Health Insurance Overview

Health insurance is a common practice where individuals pool their risk of high medical costs by paying premiums for coverage. Insurance companies then pay for these costs when individuals need medical care.

Moral hazard refers to increased risk-taking behavior when someone is insured, as they may be less concerned about costs. Adverse selection occurs when people with higher risks are more likely to seek insurance, leading to higher premiums for everyone.

Most Americans have health insurance coverage. In 2019, about 91% of the US population had medical insurance.

Instead of paying directly for medical services, most consumers have expenses covered by insurance premiums, which are often partially paid by employers or the government.

Employer-sponsored plans are common, but government programs like Medicare (for seniors) and Medicaid (for low-income individuals) also play a significant role in providing health coverage.

Insurance plans offered through employers are often cheaper because insurers can sell to a larger group of people, reducing costs associated with sales and risk selection.

Insurance plans offered to employees are less prone to adverse selection because employees generally get insurance regardless of their perception of their health needs.

Employer-sponsored insurance benefits employers by potentially improving employee health and productivity, which ultimately translates to higher profits.

Insurance plans offered through employers cover a large majority of Americans under 65, with employer-sponsored and government-sponsored plans being the most common types.

While some younger Americans purchase their own insurance, this often is in addition to another form of insurance.

A type of health insurance plan that pays providers for each service they provide.

A plan where the insurer sets a pre-determined amount that they will pay for each service, regardless of the actual cost.

A plan that covers a set amount of healthcare services for a fixed premium.

A type of health insurance that emphasizes preventive care and managing chronic conditions.

A type of managed care plan that restricts members to a network of providers.

A type of managed care plan that allows members to see out-of-network providers for a higher cost.

A type of health insurance plan that is funded by the government.

A type of health insurance plan that is funded by the individual.

Oregon Medicaid is a government-run health insurance program that covers low-income individuals in Oregon. It's a type of 'managed care' insurance, which means patients need to choose a provider from a network.

Community health workers (CHWs) can help improve outcomes and save money by connecting people with healthcare services, navigating complex systems, and providing culturally sensitive support. They can bridge the gap between patients and healthcare providers.

Medicare, a federal insurance program for people 65 and older, generally does not pay for community health workers because they are not considered traditional medical services.

By linking behavioral health (e.g., mental health) and primary care services together, patients can get more comprehensive care, leading to better overall health and potentially lower costs. This approach addresses the connection between physical and mental health.

Connecting patients with primary care providers - their regular doctor - can improve outcomes and save money by promoting preventive care, managing chronic conditions, and catching health issues early. It's like a 'health home base'.

There is growing evidence that high-quality primary care leads to improved health outcomes and lower costs. This happens because primary care can prevent diseases, manage chronic conditions effectively, and reduce unnecessary hospitalizations.

By increasing treatment for substance abusers, individuals can improve their health and reduce the associated costs of substance use. This includes things like addiction treatment, mental health support, and social services.