Exam 4 Flashcards
Accreditation
a process of setting standards for educational/training institutions and enforcing these standards
Certification
A profession led process in which applicant who have completed the required educational process take an examination
Primary Care
first contact providers who are prepared to handle the majority of common problems
Secondary Care
specialty care is provided by clinicians who focus on one or a small number of organs or a specific type of service (like OB/GYN
Tertiary Care
Defined in terms of the type of institution in which it is delivered, often academic or specialized health centers. Trauma centers, burn centers, neonatal ICU, etc
What are some mechanisms used to compensate clinical health professionals?
Fee for service - Clinician paid for each covered service
Capitation - set amount per time period for each patient for whom they are responsible, regardless of level of use of services
Salary - Set amount per time period
Episode of care - set amount for providing comprehensive services, such as hospital treatment based on patient diagnosis
Pay for performance - Compensation adjusted based on measures of the quality of care delivered
Inpatient Institution
Implies that the patient remains for at least 24 hours (Hospitals, skilled nursing/rehabilitation facilities, etc)
Outpatient Institution
One day trip (lol)
Include those providing diagnostic testing or treatment, “the doctor’s office”
What are some approaches being used to define and measure the quality of health care?
- Structure, process, and outcome measures
- Access of care
- Qualified providers
- Staying healthy
- Getting better
- Living with illness
Clinician-patient relationship
Ensuring coordination of information and services, development to one-to-one knowledge and trust over extended periods of time
Institutional coordination
Coordination of individual’s information between institutions needed to inform individual clinical and administrative decision-making
Financial coordination
Implies that a patient has comprehensive coverage for services provided by the full range of institutions, aims to maximize the efficiency of care received and minimize the administrative effort required to manage the payment system
Coordination between health care and public health
Coordination of services between clinical care and public health requires communication to ensure follow up and to protect the health of others
Medical Malpractice
All 4 must be met
A duty was owed: Implies that provider undertook care or treatment of a patient
A duty was breached: Implies a failure of the provider to meet a relevant standard of care
The breach caused an injury: The legal concept of causation is based on proximal cause (chance that the injury would’ve occurred if the negligent act had not occurred)
Damaged occurred: Direct (lost items, medical expenses, etc), indirect (pain and emotional distress), and punitive (when damages are intentionally harmful or grossly negligent)
How do U.S. healthcare outcomes compare to other developed nations?
Worse than many other developed nations, we rank number 11 (overall and in most categories)
What facts demonstrates that U.S. healthcare is inefficient and less effective than
desired?
- Our spending is much higher, with much worse outcomes generally
- High obesity rates
- Higher rate of preventable deaths
How does medical practice variation contribute to our system’s inefficiency?
No standards of cost, no standards of coverage from healthcare, no standard of regular care etc
What sector of U.S. healthcare is responsible for the largest proportion of expenditures?
Hospital services
What is/are the largest payers of healthcare services in the U.S.?
Medicare/Medicaid, private health insurance
Medicare
For 65+ and disabled
Part A covers hospital care, nursing care, hospice care etc.
- No premium required, paid for by payroll tax
Part B is an extra supplementary insurance that covers other diagnostic and therapeutic services, like ER trips and other outpatient services
- For most people, 75% covered by tax, 25% paid by monthly premium
Part C (medicare advantage) is a special program designed to encourage medicare beneficiaries to enroll in prepaid health plans which limit services to those provided within medicare advantage
Part D is prescription drug coverage plan
-Requires monthly premium
Medicaid
For poor people!
The largest federal health insurance system
Options for obtaining health insurance?
Health insurance exchanges
- For those that are self-employed or small businesses etc
- Helps people find and enroll in health insurance
Affordable care act (ACA)
- dropped uninsured rate to 10%
- Requires most health insurance to cover essential health benefits
consequences of un-insurance.
o Less preventative care, diagnosed later in disease progression, less treatment once diagnosed
o Less likely to have a usual source of health care, more likely to use ER for routine care
o Increased mortality rate, estimated 20,000 excess deaths per year
Sources of excess costs in the U.S
Unnecessary services and overuse
Inefficiently delivered services
Excess administrative costs
Prices that are too high
Missed prevention opportunities
Fraud
