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Unit 2 > Health Care Delivery Systems 2 (10/25b) [Integrative] > Flashcards

Health Care Delivery Systems 2 (10/25b) [Integrative] Flashcards

1
Q

Access

A

the means to have health insurance and medical care

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2
Q

Financial Cost

A

Financing
- the flow of dollars (premium/tax) from individuals and employers to the health insurance plan

Reimbursement
- the flow of dollars from insurance plans to hospitals and health care providers

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3
Q

Quality

A

The degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

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4
Q

Cost Effective Analysis (CEA)

A

tool for assessing the value of an intervention

identifies the procedures that provide the greatest improvement in outcome at the lowest cost

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5
Q

Value

A

Value = (Quality + Outcomes) / Cost

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6
Q

Important Health Related Outcomes Data

A

Life Expectancy
Mortality <5 Years Old
Mortality 15-60 Years Old

Also consider Per Capita Spent on Health

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7
Q

Health Related Outcomes Data for US

A

US spends significantly more per capita on health, but outcomes aren’t better

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8
Q

More civilized countries have what kind of health insurance?

A

More privately funded, employer funded, more entrepreneurial

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9
Q

Third world countries have what kind of health insurance?

A

More communist, government funded

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10
Q

Socialist Economy (United Kingdom)

A

Financing comes more from government, less from employer/employee/individual

More gov involvement in setting prices and allocation of goods/services

Less incentive to see more pt

Universal coverage, can have private insurance for elective procedures

EX: United Kingdom

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11
Q

Socialist (UK) - Financing

A

Mostly general taxes, some employer/employee contributions, user fees

No employment relationship

Used of private insurance to hop over queues for services

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12
Q

Socialist (UK) - Reimbursement

A

All healthcare workers are salaried government employees

Periodic negotiation and evaluation of salaries

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13
Q

Socialist (UK) - Access

A

Access generally through general practitioner (66% of physicians)

Free general services

GPs not in hosp, work closely with social service agencies/home care

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14
Q

Socialist (UK) - Quality

A

59% satisfaction

80% waited less than 13 weeks to see specialists

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15
Q

Comprehensive Economy (Germany) - Financing

A

Taxes, pooled employer/employee contributions managed by nonprofit sickness funds

Minimal OOP payments

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16
Q

Comprehensive Economy (Germany) - Access

A

Separation of IP and OP physician practice

51% generalist

Dispersed model with little coordination between OP physicians and hospitals

Fee for service, copayments

17
Q

Comprehensive Economy (Germany) - Reimbursement

A

Sick funds pay global fee to regional physician associations, which pays docs on fee schedule

Sick funds pay hospital a DRG which includes salary of hosp-based docs

18
Q

Comprehensive Economy (Germany) - Quality

A

Ease of access and timeliness

Poor communication between IP and OP causes significant errors

19
Q

Welfare (Canada) Economy

A

Based on social philosophy that health service is a right

There are still more private providers

20
Q

Welfare (Canada) - Financing

A

Completely by gov/tax

Medicare paid ~70% of all health service spending

Private paid 13%, OOP was 15%

21
Q

Welfare (Canada) - Access

A

50% GPs who act as gate keepers

GPs care for hosp inpatients

Specialist fee higher with referral, waiting lists for elective procedures

22
Q

Welfare (Canada) - Reimbursement

A

Total spending on health services ~9.9% of GDP

PTs in hosp are salaries

OP services at private clinics are paid mostly through public health plans, private insurance, or by patients depending on area

23
Q

Welfare (Canada) - Quality

A

2.1 GPs per 1000 pts, low ratio and high waiting times

Waiting lists exist for some diagnostic tests, specialists, surgeries, etc

Avg wait time 18 weeks

24
Q

Entrepreneurial (US) Economy

A

Solve advanced industrialized nation where not everyone has health care

HHS is fed gov department responsible for health related services, role in financing and managing services is limited to gov-initiated social/health benefit programs focused on helping most underserved

25
Q

Entrepreneurial (US) Economy - Financing

A

Large private (nongovernment) component

Smaller public (government) component

26
Q

Entrepreneurial (US) Economy - Access

A

Variety of ways

One of the few countries where you can bypass GPs and see specialists

Right to Choose

27
Q

Entrepreneurial (US) Economy - Why Don’t People Access Healthcare

A

Mostly too expensive (48%)

Unemployed/work doesn’t offer (12%)

28
Q

Entrepreneurial (US) Economy - Quality

A

Lowest wait time for non emergent care compared to similar systems

Spends more of GDP on healthcare than any other country, but not high spender when considering health and social services

Lowest ration of social service spending to health care spending in OECD (correlated w lower health outcomes)

Limited attention to social determinants of of health, leads to high costs and poor outcomes

29
Q

Spending vs Quality

A

The amount spent on health care does not correlate with the perceived quality

EX: France spends little, but high quality

30
Q

France Economy

A

Universal health care mostly financed by gov national health insurance

Spent 11.6% of GDP

GPs in private practice but reimbursed by public insurance funds, gov sets premium levels related to incomes

Reimburses 70% costs, 100% of long term ailment, better at managing chronic ailments and incentivizes more GPs

Supplemental insurance available, most non for profit

31
Q

France Economy - GP vs Specialists

A

Only GP they are registered with can refer pt

Specialists charge higher fees, apply tariffs higher than official rates

Official rates forms the basis on which pt are reimbursed, must be referred by GP

32
Q

Osteoarthritis

A

most common form of joint disease and disability in older people and ranks amongst the top 5 causes of disability

33
Q

Osteoarthritis - Access

A

Interventions

  • Conservative
  • Pharmacologic
  • Procedural
  • Surgical
34
Q

Osteoarthritis - Financing

A

Germany - financing from taxpayers, reimbursement from private sickness funds

UK - financing from government and employer/employee, reimbursement depends

Canada - financing from taxes, reimbursement from government, start with conservative treatment

US - financing depends on age/disability

35
Q

Osteoarthritis - Cost of Replacement

A

HIP
Highest – $20k in US
Lowest – $2.6k in Mexico

KNEE
Highest – $42k in US
Lowest – $9k in India

36
Q

Knee Osteoarthritis - Quality

A

Depends on societal/payer/individual perspective

From societal, direct (hospital stay, med cost) and indirect costs (productivity loss)

From payer, only direct costs

37
Q

Cost Effectiveness Approach

A

Between different procedures for the same condition

Between same procedure over different countries

Between settings

Unit 2 (27 decks)

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