1) Intro to Health Care Delivery Flashcards
Health
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
Suppliers
Manufacture equipment, supplies, and medications used by providers to give care to pt’s
Providers
Organizations or individuals who provide care
Purchasers (Buyers)
Supply funds for health care
- Includes:
- Businesses w/employer-sponsored health insurance
- Govt
- Individual consumers
Insurers
Receive money from the purchaser, which they use to reimburse providers
Explain how traditional insurers work
Take money from purchasers → Assume Risk →Pay providers when policyholders seek care
Payer
Pays the provider; AKA insurance companies
What role does the government have in health care?
- Public insurance financing
- Health regulations
- Health policy
- Research funding
- Public health
What are the different levels of care? Explain them
Primary Care- Preventative measures & tx of common health problems
- 1st contact care, Longitudinal, Comprehensive, Coordination/Communication
- 75-85% of services
- Usually outpatient or ambulatory care
Secondary Care - Care for problems that require more specialized clinical expertise
- Usually short-term, including hospitalization, routine surgeries, specialty consultation, & rehab
- 10-12% of services
Tertiary Care - Management of complex and/or rare disorders
- Typically institution-based, highly specialized, and technology driven
- Trauma, Burn, NICU, Cardiothoracic Surgery
- 5-10% of services
- Most costly level of care
Dispersed Model
Everyone just kind of does their own thing & pt’s do what works for them rather than following the lines of care
Why is our health care system so complex?
- For-profit
- Many ways peeps can pay for care
- Variety of insurer methods to manage risk
- Multiple payers determine payment rates
- Variety of settings for care
- Need for expertise in negotiating the system
System Fragmentation
No overall planning, direction, or coordination; Entities seek to manipulate financial incentives to their own advantage w/out regard for the whole
- Sx’s=Duplication, Overlap, Inadequacy, Inconsistency, & Waste
Biomedical Model
Focus on expertise and specialization; Moving towards more of this bc its lucrative & sexy for the physician and the hospital
What are the 3 points on Kissick’s Iron Triangle? Explain it.
Cost, Quality, & Access -As one changes, the others will change as well
What are the 10 basic characteristics of the US healthcare system?
- No central agency governs the system
- Access to health care services is selectively based on insurance coverage → More likely to seek care if you’re insured
- Health care is delivered under imperfect market conditions (moral hazard) → More likely to seek services if someone else is paying
- 3rd-party insurers act as intermediaries btwn financing and delivery
- Multiple payers make the system cumbersome (administrative costs)
- Balance of power among players prevents domination by any entity
- Legal risks influence provider behavior → Cover-your-ass medicine
- Devo of new technology creates demand for use
- New service settings have evolved along a continuum
- Quality no longer accepted as unchievable
