Health Outcomes in the United States (Nursing)

by Heide Cygan, DNP, RN

My Notes
  • Required.
Save Cancel
    Learning Material 3
    • PDF
      Slides Health Outcomes in the United States Nursing.pdf
    • PDF
      Reference List Public Health Nursing.pdf
    • PDF
      Download Lecture Overview
    Report mistake

    00:01 Today we're going to discuss basic health insurance concepts.

    00:05 There are a few definitions that are important to understand in relationship to health insurance.

    00:10 The first is an indemnity policy.

    00:12 This is our basic insurance plan, where individuals pay a monthly premium to insurance companies to offset the risk of large medical bills.

    00:21 So again, individuals pay insurance companies monthly premiums, with the agreement that if a large medical expense occurs, the insurance company will cover that cost because the individual has paid into the insurance plan monthly.

    00:36 Most Americans are covered by this type of policy and it's subsidized through their employer.

    00:41 We call this an employer sponsored health plan.

    00:44 Now, this system is somewhat unique to the United States.

    00:47 And the reason that about 50% of our non elderly US citizens are covered by this type of plan is result of three policy decisions that were made during the 1940s and 50s.

    00:58 First, during World War 2, the government placed wage freezes on employers.

    01:03 However, those wage controls did not apply to health insurance.

    01:07 So employers used health insurance to lure workers from their competitors during these wage freezes.

    01:13 Second, the US government passed laws that health insurance could be a part of collective bargaining agreements.

    01:20 And finally, in the 1950s, the IRS exempted health insurance premiums paid by employers from federal income tax.

    01:29 So, as a result of these policies, we have a unique health care system in the United States in which employer sponsored health insurance plans are the norm.

    01:40 Employer based insurance is an example of a private third party payer.

    01:45 Third party payments are monetary reimbursements made to providers of health care by someone other than the consumer, other than the patient.

    01:54 The organizations that administer these funds are called third party payers, because they are a third party or they're external to the consumer provider relationship.

    02:03 Later, we'll talk about the two most common third party payers, private insurance companies and government health plans.

    02:09 But first, let's finish up with our definitions.

    02:14 Cost-sharing.

    02:15 Cost-sharing divides the cost of healthcare services between patients and insurance companies.

    02:20 Insurance companies use cost-sharing to prevent overuse of health care services.

    02:25 Some examples are those monthly premiums I just talked about, co-pays and deductibles.

    02:33 Moral Hazard.

    02:35 This is the idea that health insurance can change the behavior of people actually resulting in more risk taking and more wasteful actions.

    02:43 So as an example, because I have health insurance, I may be more likely to risk getting seriously injured, because the cost of caring for that injury will be offset by my insurance company.

    02:57 However, how we typically see this is that because I have health insurance, I'm willing to have an expensive possibly wasteful procedure, again, because I know that my health insurance company will cover some or all of the cost.

    03:10 That's how we see moral hazard play out in health insurance.

    03:16 Underinsured.

    03:17 This occurs when cost-sharing is not enough to offset the cost for the consumer.

    03:22 We hear this term a lot, but it's important to understand the definition.

    03:27 Uninsured people fall into one or more of the following three categories.

    03:31 The first category is individuals for which medical expenses total more than 10% of their annual income.

    03:39 The second category is individuals whose annual income is 200% of the federal poverty line, and they have medical expenses that are greater than 5% of their yearly income.

    03:53 The third and final category is individuals for which health insurance deductibles are 5% or more of their annual income.

    04:02 Understanding these basic definitions lays the foundation for learning how our complex healthcare system works and how it impacts the health of our patients.

    About the Lecture

    The lecture Health Outcomes in the United States (Nursing) by Heide Cygan, DNP, RN is from the course Public Health and Policy (Nursing).

    Included Quiz Questions

    1. Moral hazard
    2. Cost-sharing
    3. Indemnity policy
    4. Underinsurance
    1. The client whose medical expenses amount to 15% of their annual income.
    2. The client whose medical expenses amount to 7% of their annual income, and their yearly income is 200% of the federal poverty line.
    3. The client whose health insurance deductibles amount to 10% of their annual income.
    4. The client whose medical expenses amount to 8% of their yearly income.
    5. The client whose health insurance deductibles amount to 3% of their annual income.

    Author of lecture Health Outcomes in the United States (Nursing)

     Heide Cygan, DNP, RN

    Heide Cygan, DNP, RN

    Customer reviews

    5,0 of 5 stars
    5 Stars
    4 Stars
    3 Stars
    2 Stars
    1  Star