cms. Expenditures are increased by expansion of health insurance, and increase in health insurance premiums. Expenditures can be reduced by restricting insurance, restricting reimbursement to providers, having fewer specialists, spending less on. R&d, utilization control, and designating certain services as noncovered. Risk the possibility of substantial financial loss from some event, where probability of occurrence is small. Premium amount charged by insurer to insure against risk; employer-employee cost sharing. Experience rating premiums can be unaffordable for high-risk groups.
