Economics

Question 1

what are 2 major economic issues?

Answer 1

lack of equity in health care need (some need more/some need less)

lack of equity in health care resources (some have more/some have less)

Question 2

how should health care be allocated?

Answer 2

Macro-allocation: how does the “system” distribute care?

Micro-allocation: how is care distributed to individuals?

Question 3

what is macro-allocation?

Answer 3

how does the “system” distribute care?

1- free market
2- mixed
3- egalitarian

Question 4

what is the free market system?

Answer 4

traditional US system- pre ACA

based on exchange of resources

get care that you can pay for through private funds or insurance

Question 5

what is the mixed system?

Answer 5

partial free market or 2-tiered
(example: medicare)

minimum level of care guaranteed with independent ability to pay for more

Question 6

what is the egalitarian system?

Answer 6

everyone receives the same level of care with no option to acquire additional care

Question 7

macro-allocation health care reform:

Answer 7

47 million uninsured in 06’, or 15.8% of the civilian non-institutionalized population

US ranks 37th in the world “health system performance”

07’, healthcare costs were 16.2% of GDP

Question 8

how are scare resources distributed to individuals? what criteria?

Answer 8

fairness
efficiency
effectiveness
cost/benefit
reflective of important social values

Question 9

what is transplants- UNOS?

Answer 9

United network for organ sharing

waiting list candidates 121,355
active waiting list candidates 77,379
transplants 26,517
donors 12,994

Question 10

what is OPTN?

Answer 10

organ procurement and transplantation network

Question 11

steps to reconstructive transplants:

Answer 11

1- consent to donate
2- new definition of “organ”
3- prioritization

Question 12

what are 4 components of micro allocation?

Answer 12

1- market approach
2- selection committees
3- lottery
4- customary

Question 13

what is market approach?

Answer 13

provides service to anyone who can afford to pay for it, services denied to those who can’t

Question 14

what are selection committees?

Answer 14

independent, “objective” panel or board makes decision

Question 15

what is the lottery?

Answer 15

first come, first serve

Question 16

what is customary?

Answer 16

individual basis; MDs selects

Question 17

what are the consequences of micro and macro allocation?

Answer 17

health disparities

Question 18

what is managed care?

Answer 18

insurance coverage more restrictive

utilization management models developed (DRGs)

• comprehensive care pre-paid, fixed price
• access controlled by PCP (gatekeeper)

payers looking at outcome data

limited provider input

less rapid increase in costs (costs still too high)

patients and providers unhappy

Question 19

what are 3 types of managed care?

Answer 19

1- MCO: managed care organization
2- HMO: health maintenance organization
3- PPO: preferred provider organization

Question 20

what is a specific PT economic issue?

Answer 20

referral for profit

POPTS: physician-owned physical therapy services