Health Law Fall 2006- Weeks
I. INTRODUCTON
A. Private Health care system
1.Want people to be responsible for themselves, want people to think about whether they are really sick or not
a. Don’t really know how much it is costing
2.Capitalist society- Better care, when doctors are competing
II. Access to health Care
A. Employers, pg 11 list about why
1.Cheaper than paying wages, tax deductible
a. Easier to advertise because more in one place
2.Risk pooling
a. Cost even outs over a group, less unhealthy people in the employed population
i. Ex. long term care insurance is very expensive, because population that utilizes it and not very profitable
3.Lower transaction Costs
a. Just deal with GE, not every employee
4.Employer has an interest in healthy co-workers, more healthy less premium
a. Rational selfish interest want healthy employee that comes to work and produce
b. paternalistic view, if we just give them money they will go buy something frivolous, so buy it for them
B. Types of insurance
1.Indemnity- Pay out of pocket as patient and insurance company pays you back
a. Gives most choice of doctor
2.Service benefit plan- Insurance Company has contract with providers, have separate set of contracts with insurance, patients use that list of doctors for care. Have to use one in the group
a. Supposed to be cheaper, more efficient
3.Direct benefit plan- Contracts with individuals and the insurance company owns the hospital and the pharmacy have to use the company own health providers
i. Cheaper and more efficient
C. NON EMPLOYEE Insurance
1.Individual plans
a. More expensive
b. individual paying all
c. more transaction cost
i. riskier for insurance company
2.State services
a. Gov’t- when there is a market failure to provide, the gov’t steps in and give it to people
b. public policy- want to protect other people, health risk to others less disease risk,
c. economic- cheaper to treat preventively, healthy people are more economically productive
d. Don’t want people to resort to other methods to get health care
i. John Q- If we don’t provide there will be more violence
3.Private charity-
a. not enough to fill whole gap-
b. not nationally organized
c. able to turn anyone away
D. Medicare and Medicaid
1.Gov’t steps in
a. Came out in Social security act of 1965
2.Medicare- Gov’t pension for elderly and disabled
a. Funded through mandatory payroll deduction
b. Not automatically entitled to it, Have to qualify
c. No entitlement, if it dries up before you use than too, bad, no private account
i. types
1.Part A- Hospital
2.Part B- Physician
1. Not mandatory payment
3.Part D- Prescription benefit
d. Fully federal
i. if you change states it is fully portable doesn’t matter where you move
e. No income test to qualify for Medicare
i. Rich and poor get it just the same
3.Medicaid
a. Need based
i. Have to indigent, or have extreme need
b. Have to reenroll by state, Not portable
c. Service based
i. Doctors sign up to be providers
ii. Enrollee have card
iii. Hospitals don’t have to enroll in Medicare and medicate but they do, it is a huge source of revenue
iv. There are some doctors that don’t because less desirable patients and less money
E. Common Law
1.Tor
2.Challenged because beyond the scope
1. 7th circuit rejects- reasonable use of spending power
d. enforcement
i. Not private right of action for medical treatment
ii. Right to seek enforcement
2.EMTALA generally
a. Emergency Medial Treatment and Labor Act-
i. Applies to:
1.Hospitals that participate in Medicare
2.have an emergency Dept
b. Duties
i. Medical Screening examination
ii. If emergency Medical condition that Stabilization
iii. Transfer requirements
c. Enforcement-
i. Private cause of action- Any individual suffering harm as a direct result
1.Civil monetary penalties against hospital and responsible physical
1. no private suit against individual physician
ii. Also medical facility that suffers damage because of a hospitals violation is entitled to damages
d. Often coupled with Med Mal
i. Malpractice is not required for EMTALA to succeed
3.Location of Treatment
a. “if any individual comes to the Emergancy Dept”
i. Only have a duty to screen if patient seeks treatment from the emergency dept
1.no duty if admitted directly to psych ward
b. Transfer
i. Claim of transfer in an unstable condition does not reuire that patient enter through ER
