Block 1 Flashcards
What 3 components do health caresystems need
Access, Cost, Quality
US healthcare system
market oriented
fragment system- multiple payers and guidlines
includes both public and private
Historical factors that have influenced our system
Cultural beliefs/values
social changes
technological advances
economic constraints
political opportunism
Pre industrial Era
minimally educated physicians
inexpensive- cash or trade
Medical institutions- poorhouses, asylums, deplorable hospitals
Post industrial era
Increased education
Development and growth of hospitals
Emergence of health insurance
Corporate Era
Corporatization
Growth of non-physician workforce
Information revolution- massive amount of knew knowledge an technology
Globalization- migration of health professionals
Guaranteed Issue
If someone applies for insurance they must be sold a policy
Insurance mandate
Individual- everybody in the country is required to obtain insurance
Employer- all employers are required to give insurance to employees
Underwriting
someone who decided if a company should sell insurance to someone who applied (low/high risk etc.)
(illegal under ACA)
Adverse selection
higher amount of sick people
Favorable selection
higher amount of healthy people
Stabilizing risk pool
in an area with more pre-existing conditions, an insurance company will either choose not to do business OR charge higher premiums to reduce their risk
Community rating
everyone pays the same price for the same policy
Individual Rating
riskier people pay more than lower risk people for the same policy (ex. older population, women of childbearing age, pre-existing conditions)
Modified Community rating
the government allows some variation to cost (age geography tobacco use)
Rescission
insurer takes action retroactively to find errors in application to cancel policy holders coverage
(illegal under ACA)
Common insurance practices higher to the ACA
Denying coverage
excluding care
charging higher premiums
limiting benefits
imposing annual/lifetime caps
Normal market
regulation of food safety
fees on ride sharing to cover road upkeep
taxes on goods/services
Primary players in healthcare (3)
Payers/insurers
Providers
Patients
Premiums
Amount of money a person pays to buy insurance
Cost sharing
paid by patient at time of care
copay
co insurance
deductible
Information Asymmetry
Assumes there is an imbalance of information in the provider patient relationship
provider has more knowledge and info than patients
Power Symmetry
societal construct that providers are “all knowing”
patients don’t question providers
Moral Hazard Theory
trending towards more risky behavior when insurance pays for more (less cost to patient)
over-utilization of services if cost sharing is low
