HLTH245 Chapter Notes - Chapter 8: Ontario Health Insurance Plan, Health Economics, Outsourcing

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fuchsiaseal533

24 Oct 2015

School

University of Waterloo

Department

Health Studies

Course

HLTH245

Professor

Chris Perlman

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Document Summary

Includes cash that is transferred and tax points: tax points: reduction in amount of tax that provincial government has to pay (income tax to federal government, the canada social transfer provides funding through cash and tax points for social programs, childcare and early childhood development and learning programs, and postsecondary education, transferred to provinces to be spent on health care/education. Negotiating funds: health accords: accord: agreement between 2 or more parties, needs are studied and analyzed, proposals are made, agreements called accords are signed) to bargain for health care funding, meeting between prime minister and prov/terr premiers to negotiate terms related to health funding and federal government, bargaining for health care funding is ongoing among the provinces, territories, the latest accord, which came into effect in 2014 and will expire in 2024, affects funding to the cht (canada health transfer) and the cst (canada social transfer)

Related Questions

two more pages of elaboration to how Trumpcare and Obamacarerelates to health care finance. 30 resources

Obamacare, also known as the Affordable Care Act (ACA), waspassed in 2010 as a health care insurance plan for all Americans.The law made many changes to the existing minimum coverage ininsurance, and increase the federal subsidies for the middle-incomehouseholds of the country. Trumpcare, also known as the AmericanHealth Care Act (AHCA), is a replacement health insurance plandesigned to partly repeal the existing ACA. The new healthcarebill, is one step closer to repealing . The nonpartisanCongressional Budget Office (CBO) has an estimate with ACA as thelaw of the land, the uninsured Americans would be 28 million willremain stable for the next decade. The analysis of an earlierversion of the bill, there is an estimate of 54 million could beuninsured by 2026 in case of implementation of the AHCA. The ACAhave provision to impose penalty on consumers who can afford to buyhealth insurance but do not do so, known as the individual mandatepayment. itâs paid when you file your federal tax return. Thispenalty can be either 2.5% of income up to the totalyearly premium or $695 per person up to $2,085, whichever ishigher. AHCA eliminates the individual mandate and offers anincentive to consumers who maintain insurance coverage: insurancecompanies can charge a 30% penalty who buy health insurance afterhad a gap in required coverage exceeding 63 days. The 30% penaltywould apply for 12 months. The ACA requires that all major healthpolicies sold to consumers offer coverage for 10 categories ofessential health benefits: Outpatient services, Emergency services, Maternity and newborn care, Hospitalization. Prescriptionmedication , Mental health and substance abuse services, Laboratoryservices. Pediatric services, Rehabilitation services, includingvision and oral. Preventative, wellness, and chronic diseasemanagement services. The AHCA eliminates these protections bygiving a waiver to define what they consider essential healthbenefits. States could allow insurance companies to sell plans thatdo not cover prescription drugs or maternity care. The ACA and AHCAhave the same rules for newborns. A baby can be added to familyexisting health insurance plan or can buy a new plan to give coverthe baby. AHCA is making major changes in the health insurance byreducing the requirements and making change in the structure oftotal offered government subsidies. On the analysis, the CBO hasreported the current changes would make health insurance moreaffordable for few customers. Obamacare: The ACA increased Medicaretaxes for the households having incomes above $250,000. Thelegislation gave some tax credits to middle-income earners to helpthem pay out-of-pocket health expenses. The AHCA repeals taxes ofprevious insurance plan. It was mandatory for the companiesemploying more than 50 employees to offer health insurance or pay apenalty. Trumpcare: The mandatory insurance of employees andpenalty has been repealed under Senate plan. Insurance fordependents under 26 (Obamacare) : It requires insurer that thechildren under the age of 26 are allowed to be covered under theparent's policy. Trumpcare: Well this requirement is not repealedby trump care. Trumpcare: Pre-existing condition coverage(Obamacare):The insurer is prohibited fromdenying coverage or charging more to individuals whohave pre-existing medical conditions. Trumpcare: Gives states theability to opt-out of requirements that insurers charge the samepremiums for healthy and sick customers. Women care (Obamacare): Itis mandatory for the insurance companies to provide core servicesincluding maternity care and contraceptives and the insurancecompanies are prohibited from charging women more than men for thesame health plan. Planned Parenthood receives federal funding forfamily planning and other medical services used by Medicaidrecipients. Abortion cannot be funded with federal dollars.Trumpcare: Insurance companies prohibited from charging women morefor health insurance, but states could apply for waivers that allowthem to drop coverage for maternity care and contraceptives. Thebill also bans women from using government money to buy plans thatcovers abortion and ends non-abortion Medicaid reimbursement toPlanned Parenthood, a non-profit group that provides abortionservices in some of its clinics, for one year. Older Americans(Obamacare):The insurer are not allowed to charge the olderAmericans more than three times the cost for younger Americans.Trumpcare: States can receive waivers to allow them to charge olderAmericans more. Insurance marketplaces (Obamacare) : The Obamacaremarketplaces, such as HealthCare.gov, enable people who don't gethealth benefits at work to compare plans, just as they mightcompare hotel rooms or airline tickets online. All plans on themarketplaces must offer a basic set of benefits, such as hospitalcare, mental health services and prescription drugs. Trumpcare:Under both the House and Senate bills, it is unclear how themarketplaces would work because insurers might potentially offerhealth plans that do not offer the same set of benefits.

If an insurer incorrectly estimates an insured person'spremium

, then the insurer will suffer a financial loss.

can appeal to the state insurance commissioner for asubsidy.

will drop people whose medical expenses exceed theirpremium.

