Economics

Question 1

macro-allocation

Answer 1

how does the system distribute care?

Question 2

micro-allocation

Answer 2

how is care distributed to individuals?

Question 3

Macro-allocation - 3 types

Answer 3

1. free-market
2. mixed
3. egalitarian

Question 4

Free-market

Answer 4

• traditional US system (pre ACA)
• based on exchange of resources
• get care that you can pay for (private funds or insurance)

Question 5

Mixed system

Answer 5

• partial free-market or 2-tiered
• e.g. Medicare
• minimal level of care guaranteed with independent ability to pay for more

Question 6

Egalitarian

Answer 6

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

Question 7

How many uninsured in 2006

Answer 7

47 million (15.8%)

Question 8

healthcare costs in US

Answer 8

2007 - 16.2% GDP, projected 20% by 2015

Question 9

How are scarce resources distributed to individuals?

Answer 9

fairness, efficiency, cost/benefit, effectiveness

-reflective of social values

Question 10

Transplants

Answer 10

• waiting list candidates = 120,000
• active waiting list candidates = 77,000
• transplants 2013 = 26,000
• donors 2013 = 13,000

Question 11

Reconstructive Transplants

Answer 11

e. g. hand, face
1. consent to donate
2. new definition of organ
3. prioritization

Question 12

Micro-allocation - types

Answer 12

1. market
2. selection comittees
3. lottery
4. customary

Question 13

micro - market approach

Answer 13

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

Question 14

micro - selection committees

Answer 14

independent, ‘objective’ panel or board makes decision

Question 15

micro - lottery

Answer 15

first come first served

Question 16

micro - customary

Answer 16

individual basis, MD selects

Question 17

Managed Care

Answer 17

• insurance coverage more restrictive
• utilization management models developed (diagnosis related groups) - comprehensive care pre-paid, price fixed, gatekeeper is PCP
• payers looking at outcome data
• limited provider input

Question 18

Managed Care - Types

Answer 18

1. Managed Care Organization (MCO)
2. Health Maintenance Organization (HMO)
3. Preferred Provider Organization (PPO)

Question 19

Managed care - pro/con

Answer 19

• less rapid increase in costs

- patients and providers unhappy

Question 20

economic issues

Answer 20

PT-specific issue = referral for profit (POPTS)