1 - US Healthcare System Flashcards
Primary Care
“First-contact Care” - Basic or General Health Care
MOST ACESSIBLE type of care: 80-90% of visits to providers
Who are PRIMARY CARE Physicians?
PCP = Primary Care Providers
Pediatricians / Gynecology / Internal Medicine
- sometimes NP’s / PA’s / Chripractors*
- *depends on your Health Plan - may require a REFERRAL** to specialist
Secondary Care
Physician SPECIALIST
FACILITIES treating problems like
SURGERY / HOSPITALIZATION / REHAB
Tertiary Care
MOST COMPLEX DISORDERS
Specialized CONSULTATIVE care –
typically need Referral from PCP
Preventative Care
PREVENT disiease or injury
Reduce EXPOSURES to health problems
Chronic Care
opposite of acute diseases
CHRONIC diseases that persist over time
Respite Care
service for DEPENDENT patients
provides TEMPORARY CARE RELIEF
to their informal caregivers (family)
Long-Term Care (LTC)
EXTENDED ASSISTANCE
for the chronically/mentally/disabled ill people
Assists those who have limitations in ADLS or IADLS
activities of daily living (instrumental ADLS)
Acute Care
Short-Term / INTENSE care for an illness or injury usually HOSPITILIZATION (inpatient)
Sub-acute care
comprehensive INPATIENT services for those who need
MORE intensive skilled nursing –> nursing homes
TOO WELL FOR HOSPITAL, but too frail for nursing homes
Rehabilitative Care
Therapies to RESTORE/MAINTAIN levels of FUNCTIONING and to PREVENT further deterioration
Palliative Care
Serving to RELIEVE or COMFORT/ALLEVIATE
rather than curing
HOSPICE CARE (end-of-life)
Humane / compassionate services for the DYING
Common classifications for HOSPITALS
Size = # of beds
Length of Stay: short / long
Location: urban / rural
Type of Service: general / surgical / specialized
Hospital Classifications - OWNERSHIP
Public = federal/state/municipal
Private Not-For-Profit
Private PROPRIETARY = for-profit / investor owned
Ambulatory Care
OUTPATIENT healthcare services that do NOT require inpatient hospitilzations
wide variety of practitioners for the “WALKING” / non-institutionalized patient
Disease prevention / health promotion / medical care
Accountable Care Organization = ACO
MODEL OF CARE
From the AFFORDABLE CARE ACT - sought to reduce healthcare cost by encouraging physicians / healthcare providers
to FORM NETWORKS to COORDINATE CARE & receive bonuses for EFFICIENT care delivery ACCOUNTABLE forquality / cost of care delivered
ACO
Accountable Care Organization
INCENTIVIES hold ACO’s responsible for both COST & QUALITY OF CARE
Houses numerous medical practices within 1 organizing entity, PCP leadership ACCOUNTABILITY ( quality metrics )
SHARED SAVINGS
FREE CHOICE in PROVIDERS for the patients
Patient-Centered Medical Home = PCMH
Enhanced PRIMARY CARE delivery MODEL
PCMH uses Physician-led, coordinated team based approach to care:
Spectrum of disease state / various life stages while MANAGING COSTS
PCMH
Patient Centered Medical Home
PRIMARY CARE
Centered around a SINGLE MEDICAL PRACTICE (small/independent office)
Payers give providers a BONUS for imrpoving primary care services for each patient in PCMH
Universal goal of the healthcare system?
Adequate ACCESS to QUALITY CARE at a REASONABLE COST
Triple Aims of the healthecare system:
In concert with the universal goal:
Better Individual Care + Experiences
Better Population health
lower _Costs_
Major components of ACCESS
to health care
ABILITY to PAY (self or insurance coverage)
AVAILABILITY of health care personnel / facilitites
Issues affecting EASE OF USE / BARRIERS to timely participation
(Transportation / Language / Culture / Scheduling)
Total U.S Health Care Expenditures in 2016
3.3 TRILLION
17.9% of US GDP
Major Factors Contributing to the
COSTS of Healthcare
Social Factors
Lifestyle Factors & personal behaviors
Chronic Disease + AGING Population
Longer lives -> more CHRONIC conditions / comorbidities
Prescription Drugs + Medical Advancements
Fragmented Healthcare Delivery
Current Payment / Reimbursement Mechanisms
Administrative Costs
for providers & payers
Financial Barriers to Healthcare
28 million UNINSURED in the US
mainly due to COST BEING TOO HIGH / LOST JOB or emplyer change
41 million UnderInsured in the US
When out-of pocket costs (includes PREMIUMS) add up to
10% or more of houshold income
or
Deductables amount to 5% of income or HIGHER
Under-insured Definition
41 million UnderInsured in the US
When out-of pocket costs (excluding premiums) amount to:
10% + of household income
or
When deductables amount to
5% + of income or higher
