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Health Care Outline
created by Ahmed | 27/11/2008 @ 03:45 PM | 6 views
Health Care Report Outline
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REPORT OUTLINE: Health Care Insurers
History of Health Insurance in America
Health insurance time line 1900-2000 http://www.pbs.org/healthcarecrisis/history.htm
Key Institutions and major industry players
1900s: The American Medical Association (AMA) http://en.wikipedia.org/wiki/American_Medical_Association
Where they stand on the issue of health insurance.
1900-1950s: Two wars and a Great Depression contribute to society's apathy about the health care system.
Establishment of American Association for Labor Legislation (AALL)
Medical application of penicillin is discovered
1960s: President Lyndon Johnson and the establishment of Medicare and Medicaid
Original Goal and Intent of Medicare & Medicaid
Current role of Medicare and Medicaid
1970s: President Nixon and the establishment of Health Maintenance Organizations
Original Goal and Intent of HMOs
Current role of HMOs
1980s: The Widescale Privatization of the Health Care Sector
Corporations begin to integrate the hospital system
Under President Reagan, Medicare shifts to payment by diagnosis (DRG) instead of by treatment.
2000s: Push for National Health Care Reform
Major Health Care Reform Advocacy Groups http://en.wikipedia.org/wiki/List_of_healthcare_reform_advocacy_groups_in_the_United_States
American Medical Student Association
Health Care NOW!
Commonwealth Fund
Facts: Health Care Today
Demographic and Statistical Information
Health Insurance Premium Trends
Number of Uninsured Americans
Segmented by socio-economic background
Population Growth Trends
Baby Boomers & Health Care Costs
Health Care as a Component of U.S. GDP
Percentage of U.S. GDP
Economic implications of rising health care costs
How Health Insurers fit into Today's Health Care System
Health Insurer's relationship with Payers
Health Insurers and the Private Sector
Corporate health insurance plans and benefits
Health Insurers and the Federal Government
Medicare
Medicare Advantage
Medicaid
TRICARE
SCHIP
Health Insurers relationship with Patients
The Pros of Private Health Insurance (Consumer Perspective)
The Cons of Private Health Insurance (Consumer Perspective)
Understanding the Business of Health Insurance
Health Insurance Business Model
Primary/ Secondary Income Sources
Primary: Premium Fees
The Insurance Model: Law of Large Numbers
Why Health Insurance is fundamentally different than other Insurance Business Models
Secondary: Portfolio Investments
Asset Mix: GO, Corporates, Equity, Cash & Equiv, Comm MBS, CMO, ABS, etc...
Primary Business Costs & Risks
Cost: Patient hospital visitations
Aging population --> Higher frequency visits
Higher Provider Fees -->More Costly --> Lower Margins
Risk: Dependence on Federal Money
Break down of revenue percentage derived from Medicare, MA, and Medicaid.
Risk: Political Risk
Push for a Single Payer System
Key Industry Metrics
Variable Annuity Death Benefits (VaDB)
Medical Loss Ratio (MLR)
Implied Operating Margins (IOM)
Health Care Politics
President Obama's "New Era of Responsibility" http://www.whitehouse.gov/omb/assets/fy2010_new_era/A_New_Era_of_Responsibility2.pdf
Affect of Obama's health care proposals on health insurance companies
Establish competitive bidding for Medicare Advantage
Bundle Medicare payments for hospital and post-hospital care
Use “private sector enhancements” to ensure that Medicare “pays accurately”
The Future Outlook of the Health Insurance Industry
To be determined... Work in Process!


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