U.S. Health Care: Financing and Reimbursement Methods

*Note: I may be compensated, but you will not be charged, if you click on the links below. In this video, Monika Wahi lectures to Laboure College students in her Fundamentals of the US Healthcare System class. Want to follow along? Get “Essentials of the US Healthcare System” by Shi and Singh: https://www.amazon.com/Essentials-U-S... Want to download the slides? Go here: https://buff.ly/3KUeJHW WANT TO SUPPORT MONIKA? FOLLOW HER ON SOCIAL MEDIA! Follow Monika on LinkedIn for updates and to know about future live streams:   / dethwench   Subscribe to Monika's YouTube channel: https://buff.ly/2W6ijuc Follow Monika's educational feed on Twitter:   / phexaminer   Follow Monika's data science blog: https://dethwench.com/blog/ I listed the links I mention below as they come up in the lecture. Enjoy! 00:00:40 Slides begin 00:00:48 Learning objectives 00:01:32 Monika describes diagram that explains how money flows through the United States (US) healthcare system (moral hazard) 00:03:18 Impacts of the moral hazard on healthcare costs and choice 00:06:06 Basic insurance concepts – definitions of basic terms 00:09:00 Four principles underlying insurance 00:12:33 Affordable Care Act (circa 2013 – please see here for update: https://www.kff.org/health-reform/fac... ) 00:14:42 Private health insurance features 00:16:28 Features of employers that increase or decrease the cost of employer-based private health insurance 00:19:09 Description of four types of private health insurance plans 00:21:43 Description of managed care plans 00:22:28 Introduction to public health insurance (Medicare, Medicaid, CHIP) 00:24:07 Distribution of type of health insurance in the US in 2010 00:24:55 Medicare – description and early history 00:26:33 Description of Medicare Part A – Hospital Insurance 00:27:38 Medicare Part A expenditures in 2008 00:28:14 Description of Medicare Part B – Supplementary Medical Insurance 00:29:14 Medicare – changes in the early 2000s 00:29:30 Medicare Part C in 1997 00:31:15 Medicare “today” circa 2013 (please see here for more info: https://www.cms.gov/About-CMS/Agency-... ) 00:31:29 Medicare Part D in 2003-2006 00:33:56 Differences between Medicare Part C and traditional, original Medicare 00:35:15 How Medicare Part D works (and the donut hole) 00:37:57 Medicaid – types of beneficiaries, and description 00:40:01 Federally mandated services for state Medicaid programs 00:41:20 Children’s Health Insurance Program (CHIP) – description and history 00:42:35 Reimbursement methods – starting with fee-for-service (FFS) and package pricing 00:45:03 Procedure-based payment – “resource-based relative value scale” (RBRVS) and CPT codes 00:47:25 How reimbursement works under managed care 00:49:19 Group Health Cooperative, which did demonstration projects in healthcare: https://www.kpwashingtonresearch.org/... 00:50:24 Why the change from retrospective to prospective reimbursement saved money 00:53:43 Prospective reimbursement strategies: DRGs, APCs, RUGs, and HHRGs 00:56:40 Graphs showing national health expenditures skyrocketing 01:00:00 Breakdown of national health expenditures 2010 (WARNING: On this slide, I go into a rant about the underfunding of public health in 2013 that is CREEPILY PRESCIENT of the US COVID-19 pandemic response 7 years later, in 2020!) 01:01:40 Conclusion U.S. Health Care: Financing and Reimbursement Methods