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tazzygirl -> RE: Hawaiian Health Care (2/22/2010 11:03:15 AM)
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hi Master Thadius
thank you for the questions. Its indeed focusing my self study, and i thank you.
Here is what i have found so far. This is a study that was done in 1992...
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Health care system reform is an ongoing
policy issue in almost every industrialized
nation.
The United States sponsors a unique
health care infrastructure. One component
is highly regulated, and the other a
"free market." Neither component is
coordinated with the other; and they are
often in conflict.
Our choices will be to regulate more,
create freer markets, coordinate subsystems,
or do nothing. Whatever
approach is taken, cost control measures
will be paramount.
Every industrialized nation has adopted
a specific approach to the provision of
health care services to the public. Every
system has something to teach us. Each
is worth examining.
All other nations have adopted a version
of compulsory health insurance within a
regulatory framework. The most
prevalent financing method is incomeadjusted
premiums or levies.
The most common form of regulation is
standardizing professional fees and
hospital revenues. Most notably, many
countries prefer not to micro-manage the
practice of medicine nor the administration
of the system.
This series examines the health systems
of several nations and the reform actions
of three states. They include, but are not
limited to:
• Oregon • Washington
• Hawaii • Canada
• West Germany • Japan
• South Korea • Australia
February 1992
Hawaiian Health Care Reform
Primary Source
The primary reference for this brief is the article "Learning
from the Aloha State", written by Michael S. Dukakis and Cyril
Roseman, The Journal of American Health Policy, January/
February 1992. This brief abstracts significant portions of this
article. It also standardizes the analysis format and creates a
context for this analysis.
The Hawaiian Approach
The fundamental purpose is to provide a mechanism whereby
almost all Hawaiians may acquire or receive some measure of
health insurance coverage.
The state of Hawaii is attempting to create a seamless joining
of a variety of health care sub-systems. These include Medicaid,
Medicare, military, state health department, and an
employment-based private insurance market. The insurance
market is almost totally dominated by one payer, Blue Cross &
Blue Shield ... and the Kaiser Permanente HMO.
The approach attempts to fold the remaining uninsured into an
existing source of health care or into a newly created State
Health Insurance Program (SHIP) for all those who are not
covered by traditional methods. The SHIP program only
provides for primary care outpatient services. The overall goal
is to have all Hawaiians insured for some level ... but not
necessarily the same level ... of service.
• There theoretically are no Hawaiians who are employed and
uninsured. The state requires that every employee who works
over 20 hours per week be insured within 30 days of employment.
This requirement is applicable to all business. The employee
contribution is limited to 1.5% of gross income. The table on
the following page shows that calculation:
..........
Compulsory Health Insurance in Hawaii
Examples of Cost Sharing Calculations
(see the link for the graph itself, page 2)
• The poor are addressed through an expanded and
generous Medicaid.
• Other uninsured citizens are eligible for the SHIP
coverage.
Medicaid Reform
There is no Medicaid reform being proposed by
Hawaii.
Compulsory Employment Based Health Insurance
Federal ERISA guidelines prohibit states from
requiring private business to provide proscribed
benefits. Hawaii received an exemption from these
provisions in 1974. It is the only state that has ever
been granted such an exemption by the federal
government.
Hawaii legislation makes health insurance coverage
compulsory at the workplace for all employees who
work over 20 hours per week.
A Solution?
Is the Hawaiian approach a model for a national
solution? Possibly. It is questionable if the nation
could or would accept a dominant payer concept, or
would easily accept across-the-board compulsory
health insurance at the workplace.
Is the Hawaiian approach a model for a state solution?
Maybe. Some analysts cite the very unique
situation of being 3,000 miles from a competing
border state; the dominance of a single payer in the
private sector; and the all-important ERISA exemption
that other states will probably never receive.
The provision of some health care insurance for
most people is the problem, then the Hawaiian
approach is a solution. Hawaii has addressed costs
somewhat as a by-product of a dominant payer
system and through strong planning (certificate of
need) regulation.
Most states will resist the Hawaii approach because
local politics will defuse effective health planning
efforts; most states do not have a proactive pubic
health infrastructure; almost every state will resist
requiring health insurance in the workplace; and no
other state has a payer with the dominance of Blue
Cross and Blue Shield in Hawaii.
................
http://www.coph.ouhsc.edu/coph/HealthPolicyCenter/Pubs/1992/chpr9202h.pdf
Misunderstandings of the Hawaiian approach
There are many facets of the plan that may suffer
from over-simplification.
Coverage
Hawaii does not have standardized universal health
care coverage. The coverages available are of a wide
range. Those covered by the SHIP initiative will
receive essentially primary care coverage only.
Hospital care is not covered at this time. Hawaii will
continue the traditional “cost shifting” financing
mechanisms to pay for this care. This "indirect"
taxation is preferred to the traditional form at this
time.
Rationing Methods
Health care is rationed by price exactly as in other
states and by the varying insurance coverages one
may have. Those insured by comprehensive group
health plans or the Kaiser-Permanente HMO will
enjoy a wide range benefits. Those enrolled in
Medicaid are subject to the traditional Medicaid
system.
Professional Liability for Rationing Decisions
These issues are not specifically addressed or
considered in the Hawaiian approach.
Covered Business
All business, regardless of size, must comply with
the provision of insurance to its employees. There
are no exempt businesses or populations.
(same link as above)
Its a 4 page summary... and an excelent read, if you (any of you) have the time and desire to learn more.
I dont view this as universal coverage in the way Canada has it. But it is a start.
As for your question about pre-existing conditions...
Traditional Private Individual Health Insurance
This section provides information about the regulation of the health insurance market in each state for individuals seeking private non-group health insurance coverage. This includes, for each state, an explanation of how individual health insurance policies are rated, any requirements regarding the issuance of coverage on an individual basis, how individual market carriers can treat preexisting health conditions, and what credit, if any, they need to apply against preexisting condition waiting periods for an individual's prior health plan coverage.
Preexisting Condition Requirements
There is a 36-month exclusionary period limit for pre-existing conditions for traditional individual market policies in Hawaii. Pre-existing conditions may not be considered for the HIPAA-eligible population.
http://www.nahu.org/consumer/healthcare/topic.cfm?catID=22&state=HI
Im still looking to see how that is different... if it is different... when dealing with the clinics and such, Master.
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