cost and cost control Flashcards
Kissicks triangle?
cost
quality
access
annual spending?
3.2 trillion
Half of health care used to treat
5% of population
Why is cost a burden on business?
if insurance goes up everything goes up.
costing more for employers
what does increasing health care cost do?
care and insurance cost both go up/
Why is cost so high?
moral hazard
demographic shift (ppl live longer)
reduced consumer ownership(not responsible for it.)
unnecessary spending.
using insurance when they don’t need it
moral hazard.
What are the 2 factors increasing cost?
price and quantity
factors of price?
market power
administrative costs
how is price controlled?
decrease quality
increase utilization
cost-shifting
mandatory uniform fee schedule.
Volume and intensity aspects that increase cost?
fee for service fragmented care technology malpractice chronic condition demographics
What is a better cost control strategy?
- controll fees and provider incomes.
- cutting price on supplies
insurance model used to manage cost, also quality and access
Managed Care
Integrates financing and management + HCD to an enrolled population
employs/contracts with system of providers which deliver service and shares financial risk
Managed health care Plan
How does managed care work?
provider makes up network. plans pay depends on network rules.
what are the 3 types of managed care?
HMO
PPO
POS
only pay for care within network, care coordinated by PCP
HMO
pay more if care is in network, but pay a portion of outside network care
PPO
plan allows HMO or PPO each time care is needed
POS
What are early strategies of managed care cost control?
selective providers provider risk contracting primary gatekeeping utilization review invest in disease management.
Advantages of managed care benefit who?
employer not consumer
Since HMO is less strict, what increased?
hospital market power due to consolidation.
When was peak enrollment in HMO?
1999
Why Did HMO cost continue to increase after peak?
reintroduce authorization requirement concurrent review of care disease management tiered provider network quality care incentive. cost sharing benefit design
what is the proposal to contain cost HMO?
gov regulation adjust compensation invest in IT improve quality Prevention Increase consumer involvement Alter tax preference for EB insurance.
helping patients choose care that’s supported by evidence, not the same tests already done, free from harm, and actually needed consumer involvement
Choosing wisely ABIM
What does policy data say about PT?
Payer tracking MEDPAC Gov accounting office Office of inspector general Part B national summary Data file
What happened to medic between 200-2004
spending doubled
more beneficiaries used service
What were limitations in claims data MEDPAC?
no outcomes
limited Dx
Provider identifiers .