None of the above

Medicare Part B (physician and outpatient services) is financedby

a premium that is 75 percent subsidized by the government and 25percent subsidized by the aged.

a payroll tax on both the employee and the employer.

a premium that is 100 percent subsidized by the government.

both a subsidized premium and a payroll tax

The diagnosis-related group hospital payment system changedhospital incentives by making it more profitable to

employ physicians.

admit sicker Medicare patients.

reduce a patient's length of stay.

charge more for lab tests.

Medicare is difficult to reform because

		pharmaceutical manufacturers benefit from drug sales under PartD.
		senior congressional leaders do not want their Medicare benefitschanged.
		the Medicare population is opposed and have highvoting-participation rates.
		Medicare reform would likely increase the federal deficit.

Medicare is not considered to be a fair redistributive systembecause

Medicare beneficiaries receive large subsidies regardless of howhigh their income is.

low-income Medicare beneficiaries with high out-of-pocketexpenses must enroll in Medicaid.

low-income employees subsidize high-income Medicarebeneficiaries.

All of the above

Substituting an income-related voucher for the current Medicaidsystem would not achieve the following:

		An income-related voucher would eliminate the large differencesbetween states in the percentage of their populations eligible forMedicaid.
		An income-related voucher would reinforce the movement towardMedicaid managed care, with its emphasis on coordinated care andincentives to provide care in less costly settings.
		An income-related voucher would provide employees with anincentive to forego higher pay so that they qualify for the vouchersubsidy.
		An income-related voucher would provide those on Medicaid withan incentive to take higher-paying jobs because they would onlylose part of their voucher subsidy.

Most states have shifted their Medicaid beneficiaries intoprivate Medicaid managed care/HMO plans. What is the advantage tothe state for doing so?

		Medicaid patients are more likely to receive coordinated careand preventive services.
		By paying HMOs a fixed fee per person per month, states are ableto shift their risk for higher expenditures to a managed careplan.
		Medicaid patients are more likely to have access to a physicianwithin the HMO.
		The HMOs have entered the Medicaid market because they believethey can provide the care less expensively and earn a profit.

What are some legitimate ways to spend down one's assets toqualify for Medicaid?

Fixing up one's house, purchasing a new car, or setting up aspecial burial account

Providing financial gifts to one's children

Transferring property to one's children

Setting up special retirement accounts that can be passed on tochildren or relatives after seven years

How is Medicaid administered?

		By each state, but policy is shared with the federalgovernment
		By the federal government and coordinated with the states
		By a joint commission composed of federal and stateappointees
		None of the above

Why were hospitals and physicians willing to participate in anHMO's provider network?

Hospitals and physicians developed excess capacity and werewilling to discount their prices for more patients.

Hospitals and physicians believed that they could reduce medicalcosts by joining together to better manage patient care.

Some states provided hospitals and their employed physicians anincentive to join or start HMOs to serve their Medicaidpatients.

b and c

How did early managed care firms achieve their largestsavings?

		By limiting access to very expensive specialty prescriptiondrugs
		By reducing hospital utilization of its enrollees
		By making enrollees wait long periods to see their primary carephysician
		By limiting enrollees' access to the HMO's specialists

Managed care plans differ according to the restrictiveness oftheir provider network and access to specialists. Which types ofplans are likely to have the lowest premiums?

		Plans that have the largest ratio of primary care physicians tospecialists
		Plans that have the most experience and have been in existencethe longest
		Plans that have the most restrictive/narrow provider network
		Plans that have received the highest quality and outcomemeasures

QUESTION 20

As part of the Affordable Care Act, health insurance exchangeswere established. What have been the most importantcost-containment approaches used by health plans competing forinsurance exchange enrollees?

		Health plans have used very narrow/limited providernetworks.
		Health plans have dramatically reduced access to new medicaltechnology.
		Health plans have included large deductibles and out-of-pocketpayments.
		a and c

blushtermite492

Primary Health Care is one of Australiaâs leading listed healthcare companies. Primary is a service company to medical and allied health professionals. A broad range of medical and related services are offered in Primaryâs network of medical centres and pathology centres across Australia. Primary is also a leading provider of healthcare technology solutions to medical practitioners, medical practices and hospitals.

Primaryâs market capitalisation currently runs at about $2,290.5 million, with a debt-to-equity ratio of approximately 1:3. The companyâs CFO is currently recommending that the Board issue new debt worth 10% of the firmâs existing debt in order to repurchase shares for the same amount. He is advocating for a recapitalisation of the firmâs balance sheet in order to realise an increase in firm value by having a higher debt level. The debt issue will take the form of a 10- year corporate bond with a yearly coupon equal to the firmâs current cost of debt of 6.65%.

Primaryâs CFO has approached Frontier Economics for assistance in formulating a solid argument for the proposed increase in financial leverage. While there is a tax advantage associated with debt financing, the team at Frontier Economics are concerned with the more subtle considerations about personal taxes at the investor level that also need to be taken into account. The consulting team will therefore consider three different tax settings:

â¢ A world with no taxes

â¢ A world with corporate taxes only

â¢ A world with taxes paid on all levels

Primaryâs marginal corporate tax rate is 30%. Assume that the marginal personal tax rate on income from debt is 35% and that the marginal personal tax rate on income from equity is 28%.

he CFO of Primary is considering suggesting even a doubling (i.e. 100% instead of 10% increase) of debt in order to maximise the share price. Provide an explanation of the critical assumptions made within the analysis above, and discuss the limits of generating tax benefits

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HLTH245 Chapter Notes - Chapter 8: Ontario Health Insurance Plan, Health Economics, Outsourcing

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