2) Historical Overview of Health Care Delivery Flashcards
Describe medical services in pre-industrial America
- Medical services were paid directly by the consumer
- There was competition btwn providers
- Demand for care was unstable & predictable bc of the number of people living in rural communities w/healers & folk remedies
- Lack of affordability bc of the costs of travel & value of time
- People didn’t seek care unless they were desperate
- Medical practice was in disarray
- Medicine was a trade, not a profession
- No educational requirements or licensure
What year did the AMA form and what was its purpose?
- 1847
- Formed to create uniformity among physicians
Describe hospitals in pre-industrial America
A social function to protect citizens; Developed w/the development of major seaports bc there was no place for sick sailors to go
Describe medical services in post-industrial America
- Growth of medical/professional sovereignty
- Licensure
- Educational reform
- Urbanization
- Science & technology
- Institutionalization
- Dependency
- Cohesiveness & organization
- Philosophical agreement that physicians should be autonomous
What was the initial role of private health insurance?
Income protection during sickness & temporary disability
Describe the first “modern” health insurance plans
People would pay a monthly fee to their local hospital just in case
What was the provider-insurer pact?
Alliance of insurers & providers where the provider controlled the insurers
What was the 1st insurance company?
Blue Cross
When was the first time that the government took on a role in the health care delivery system?
1935 w/the Social Security Act
Describe the development of employment-based health insurance
- Started in the 1940’s bc of WW2 wage freezes
- In 1948 there was a supreme court ruling for employee benefits → Incr # of peeps w/insurance
- In 1954 there was an IRS ruling that made employment-based insurance a benefit to employers bc they got a tax break for it
What was going on w/health care during the baby boom years?
- Private health insurance was the only widely available resource, leaving the unemployed or those who worked for small companies w/out coverage
- Costs started to incr
What happened in 1965?
Introduction of medicare/medicaid
What was the first govt entity to provide healthcare payment?
Medicare/Medicaid
Describe the healthcare delivery system in the 1970’s
- Escalation of costs bc of the new medical discoveries
- Incr service demands
- Fee for service, which led to a trend of overutilization
- Global economic competitions
- Businesses became concerned w/cost of health care bc they no longer got a tax break
- Incr govt regulation in attempt to monitor care & decr costs
- Beginning of utilization review
Describe the healthcare delivery system in the 1980’s
- Purchaser revolt bc they could no longer afford it
- Incr in cost of employer-sponsored health plans
- More businesses began self-insuring
- Start of cost-control measures such as PPS, selective contracting, & managed care
Describe the health care delivery system in the 1990’s
- Corporatization
- Globalization
- Information revolution
- Hospital mergers & closures of less successful hospitals
- Fragmentation
- Access Issues
- Balanced Budget Act
What was the balanced budget act?
Primary focus was to manage costs but it ended up creating the medicare cap
Describe the health care delivery system in the 2000’s
- Decline of HMO’s bc of provider/consumer revolt
- Health care market consolidation
- More for-profit companies
- Growth of physician specialties
- Shortage of PCP’s
- Escalating pharm costs
What was the main goal of the affordable care act?
Increase access
Public Policies
Authoritative decisions that are intended to direct or influence the actions, behaviors, or choices of others
Legislative Branch
Enacts laws & statutes
Executive
Implements and enforces laws & statutes
Judicial Branch
Interprets laws, statutes, and regulations
Regulations
Rules adopted by the executive branch of the government
Health Policy
The aggregate of principles (stated or unstated), that characterize the distribution of resources, services, and political influences that impact the health of the population
Describe Health Policy
- 3 steps: Production, Provision, and Financing
- Policies affect:
- Groups/classes of individuals
- Types of organizations
- Can be regulatory or allocative
Fragmented Policy
Put a band-aid on the problem
Systemic Policy
Big Picture
Comprehensive Policy
One big change all at once
Incremental Policy
Implement in phases over time
Health Policy
Influences consumer protection, payment methodology, and standards/quality of care
Is there federal regulation of PT practice?
Nope, its all at the state level
