Health Care Delivery Flashcards
Lecture Objectives
1) Understand the organization and types of health care services and providers
2) compare and contrast US health care system with different international models
3) discuss the basic economics US health care
How is health defined?
state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
How is health care defined?
the maintaining and restoration of health by the treatment and prevention of disease especially by trained and licensed professionals (as in medicine, dentistry, clinical psychology, and public health)
How is health services defined?
all services dealing with the diagnosis and treatment of disease or the promotion, maintenance and restoration of health. They include personal and non-personal health services
What is McGriff’s definition of health services?
specific activities undertaken to restore, maintain or improve health or to prevent decrements of health
Health care provider
individual or institution; preventive, curative or rehabilitative health care services
Hospitals
private or government
What are two types of private hospitals?
for-profit and non-profit (70% of market)
What are federal government hospitals?
VA, Indian health service, military
How does the VA work?
not open to general public, free for service-related conditions, re-organized in 1995, capitation model, more efficient and effective than Medicare fee-for-service, largest integrated system in the US
How does the IHS work?
federally funded, founded in 1955 under HHS
What are modes of practice?
private (solo or group), direct employment (for-profit or non-profit), government (military, VA, IHS, State and local community health center or public health department) also industry, research, consulting
What are 3 primary types of health care services?
preventative health care, curative health care, home and community care
Preventative care primary
stop initiation of disease, most public-health efforts
Preventative care secondary
early diagnosis of disease, screening programs
Preventative care tertiary
controlling the impact of disease
Curative care primary
initial approach to a PCP for treatment, ambulatory care, early detection and routine care, 80-90% of provider visits
AAFP
Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern not limited by problem origin, organ system or diagnosis
Curative secondary
provided by specialist who generally don’t have first contact with patients; includes acute care (emergency, childbirth, intensive care, medical imaging services)
Curative tertiary
specialized consultative health care, usually for inpatient and on referral from primary or secondary health professional (rare complex disorder, technical services, St. Jude, UT, Methodist Transplant institute)
What is home and community care?
health care interventions delivered outside of health facilities; rehabilitation and long-term care
What is aging in place?
keeping elderly or disabled patients in their community but providing things like home health aide, adult day care, meals on wheels
What are four major health care system models worldwide?
single payer national health service, single payer national health insurance, social insurance model, out of pocket
Single payer national health service
UK/National Health Service/Beveridge model; government is single payer and provider; government owns hospitals and clinics, universal participation, gatekeeper model with only some private providers
How can a government be single payer and provider?
funded through taxes, universal participation with no out of pocket costs
Single payer national health insurance
Canada/Taiwan/South Korea government is single payer, government sets cost, private providers, universal participation
Explain the governments role in single payer health insurance
government pays with taxes and some out of pocket costs; government sets costs and limits procedures performed, requires waiting period for procedures, gatekeeper model; differs from province to province on coverage, scope of practice etc
Social insurance model
Germany/Japan/France/Belgium/Netherlands/Switzerland/Bismark model; government plays central role in setting costs, private insurance companies cover basic services as non-profit; private providers, universal participation
Out of pocket model
Costa Rica/Colombia/Iraq/India; no widespread public or private system of health insurance, private providers, access to care is determined by ability to pay, common in developing countries, most expensive form of healthcare
What is the most expensive model of health care?
out of pocket model, common in developing countries
What model is US Healthcare?
a combination of all four models
What is 49% of US Healthcare model?
Social insurance: BCBS, UHC, VSP; individuals and employers pay for insurance coverage, priavte providers, can be for-profit, set fees based on medicare rates
What is 37% of US Healthcare model?
National Health Insurance: Medicare, Medicaid; government pays, private providers, medicare signed into law by President Johnson 1965
What is 9% of US Healthcare model?
Out of pocket: uninsured and underinsured; individuals pay, generally most expensive
What is 5% of US Healthcare model?
National Health Service: VA, Military, IHS, Federal prison; government pays and government providers
How do ODs get paid?
25% direct pay, 19% VSP, 18% government, 15% private medical insurance, 13% self-directed vision plans, 3% other
Strengths of US system
technologically advanced, responsive, access
Weaknesses of US system
cost, coverage, outcomes
Bad news about healthcare in US
39th infant mortality, 43rd adult female mortality, 42nd adult male mortality, 36th life expectancy aka poor value for our $ (more examples in slide 19 notes)
Good news about healthcare in US
mortality is down, life expectancy is up
US Health economics and financing
highest per capita costs in the world, far exceeds other similarly developed countries
How much is spent per year?
4 trillion
What percent of the GDP is health financing?
19.7% highest percent GDP in the world
How much does each person spend per year?
$12,000 per person per year in 2020, highest per capita in the world (next closest to us is Switzerland 12.2% GDP and $7000)
T/F US Public expenditures are the same as other similarly developed countries, yet we are the only developed country that doesn’t guarantee health care for all citizens
true, public expenditure is similar to other countries but private expenditures put us over the top by far
What is driving health care spending?
chronic disease, technology, prescription drugs, utilization, administrative costs, provider salaries, prices are set high
What % of spending is public health?
3%
What % of spending is “other” health care?
5% , includes PT, OD, podiatry and chiropractic
Cost Control measures
utilization controls, EHR, evidence-based medicine recommendations, reward prevention that costs less than the treatment for the disease, control fees and provider incomes, decrease the price of drugs and products, increase taxes dedicated to health care, increase public health funding
How does public health save money?
$1 spent on prevention saves $5.60 in health spending
T/F doctors and other health care providers are paid very well in the US relative to other countries
true, one potential way to address the rising costs of health care is by decreasing payments to providers and lowering compensation expectations
Average annual salary for optometrists in 2018
$119,000 US vs $64,563 in Canada
