Block 1 Flashcards
(41 cards)
What three things are considered in an acceptable health care system?
Access
Cost
Quality
Define healthcare Access
All citizens are enabled to obtain needed services
Define Cost in the Healthcare System
Healthcare services are Cost Effective
Define Healthcare Quality
Services must meet established standards
Banyan Tree Analogy for US Healthcare “System”
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
Unique attributes of US Healthcare System
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
T or F: The US has the highest expenditure per capita in the world for healthcare
True
T or F: The US spends the highest % of GDP in the world on healthcare
True
Cultural Beliefs and Values Influencing American Healthcare System
Self-reliance, Independence, Individualism
“Welfare” only for most needy
Decentralized government (state> fed) and resistance to increased taxes
Social Changes Influencing American Healthcare System
Demographic Shifts, Immigration, Urbanization
Decreasing % of White only demographics & Increasing % of Non-White and 2+ race demographics
Increasing Urbanization
Technological Advancements Influencing American Healthcare System
New treatments are expensive
Progressively increased training of health professionals creates more expensive system
Tech, Facilities, & Equipments advancing = increased cost
Economic Constraints Influencing American Healthcare System
Health care costs
Health Insurance Cost
Family Incomes disproportionately increasing alongside service costs
Political Opportunism Influencing American Healthcare System
President’s agenda
Domestic and Foreign priorities
Party politics
Power of interest groups (APTA)
Laws, regulations, policies
Three Eras of US Healthcare System
Pre-Industrial
Post-Industrial
Corporate
Pre-Industrial Era
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)
Post- Industrial Era
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
Post - Industrial Era Insurance
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
What post-industrial insurance policy emerged in 1954?
Congress made employer based health insurance non-taxable
equivalent of getting more salary with out having to pay taxes
4 Main Features of the Corporate Era
Corporatization
Growth of Non-Physician Workforce
Information Revolution
Globalization
Corporatization : Corporate Era
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)
How has the Information Revolution impacted the Corporate Era?
COST!!!
Telehealth, Electronic Health Records, massive amounts of information and resources at everyone’s disposal creates larger health service costs
Globalization in Corporate Era
Cross-border exchange of goods and services
Migration of health professionals: majority of PCPs in America have immigrated from other countries to fulfill residencies
Historical Reasons for Failure of US Health Care Reform
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
Affordable Care Act
2010
Access > Quality > Cost
Political Battlefied
