Block 1 Flashcards

(41 cards)

1
Q

What three things are considered in an acceptable health care system?

A

Access
Cost
Quality

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2
Q

Define healthcare Access

A

All citizens are enabled to obtain needed services

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3
Q

Define Cost in the Healthcare System

A

Healthcare services are Cost Effective

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4
Q

Define Healthcare Quality

A

Services must meet established standards

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5
Q

Banyan Tree Analogy for US Healthcare “System”

A

Loosely capitalistic / market oriented in terms of morals and ethics and governmental oversight

Fragmented system with multiple payers, sets of rules, lots of money made by different stakeholders

Broadly described: financing insurance, delivery, payment mechanisms are somewhat coordinated by public and private actors

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6
Q

Unique attributes of US Healthcare System

A

Highly fragmented: in regulation, financing, and delivery

High rates of uninsured and underinsured

Major inequality in quality of care

No comprehensive payment systems for services

For-profit

Expensive

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7
Q

T or F: The US has the highest expenditure per capita in the world for healthcare

A

True

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8
Q

T or F: The US spends the highest % of GDP in the world on healthcare

A

True

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9
Q

Cultural Beliefs and Values Influencing American Healthcare System

A

Self-reliance, Independence, Individualism

“Welfare” only for most needy

Decentralized government (state> fed) and resistance to increased taxes

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10
Q

Social Changes Influencing American Healthcare System

A

Demographic Shifts, Immigration, Urbanization

Decreasing % of White only demographics & Increasing % of Non-White and 2+ race demographics

Increasing Urbanization

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11
Q

Technological Advancements Influencing American Healthcare System

A

New treatments are expensive

Progressively increased training of health professionals creates more expensive system

Tech, Facilities, & Equipments advancing = increased cost

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12
Q

Economic Constraints Influencing American Healthcare System

A

Health care costs
Health Insurance Cost
Family Incomes disproportionately increasing alongside service costs

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13
Q

Political Opportunism Influencing American Healthcare System

A

President’s agenda
Domestic and Foreign priorities
Party politics
Power of interest groups (APTA)
Laws, regulations, policies

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14
Q

Three Eras of US Healthcare System

A

Pre-Industrial
Post-Industrial
Corporate

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15
Q

Pre-Industrial Era

A

Minimally educated physicians, some nurses
Inexpensive: cash payment or trading
Medical Institutions: Poorhouses (Almshouses) run by government, Hospitals were few w/ poor conditions, Asylums for housing people w/ chronic untreatable illnesses (esp. mental illness)

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16
Q

Post- Industrial Era

A

Development of medical and nursing professions: increased education, urbanization begins office-based practice rather than house calls, science and technology begins to drive medicine

Development and growth of hospitals: centralized and institutional approach from medical science advancement for facilities and equipment & nursing especially becomes a profession

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17
Q

Post - Industrial Era Insurance

A

Health insurance emerges: care advancement = cost increase, so people invested in insurance for unpredicted care needs, largely provided by hospitals early on due to Great Depression

Provider inspired insurance followed including: American Hospital Association’s Blue Cross & State Medical/Physician Societies Blue Shields

Creations of public health insurance like Medicaid (poor) and Medicare (elderly)

Post Great Depression: economy booms and employers utilize health insurance as a benefit to attract employees instead of raising wages

18
Q

What post-industrial insurance policy emerged in 1954?

A

Congress made employer based health insurance non-taxable

equivalent of getting more salary with out having to pay taxes

19
Q

4 Main Features of the Corporate Era

A

Corporatization

Growth of Non-Physician Workforce

Information Revolution

Globalization

20
Q

Corporatization : Corporate Era

A

Medical care is dominated by large corporations with little attention from federal government (no anti-trusts enforced) resulting in:

Managed care insurance companies
Large pharmaceutical and device manufacturers
Large hospital systems
Large physician practices ( can be owned by hospital systems)

21
Q

How has the Information Revolution impacted the Corporate Era?

A

COST!!!
Telehealth, Electronic Health Records, massive amounts of information and resources at everyone’s disposal creates larger health service costs

22
Q

Globalization in Corporate Era

A

Cross-border exchange of goods and services
Migration of health professionals: majority of PCPs in America have immigrated from other countries to fulfill residencies

23
Q

Historical Reasons for Failure of US Health Care Reform

A

Anti-German feelings and criticism of social insurance during WW I
Lots of rhetoric has been historically created that equates national health insurance to socialized medicine
Opposition from the AMA (literally fuck the AMA so bad)
🦅🦅Traditional American Beliefs and Values 🦅🦅: capitalism, self-determination, distrust of big government, tax aversion

24
Q

Affordable Care Act

A

2010
Access > Quality > Cost
Political Battlefied

25
Why do people have insurance?
To reduce their risk of financial strain in the event of the need of medical services
26
Guaranteed Issue
the government passes a law stating that if an individual applies for insurance that the insurance company has to sell a policy that applies
27
Individual Mandate
*Insurance mandate* the government has determined that everyone living in the country is required to obtain insurance
28
Employer Mandate
*Insurance Mandate* all employers are required to provide insurance to their employees
29
Underwriter in Health Insurance
A person employed by an insurance company who decides whether or not the company should sell a policy to an individual who has applied *low risk, high risk, etc*
30
Risk Pool
A certain group of people who have bought an insurance policy from a company Characteristics: Large vs Small and Healthy vs Sick ex: Large, healthy pool or small, sick pool changes how premiums work
31
Favorable Selection
Higher number of healthy people in the risk pool
32
Adverse Selection
Higher number of sick people in the risk pool Bad for insurance companies b/c increased claims and decrease $
33
What Risk Pool will pose the highest risk for insurance companies and how does this affect?
a Large, Sick pool because adverse selection The insurance company will likely increase premiums to stabilize the risk pool or refuse to operate in a region
34
Individual Rating
Rating individuals by select factors *Preferred by insurance companies* *They would be able to charge people more/not sell at all if they are old, of child bearing age, have pre-existing conditions, risk factors, etc*
35
Community Rating
The policy being sold by the insurance company has to be the same for all individuals who apply
36
Modified Community Rating
*ACA* An Insurance company *cannot* use individual rating; however to allow more Healthy people into the Risk Pool, they can give lower premium rates if : younger, in a region where it is inexpensive for insurance company to do business (urban), and does not use tobacco
37
T or F: The Affordable Care Act allows price variation based only on age, geography, and tobacco use
True! This is a part of the *Modified Community Rating* concept
38
T or F: The ACA only allows a limited amount of price variation
True
39
Rescission
Existed before ACA An insurance industry practice in which an insurer takes action retroactively to cancel a policy holder's coverage by citing omissions or errors in the customer's application even if the policy holder has diligently kept their policy current Usualy occured when someone would suddenly get a bad diagnosis
40
Common Insurance Practices Prior to ACA
*Denying* *Excluding* *Charging* based on gender, pre-existing, or certain occupations *Limiting benefits* associated with mental health, substanc use, maternity, prescription drugs, pre-existing *Imposing* lifetime or annual benefit caps
41
Changes to Insurance Following ACA
Elimination of: Recission, Underwriting, Individual vs Community