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Health Care Systems > Health Care Systems > Flashcards

Health Care Systems Flashcards

0
Q

Complexity of health care delivery (components)

A 
Education/research
Suppliers
Insurers
Providers
Payers
Government
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1
Q

Objective of health care delivery system (2)

A

Enable all citizens to receive health care services

Deliver services that are cost effective and meet standards of quality

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2
Q

General facts about US health care

A

16% of GDP - highest of all countries
Per capita spending ~$8000 - also highest
Per capita spending projected to continue to rise.
Life expectancy and mortality measurements worse than most other countries

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3
Q

Who finances health care?

A

Private - employer based or patient purchases individually

Public - Medicaid, Medicare, other (VA, IHS, etc)

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4
Q

Medicaid

A

For the impoverished poor diasbiled

Joint venture between federal and state govt
States choose how to run them
Some federal requirements

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5
Q

Medicare

A

For the elderly

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6
Q

External forces affecting health care delivery

A 
Social values and culture
Global influences
Population characteristics
Physical environment
Technology development
Economic conditions
Political climate
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7
Q

Description of US health care delivery

A

Large and complex
Fragmented
Many organizations and individuals

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8
Q

Major characteristics of US health care delivery (10)

A 
No central agency governs
Access is based on insurance coverage
Under imperfect market conditions
3rd party insurers act as intermediary between finance and delivery function
Multiple payers makes cumbersome
Balance of power between all players - no single dominant entity
Legal risks influence physician behavior
New technology creates automatic demand
New service settings over continuum
Quality not seen as unachievable
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9
Q

No central agency

A

Mostly private financing and delivery
Hospitals and physicians independent of govt
No monitor of budget or utilization
(Exception is Medicare and Medicaid)
Govt sets standards thru policy and regulation
Minimum standards of quality

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10
Q

Partial access

A 
Access restricted to:
1-have health insurance thru employer
2-are covered by govt plan
3-can afford insurance out of pocket
4-can pay for services at time of delivery

Emergency room - catastrophic insurance

Primary care access is lacking - reason for deficit in US health

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11
Q

Imperfect market

A

Consolidation and alliances

Quasi-market
1-patients and providers are not independent
2-prices not set by interaction of supply and demand
3-not unrestrained competition
4-patients lack info on different services
5-patients lack info on prices and quality
6-patients don’t bear full cost of services
7-patients don’t make decisions

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12
Q

Types of pricing

A

Item pricing

Package pricing

Capitation

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13
Q

Capitation

A

All services include one set fee per person

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14
Q

Package pricing

A

Bundled fee for group of related services

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15
Q

Phantom provider

A

All services billed separately; pathologist, anesthesiologist, supplies, hospital facility use

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16
Q

Third party insurers and payers

A

Wall is separation between financing and delivery

Quality of care is secondary

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17
Q

Multiple payers

A

Many different plan options available

Cumbersome

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18
Q

Power balancing

A

Multiple players

Fragmented self-interests

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19
Q

Legal risks

A

Litigious society

Defensive medicine

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20
Q

High technology

A

Creates demand despite cost
Need utilization of capital investments
Legal risk if don’t provide

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21
Q

Continuum of services

A

3 broad categories
Curative
Restorative
Preventative

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22
Q

Quest for quality

A

Continuous improvement
Higher expectations
Compliance standards

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23
Q

Quad function model

A 
By shi and Singh
4 functional components of healthcare delivery
FIDP
financing
Insurance
Delivery
Payment
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24
Q

Types of financing

A

Employers
Government (Medicare and Medicaid)
Self funding

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25
Q

Types of insurance

A

Insurance companies
Blue cross/blue shield
Self-insurance

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26
Q

Types of payment

A

Insurance companies
BCBS
third party claim processors

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27
Q

Type of delivery

A 
Physicians
Hospitals
Nursing homes
Diagnostic centers
Vendors medical equipment
Health centers
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28
Q

What is managed care?

