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Addressing the Needs of the Uninsured in a Challenging Economic Environment
Slide Presentation by John Santa, M.D.
On March 14, 2002, John Santa, M.D., made a presentation in a Web-assisted teleconference at Session 3, which was entitled "Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages."
This is the text version of Dr. Santa's slide presentation. Select to access the PowerPoint® slides (281 KB).
Resources: State Strategies to Design Effective, Affordable Benefit Packages
John Santa, M.D.
Office for Oregon Health Policy and Research
Slide No. 1
- Pre 9/11
- Uninsurance rising
- Economy in recession
- Post 9/11
- $800 million deficit
- Highest unemployment in the United States
Slide No. 2
- Benefits/eligibility flexibility
- Maximize leverage—access all $$ sources possible
- Use resources—expand eligibility
- Cap enrollment for expansion populations
Slide No. 3
Making Tough Choices
- Ration services rather than people
- Explicit, public decision process
- Oregon data for reference and relevance
- Rely on evidence when available
Slide No. 4
Prioritized List—Lessons Learned
- Priorities made explicit—prevention high on list. Futile and inefficient care lowest
- Overall rankings make sense
- Less valued services excluded—about 3 percent more than usual exclusions
- Difficult to administer
- Still complex and emotional process
Slide No. 5
Listening to the Public
- Multiple public sessions—over 2,000 participants
- Oregonians understand tradeoffs
- Prefer cost-sharing to benefit elimination
- Prescription drugs highest valued
- Dental and mental health similar
Slide No. 6
Dental—"on the Cusp"
- Dental—first benefit with substantial resources "on the cusp"
- Motivated managed dental plans
- Data shows minimal preventive, substantial high cost use
- Focus on maintaining function
- 6 month $ limit, copays on restorative
Slide No. 7
Importance of Research
- Good research on low income, churning, subsidy for ESI
- Lack of research on cost-sharing at lowest incomes other than Rx
- Using evidence-based analysis done by Oregon Evidence-based Practice Center for high cost prescription drugs
Slide No. 8
- Taking benefits away is tough work
- Uninsured have little leverage
- Keep presenting options, keep participants talking, be a catalyst
- Identify basic services
- Identify less valued, less effective services
- Pursue every option until you get pushed back
Slide No. 9
- Cost sharing in poor adults
-What works, what doesn't?
-How can delivery systems and communities help?
- Effect of premiums on poor adults
- Does trading off benefits for expansion of eligibility result in net benefits to the population as a whole?
Slide No. 10
Resources for Poor/Low Income
- Focus on adults—no premium/nominal copays for children
- No discretionary income
- Family/friends/other sources
- Financing options
- Other resource help—food, housing
Slide No. 11
Strategies to Moderate Impact
- Premium subsidy
- Premium financing
- Copay financing
- Continuous enrollment
- Medical culture
- Community culture
Slide No. 12
Alternatives to Cost-sharing
- Eliminate coverage for specific treatments—return to list
- Site of service strategies—individual visit to group, subacute detox
- Limits on visits
Current as of July 2002
Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages. Presentation by John Santa at Web-Assisted Teleconference, "Addressing the Needs of the Uninsured in a Challenging Economic Environment". July 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/uninsuredtele/session3/santatxt.htm
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