Health Care Environment Flashcards
What are determinants of consuming health care?
Predisposing factors are those impacting the propensity to seek care including knowledge of self, health, and health system (under/over utilization)
Enabling factors are those encouraging obtaining services including where services are located and how they are paid for
Perception of need can be by either patient or health care provider
T/F: In the US health services are directly affected by the largest single payment system Medicare?
True
What are some health care policy changes that have occurred in recent years?
Policies enacted to: protect individual privacy and insurability, promote affordable access and curb Medicare spending
T/F: there is increased legal accountability in the form of regulations driven by the political environment
True
What are major policy changes affecting health care delivery?
1996: passed HIPPA
1997: caps placed on PT, balanced budge act
1999: medicare payment for SNF
2000: payment for OP and home health services
2001: direct access
2010: affordable care act
What are aspects of the economic environment?
Supply and demand
Job outlook
Business cycles
Global economy: inflation, interest rates
What is the current economic environment?
17.9% of GDP in 2012
Rising costs associated with technology, increased utilization, changing perception that health care should be available to all people
Consumer need is projected to increase dramatically
Cost savings measures part of any plan in order to remain viable
What are areas of largest health care expenditures?
Sector with most rapid growth cost: prescription drugs, administrative costs of private health insurance
Personal expenditures: hospital care, physician care, drugs. The remaining costs are for other personal health care including visits to non physician medical providers, medical supplies, and other health services
What are factors affecting a decrease in utilization?
Decreased supply of hospitals and doctors, advances in public health and sanitation, risk factor knowledge and prevention initiatives, discovery and availability of curative treatments, guidelines recommending decreases, shift to other sites of care, payer pressure to reduce cost, practice pattern changes, consumer preference changes
What are factors affecting an increase in utilization?
Increased supply of services, growing population, aging population, new procedures and technologies, guidelines recommending increases, new disease entities, new drugs, increased health insurance coverage, pressure for more comprehensive insurance coverage, changes in practice patterns, consumer preference and demand changes
What are the ethical principles related to access and allocation of health care services?
Justice: distributive. discusses who gets what within limitations in resources
Rights: is access to health care a right of ALL members of society, what is quality and quantity of health care that it right
What are three basic needs of a health care system?
Keeping people healthy
Treating the sick
Protecting families against financial ruin from medical bills
What is the Beveridge model?
Health care provided and financed by the government through tax payment.
Most hospitals and clinics are owned by government, providers are government employees
Never get a doctor bill
Low costs per capita because the government controls what doctors can do and what they can charge
T/F: Great Britain, Cuba, Spain, New zealand are part of beveridge model?
True
What is the Bismarck model?
Uses insurance system called “sickness funds”: usually financed by joint employers and employees through payroll deduction
Plans cover everyone and don’t make a profit
Healthcare providers and hospitals tend to be private
Tight regulation gives government cost control
Countries involved: Germany, France, Belgium, Netherlands, Japan, Switzerland, Latin America
