Final Flashcards
Cost containment strategies
Combination of govt regulation and market-based approaches
Supply side controls (ex certificate of need - doesn’t work)
Price controls
Utilization controls
Supply side regulation
Demand side incentives
Payer driven competition
Utilization controls
Drivers of healthcare costs
Third party payers Technology Market imperfections Aging population Medical model Admin expenses Defensive medicine Waste and abuse Practice variation
Certificate of need
Method to contain costs
Need prior approval for expansion or equipment purchases based on demonstrated need
Did not work
6 areas of waste in US health care
Failure of care delivery Failure of care coordination Over treatment Administrative complexity Pricing failures Fraud and abuse
Bending the cost curve
30% of spending could be eliminated without consequence
Areas of savings Bundled payments Unnecessary treatments Medical errors Care coordination Pay for performance
Care transition
Movement of patient thru healthcare system as there condition and thus needs change
Transitional care - coordination and continuity
Re hospitalization rates
Around 20% in first 30 days
Means systems not well coordinated
ACA and care transition
Reduces Medicare payment if readmission within 30 days
Tests models in place
Key implications of healthcare access
Determinants of health Benchmarking Assessing effectiveness Measure of equality Quality and efficiency of medical services
Determinants of healthcare access
Insurance Availability of care Coordination of care Effluence Equity (predisposing vs enabling conditions)
3 things that affect healthcare access
Predisposing conditions
Enabling conditions
Characteristics of policy and system
When enabling conditions create difference in medical care utilization
The delivery of Medical care is considered inequitable
Define quality in healthcare
Application of medicine to maximize its benefits without increasing its risks
Two components of quality
Technical standards and patient expectations
Dimensions of quality
Technical performance access to services effectiveness of care efficiency of service delivery interpersonal relations continuity of services safety physical infrastructure choice
Both objective and subjective
Macro versus micro view of healthcare quality
Macro view includes life expectancy mortality rates Epidemiologic measures population policy
MicroView includes clinical care patient centeredness quality-of-life care delivery system
Three studies by the Institute of medicine
1996 IOM round table
1999 to err is human
2001 crossing the quality Chasm
Safety in medicine
50000-100000 people die in hospitals each year due to preventable medical error
Medical errors 5th leading cause of death
Result of system failures not health care workers
Medication errors
One of the most common medical errors
1.5 million preventable injuries
Cost $3.5 billion
Misuse abuse and underuse
Six aims for healthcare improvement
Safe timely effective efficient equitable patient centered
Imperatives for health care redesign
Reengineer care process Information technology Knowledge and skills management Effective teams Care coordination
System failures
