354 final chap 12

Question 1

3 major cornerstones of health care delivery

Answer 1

cost, access, quality - they are interrelated and complex

Question 2

expansion of access will…

Answer 2

increase cost

Question 3

high quality health care should be…

Answer 3

cost effective

Question 4

consumers and finaciers

Answer 4

price, bills

Question 5

national

Answer 5

NHE - national health expenditure (how much the nation spends on health care)

Question 6

providers

Answer 6

cost of producing services

Question 7

per capita

Answer 7

$11,172

Question 8

GDP

Answer 8

17.7%

Question 9

total NHE

Answer 9

$3.6 trillion

Question 10

cost containment strategies

Answer 10

top down vs bottom up

Question 11

top down

Answer 11

health planning, single payer systems, the gov. established global budgets and funds distributed within these limits

Question 12

bottom up

Answer 12

U.S, providers and insurers establish fees

Question 13

cost control in the U.S…

Answer 13

gov. regulation and market-based competition
(limited success b/c of cost shifting)

Question 14

reasons for cost escalation (9)

Answer 14

1.third party payment- less provider induced demand
2. imperfect market- high prices, unchecked quality/prices
3. growth in technology
4. elderly/chronic diseases - they use more
5. medical model - more preventative care
6. multiple payers and administrative costs - insurance, billing
7. defensive medicine - overuse of unneeded services
8. freud/abuse - false billings, unnecessary services
9. practice variations - cost and utilization differences between providers

Question 15

access

Answer 15

timely use of needed, affordable, convenient, acceptable and effective health services

Question 16

access is important b/c…

Answer 16

it is a health determinant, significant for assessing effectiveness of medical care delivery, and reflects if delivery is equitable

Question 17

5 dimensions of acess

Answer 17

1. availability - service capacity and individuals requirements
2. accessability - locations
3. affordability - ability to pay
4. accommodation - manner that resources are organized and individuals ability to take advantage of arrangement
5. acceptability - attitudes of all parties

Question 18

3 factos of donabedian model

Answer 18

structure -> process -> outcome

Question 19

structure

Answer 19

facilities, license, staff, equipment, beds, delivery

Question 20

process

Answer 20

technicals, wait times, cost, interpersonal, communication

Question 21

outcome (final results)

Answer 21

patient satisfaction, recovery, improvement, rehospitalization

Question 22

quality

Answer 22

degree to which health services increase the likelihood of desired health outcomes and are consistent

Question 23

micro view of quality

Answer 23

clinical, interpersonal, quality of life

Question 24

macro view of quality

Answer 24

cost, access, population health measures

Question 25

clinical practice guidelines

Answer 25

standard guidelines based on scientifically established protocols to guide physicians clinical decisions

Question 26

cost-efficiency (effectiveness)

Answer 26

medical services are cost efficient as long as the benefits received are greater than the costs incurred/risks anticipated

Question 27

risk management

Answer 27

proactive efforts to prevent adverse events, with focus on medical malpractice

Question 28

ACA impact on cost

Answer 28

slowed down health care spending, largely in Medicare by tightening provider payment rates and providing incentives to reduce costs

Question 29

ACA impact on access

Answer 29

insurance and access have increased, preventative services without cost-sharing have expanded

Question 30

ACA impact on quality

Answer 30

linking payment to quality outcomes in Medicare, strengthening quality infrastructure, and encouraging new patient care models -> medical errors have decreased