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CHAPTER 2: PAYING FOR HEALTH CARE

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  1. What are the four modes of financing health care? Describe each.

  2. Describe regressive, proportional, and progressive financing. Explain how each of the following is regressive, proportional, or progressive: out-of-pocket payments, experience-rated individual private insurance, community-rated individual private insurance, health insurance purchased 100% by the employer (assuming that employees actually pay for health insurance as explained in the text), and the federal income tax.

  3. Harvey, who has worked all his life for General Electric, reaches 65 years of age. He does not retire. Is he eligible for Medicare Part A? Part B? Six months later, his wife, who has never worked, reaches 65 years of age. Is she eligible for Medicare Part A? Part B? How are Parts A and B paid for?

  4. Hubert has received social security disability for 24 months because he has AIDS. Is he eligible for Medicare?

  5. Rena developed chronic renal failure and started renal dialysis 2 weeks ago. She feels fine and is working. Is she eligible for Medicare?

  6. Heidi, aged 72 years, on Medicare Part A and B without Medicaid or a Medigap policy, is hospitalized for a stroke complicated by a deep vein thrombosis of the leg and a pulmonary embolus. She is in the acute hospital for 70 days and cared for by a family practitioner and a neurologist. She improves somewhat and is then transferred to the skilled nursing facility (SNF) for rehabilitation. She remains in the SNF for 30 days and is still severely disabled and unable to go home. She is sent to a nursing home for custodial care, where she stays for 3 months. Surprisingly, she improves and goes home, where she receives skilled physical therapy services from a home care agency and also has a homemaker come in for 4 hours a day to buy food, cook, and clean the house. She is on three prescription medications at home. What does Heidi pay and what does Medicare pay? Acute hospital? SNF? Nursing home? Home care? Physicians? Prescriptions while in hospital? Prescriptions while at home?

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Discussion Topics

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  1. Discuss your experiences with health insurance that was provided through a job. How did you obtain the insurance? Did you pay part of the premium? Were there deductibles or copayments? How many choices of plans did you have? What happened if you left your job?

  2. Divide into two groups: one insurance company selling community-rated health insurance policies and the other selling experience-rated policies. Each side should try to convince the instructor to buy its policy, first with the instructor as a young, healthy person, and then with the instructor as an older person with diabetes. Which policy is the young person more likely to choose, and which the older person?

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CHAPTER 3: ACCESS TO HEALTH CARE

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  1. What are the main features of the ACA that expand health insurance coverage?

  2. Compare access to health care for ...

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