A

System to improve efficiencies by integrating basic functions, control utilization, and set prices for services

Integrates the 4 functions of healthcare delivery to better deliver care

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29
Q

Financing mechanisms (for MCO)

A

Capitation - for one set fee per month per member, MCO delivers all needed healthcare

Discounted fees

1-insurance- MCO assumes risks
2-delivery-MCO arranges services and controls utilization
3-payment-MCO is payer and pays providers based on capitation or discounted fees

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30
Q

Evolution of health services - 3 periods

A

Pre-industrial era 1700 1800
Post industrial era late 1800s to mid 1900s
Corporate era

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31
Q

Characteristics of pre industrial era of health service

A 
Open entry into medical practice
Primitive medical procedures
No institutional core - almshouses, mental asylums, penthouses, dispensaries
Family based care
Substandard medical education
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32
Q

Characteristics of post- industrial era in health service

A 
Physicians gained professional sovereignty
Scientific basis for medicine
Hospitals
Formal medical training
Licensing
Development of public health
Workers compensation starts
Private insurance
Medicare and Medicaid
Prototypes of managed care
33
Q

What changed health services in 1900s?

A 
Urbanization
Science and technology
Institutionalizations
Patient dependency
Autonomy and organization
Licensing
Educational reform
34
Q

Concept of urbanization

A

People away from families
Women enter workforce
Physicians more productive
Less travel reduces opportunity cost

35
Q

Concept of science and technology

A

Cultural authority
Increased demand for professional services
Decreased reliance on family treatment

Anesthesia
Penicillin
X-rays
Antiseptics
Pasteur and microbiology
Hand washing and sanitation
36
Q

Concept of institutionalization

A

Pooling of resources needed
Hospital becomes institutional core

Urbanization, technology, and professionalization demand pooling of resources

37
Q

Concept of autonomy and organization

A

Physicians remain independent from hospitals and corporations
Physicians organize thru AMA

38
Q

Concept of licensure

A

Medical practice acts of 1870s
Debt vs West Virginia 1888
Need to upgrade medical education
Relieves intense competition in medical practice

39
Q

Timeline of health insurance

A

1914 - workers compensation
1900- present - voluntary health insurance (disability insurance)
1929 - hospital insurance (prepaid plans)

40
Q

Origins of health insurance

A

1929 - Baylor university - for school teachers; model for blue cross blue shield

1940s - WWII wage freeze - bargain with unions, becomes permanent part of employee benefits, grows to major medical

41
Q

Federal efforts for national health insurance

A

1917 - American association of labor legislature
1935 - FDR New Deal
1940s - Roosevelt and Truman
1962 - Medicare and Medicaid
1992 - Clinton and Bush proposals
2009 - patient protection and Affordable Care Act

42
Q

Why no national health insurance?

A

Political inexpediency
Institutional dissimilarities
Ideological differences
Tax averse

43
Q

Characteristics of Corporate Era of health services

A 
Corporatization
High tech
Comfortable surroundings
No cost control
Managed care - for insurance and delivery
Integrated health care organizations
Consolidation of physicians
Information revolution
Globalization
(Seen as government dominance)
44
Q

Differences between private and public health care systems

A

Private - focuses on illness, FIDP, markets, biological causes, cure and individuals

Public - focuses on wellness, medical and non- medical interventions, social and govt services, biological and non- biological causes, prevention, and populations

45
Q

4 components of health

A

Physical
Social
Spiritual
Mental

PMSS

46
Q

Levels of health determinants

A

Individual
Community
State/national
Global

47
Q

Blum’s model of health determinants

A

ELHM

environmental
Lifestyle/behaviors
Heredity
Medical care

(In order of importance)

