with Test Bank MCQs - in part, except for use as permitted in a licen...

Instructor Manual with Test Bank (MCQs Only) Health Economics and Policy 6 th Edition By James Henderson All Chapters 1-16, 100% Original Verified, A+ Grade. 1 / 4

© 2015 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.Chapter 1: U.S. Medical Care: A System in Transition This chapter introduces the student to the economic way of thinking as it relates to the study of the U.S. medical care system. After a brief summary of the historical development of medical care delivery and finance, the basics of economic modeling and analysis are addressed. The similarities and differences between medical care and other economic goods and services are also discussed. As a set of unifying themes providing focus and continuity throughout the book, ten guiding principles are introduced and defined.

Chapter Outline

• Historical developments in the delivery of medical care
• Post-war experience
• Concern over high and rising spending
• Changes in medical care delivery
• Health economics defined
• Ten key economic concepts
• Summary and conclusions

Issues in Medical Care Delivery • Spending Somebody Else’s Money Chapter Objectives

• Understand the nature of the health care crisis in America.
• Identify the important historical developments affecting health care delivery and

finance in the U.S. system.

• Identify and explain the major reasons for the high and rising cost of medical care.
• Understand how the third-party payment mechanism and managed care affect

health care delivery.

• Recognize the relevance of economics in studying health care issues.
• Understand the aspects of medical care that contribute to its uniqueness as a

commodity.

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© 2015 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.Opening Video

A Health Care System in Crisis

The Rainmaker (1997) Distributed by Paramount Pictures Produced by Michael Douglas, Steven Reuther, and Fred Fuchs Directed by Francis Ford Coppola Written by John Grisham Screenplay by Francis Ford Coppola

Cast:

Matt Damon as Rudy Baylor, young attorney handling his first case Jon Voight as Leo F. Drummond, lead attorney for Great Benefit Life Michael Girardin as Everett Lufkin, vice president of claims for Great Benefit Life Johnny Whitworth as Donny Ray Black, young man dying from leukemia

Synopsis:

A court room drama where recent law graduate Rudy Baylor teams up with Deck Shifflet, an “ambulance-chasing” paralegal, who has failed the bar exam six times. From the beginning, Rudy has misgivings about the questionable ethics of the type of client solicitation practiced by Shifflet. When Rudy asks, “What’s wrong with ethics?” Deck answers, “Oh, nothing, I guess. I mean I believe a lawyer should fight for his client, refrain from stealing money, and try not to lie, you know, the basics.” With these rules of professional conduct guiding him, Rudy accepts his first case, a lawsuit against Great Benefit Insurance Company. Great Benefit has been selling its health policies door-to-door in low-income neighborhoods and denying most of the presented claims, betting on the fact that none of their clients will file suit. For seven years, Dot Black has paid the premiums, but when she files a claim for Donny Ray’s recently diagnosed leukemia, Great Benefit denies the request for a bone marrow transplant. Great Benefit Life refused to pay for the procedure on four grounds: that the leukemia was a pre-existing condition, that due to his age (21) he was no longer a dependent and therefore not covered by the policy, that his health status has been misrepresented on the original insurance application four years before diagnosis, and that the procedure was “experimental.”

Film Clip:

Scene 16, “Do you remember when you first sold out?” starting at 59:53 to 1:05:18 (5 minutes, 22 seconds) Rudy travels to Cleveland to depose several key insurance company employees. Of the four employees he wants to depose; only one is available. Jackie Lemancyzk (Claims Handler) has resigned and Russell Crockett was downsized. In a dramatic confrontation, Baylor asks Drummond if he remembers “when he first sold out,” implying that Drummond has tampered with witnesses. The scene ends in Danny Ray’s bedroom with Baylor indictment against the U.S. healthcare system. “This is how the uninsured die. In a society filled with brilliant doctors and state-of-the-art technology…it is obscene to let this boy die.” Do you think this is a fair 3 / 4

© 2015 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.indictment of the U.S. healthcare system? What are the circumstances, if any, that would justify denial of a “valid” insurance claim? Are any of the four grounds used by Great Benefit Life valid?

Discussion:

In Donny Ray Black’s case we find the behavior of those associated with Great Benefit Life morally repugnant, as did the jury be rewarding the plaintiff $50 million in economic and punitive damages. In the case of Great Benefit Life, the verdict resulted in the insolvency of the company, its eventual bankruptcy, and an opportunity for us to explore the impact of such awards on other stakeholders in such cases.

Teaching Suggestions • Get a copy of the survey from Victor R. Fuchs, “Economics, Values, and Health Care Reform,” American Economic Review 86(1), March 1996, 1-24. Ask your students to answer the survey and tabulate the answers. Compare their answers with those of the economists who answered the survey originally. This is a good way to check the pulse of your class.The ensuing discussion can be a good way to introduce many of the topics covered in the course.• National media attention has focused on the problems of the medical care sector periodically in recent years. The “crisis” in medical care is well documented. Discuss the various meanings of the term “crisis.” Students will have some interesting perspectives on this issue.• It is a good idea to discuss the use of the Internet as a research tool. It is important that students be able to discern good sources from bad. The Internet is full of both. That is the purpose of the Internet exercise in my class. Students join a ListServ or eavesdrop on a newsgroup to get some idea how to judge the quality of the information available in cyberspace. There are literally thousands of forums to join. Many of my students begin their electronic discussions with DejaNews, a leading site for Internet discussion groups.

You can find it at http://w2.dejanews.com/.

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