INTRODUCTION HEALTH CARE FINANCE HEALTH CARE IS A

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INTRODUCTION HEALTH CARE FINANCE

INTRODUCTION HEALTH CARE FINANCE

HEALTH CARE IS A BUSINESS � 3 T across the world = 2. 1

HEALTH CARE IS A BUSINESS � 3 T across the world = 2. 1 US �Political activity �Largest sector �Employs most people �Largest % of GDP

How do we know HC is a business? �A business needs to have sufficient

How do we know HC is a business? �A business needs to have sufficient revenue to pay all of the costs associated with creating and selling its good or services

Health care is different/health care is the same �Same ◦ Must generate cash flows,

Health care is different/health care is the same �Same ◦ Must generate cash flows, just as everyone else

Health care is different/health care is the same �Different ◦ Abundance of agency relationship

Health care is different/health care is the same �Different ◦ Abundance of agency relationship ◦ Health care is delivered by a complex mixture of government, private NFP, and private FP organization ◦ Health care is delivered in a regulatory environment ◦ Wider range of financing options available �Tax-exempt �Bank, Investors

Different, cont. ◦ Most of the revenues received comes from third-party payers ◦ Growing

Different, cont. ◦ Most of the revenues received comes from third-party payers ◦ Growing more rapidly than other sector in the US economy ◦ Many organizations are not for profit

Major industries in the health care sector Industry Health services Health insurance Medical supplies

Major industries in the health care sector Industry Health services Health insurance Medical supplies Pharmaceuticals and biotech Other What’s included Medical practice, hospitals, clinics, nursing homes, home health, hospice Gov’t programs; commercial; ESHI; managed care Diagnostic equipment, medical supplies, surgical instruments Drugs and otherapeutic products Educational institutions; research; consultation Example

Hospitals �Provide diagnostic and therapeutic services to individuals that require several hours (overnight) care;

Hospitals �Provide diagnostic and therapeutic services to individuals that require several hours (overnight) care; also provide walk-in services

AMBULATORY CARE �Outpatient �Locations- clinics, medical practices, ER, home health, urgent care, retail clinic

AMBULATORY CARE �Outpatient �Locations- clinics, medical practices, ER, home health, urgent care, retail clinic

LONG-TERM CARE �Provide care to individuals who lack all or some functional ability

LONG-TERM CARE �Provide care to individuals who lack all or some functional ability

OTHER TYPES �HOSPICE �PALLIATIVE CARE �HOME HEALTH

OTHER TYPES �HOSPICE �PALLIATIVE CARE �HOME HEALTH

HEALTH INSURANCE �A significant portion of services are paid for by 3 rd party

HEALTH INSURANCE �A significant portion of services are paid for by 3 rd party payers (AKA insurers) �Public �Private

Insurance, cont. �Other ◦ Organization self-insured ◦ Non-health insurance �Home �Car �Boat ◦ Worker’s

Insurance, cont. �Other ◦ Organization self-insured ◦ Non-health insurance �Home �Car �Boat ◦ Worker’s compensation ◦ Victims of crime