48
Q

Determinants of premature death

A

LEGM

Lifestyle
Environment
Genetic
Medical are

49
Q

Define social cohesion

A

Hospitable environment in which people trust each other and participate

Linked to lower overall morbidity and better self-rated health

50
Q

Leading cause of death in US

A

Heart disease
Cancer
Respiratory diseases
Stroke

51
Q

Actual causes of death

A

Tobacco
Poor diet and physical inactivity
Alcohol consumption

52
Q

Define:
Acute
Subacute
Chronic

A

Acute - relatively severe, short duration (myocardial infarction, kidney interruption)

Subacute - less severe phase of an acute illness (rehab for hip fracture)

Chronic - less severe, irreversible, long duration but can be controlled (diabetes, -ashrams)

53
Q

Continental poverty divide

A

Lower usa

54
Q

Measures of health status

A 
Morbidity/mortality
Incidence/prevalence
Disability
Demographic change
Dimensions of health
Utilization
55
Q

Define morbidity

A

Burden of disease, disability, or sickness

56
Q

Define mortality

A

Death rate

57
Q

Define at risk community

A

All people in the same community or group that can acquire a disease or condition

58
Q

Define cases

A

Number of people acquiring a given negative health condition

59
Q

Define incidence

A

Number of new cases occurring/population at risk

60
Q

Define prevalence

A

Total number of cases at specific point in time/specified population at same point in time

61
Q

Define life expectancy

A

Prediction of how long a person will live

Two types:
Life expectancy at birth
Life expectancy at age 65

62
Q

Activities of Daily Living Scale (ADL)

A

Used to measure disability in the elderly

6 activities of self care and mobility
Eating
Bathing
Dressing
Toilet
Continence
Transfer from bed to chair
63
Q

Katz Scale

A

Modified ADL scale

For people in community-dwelling

Added tasks
Grooming
Walking 8 feet

64
Q

Instrumental ADL

A

For those living independently
Self sufficient

Phone
Driving or public transportation
Shopping
Making meals
Housework
Medications
65
Q

Utilization

A

Consumption of health care services or extent to which they are used

66
Q

Examples of measures of utilization

A

people in given population who visit primary care doctor/#people in study population

Crude, specific, institution specific

67
Q

US cultural beliefs and values (5)

A 
Advancement of science
Capitalism - economic good
Capitalism and health care
Concern for under privileged
Free enterprise/distrust of big govt
68
Q

Distributive justice

A

Equal distribution of/access to health care

69
Q

Market justice

A

Capitalism and free markets extends to health care
In United States
Doesn’t work when dealing with human problems
Market-based demand
Health care is economic reward
Emphasis on individual
Based on ability to pay

70
Q

Social justice

A 
Govt distributes health care 
Assumed more efficient
Central planning and rationing
Equal access is basic right
Community supersedes individual
71
Q

Public health

A

Ensure conditions in which people can be healthy
Organized community efforts
Maximum positive impact on the health of a population, quality of life, overall satisfaction

72
Q

Roles of public health

A 
Prevent epidemics and spread of disease
Protect against environmental hazards
Prevent injury
Promote healthy behaviors
Respond to disasters
Assure quality and accessibility of health services
73
Q

Sciences behind public health

A 
Biomedical
Environmental
Epidemiology
Social and behavioral
Health policy and management
74
Q

Risk factors and disease

A

Attributes that increase likelihood of developing a disease or negative health condition

75
Q

Epidemiologic triangle

A

Host
Agent
Environment

HAE

76
Q

3 types of prevention

A

Primary - prevent occurrence
Secondary - minimize damage
Tertiary - minimize disability

77
Q

Controversy of public health

A

Economic impact
Individual liberty
Moral and religious objections

78
Q

Public policy considerations

A

Scientifically plausible
Politically acceptable
Practical implementation

79
Q

Examples of vulnerable populations

A 
Minorities racial and ethnic
Uninsured children
Women
Homeless
Mentally ill
HIV/AIDS
disabled
Rural populations
80
Q

Three categories of vulnerable populations

A

Predisposing characteristics
Enabling characteristics
Need characteristics

Health Care Systems (3 decks)

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