CHAPTER 1- an overview of US health care delivery Flashcards
How many people under 65 were uninsured in 2014 (in US)?
32 million
Since the ACA passed how do uninsured rates for children compare to those of adults?
Children are less likely to be uninsured
The remaining non-elderly uninsured population is made up of predominantly…
people from working families
Before the ACA the majority of US citizens are covered under…
private insurance
Before the ACA employers were/were not required to provide insurance by law
were not
The ACA brought the number of uninsured down to lower than….
10%
The ACA act has not addressed _____
cost efficiency
When was the ACA passed?
2010
no central agency
- No global budget to determine total health care expenditures on a national scale and allocate resources within budgetary limits to controls availability of services and payments to providers
- US mainly private system of finance. Private 53% (Majority of hospitals and clinics are private)
- 47% government
- government formulates standards of participation through health policy and regulation providers must comply with standards to be certified to medc. And chip. (minimum standards of quality in general)
Partial access: Access to health care services is selectively based on insurance coverage
- Americans can access health insurance through employers or if they are covered under a government health care program, can afford to buy it themselves, charity or subsidized care
- Health insurance is the primary means for determining access, Barriers to obtaining even if qualified
Health Care is delivered under imperfect market conditions
- not a free market because prices aren’t governed by supply and demand and there is not free choice
Third- party insurers act as intermediaries between the financing and delivery functions
- insurance- job- you- doctor
The existence of multiple payers makes the system cumbersome
- hard for providers to keep track of which services are provided under which coverage
- billing practices are not standardized
The balance of power among various players prevents any single entity from dominating the system
- Big businesses, labor, insurance companies, physicians, and hospitals make up the powerful and politically active special interest groups represented before lawmakers
Legal risks influence practice behavior of physicians
- to avoid mal practice suits…
- defensive medicine ordering extensive unnecessary tests = costly and inefficient
Development of new technology creates an automatic demand for its use
- creates demands for new services but without new resources to provide them
- costly
New service settings have evolved along a continuum
services three categories - curative - restorative - preventive no longer confined to hospital and doctors office
Quality
no longer accepted as an unachievable goal
The US spends more on ______ than anything else in health care
administrative costs
illness –>
wellness
acute care –>
primary care
inpatient –>
outpatient
individual health –>
community well being
fragmented care –>
managed care
