Health policy

Question 1

How do health systems differ based on the model of the system?

Answer 1

Public vs. private system
Single vs. multiple payers
Centralized vs. decentralized
FFS payments or capitation (lump sum payments dealt out for a predetermined number of patients)
Covering “first dollar” (the amount a patient pays upon their first medical visit)
Use of gov’t regulation/price control
Competition among providers and payers

Question 2

What are common issues most countries have with their HC systems?

Answer 2

Controlling costs
Providing equitable access
Assuring quality care
Use of technology
Measurement of outcomes

Question 3

How is the micro model of health policymaking defined/characterized?

Answer 3

It is the relations and negotiations between providers and insurance companies (or patients, providers, payers (plans), employers, and pharma advocates)
Non governmental organizations are advocates (HIV advocacy)
Currency used: power, dollars, contracts

Question 4

How is the macro model of healthcare defined/characterized?

Answer 4

It is very complex and has many interdependencies, which come as a result of disorganization within the government

Question 5

What is an example of the macro model at work?

Answer 5

Policies are formed by CMS, politicians, or other interest groups. Acts, like the ACA, are the output. Then they are implemented, for example insurance exchanges… where someone can buy health insurance on exchange if they are unable to purchase it.

Question 6

What are the problems that present?

Answer 6

Cost containment, which is causing costs to rise. (waste, admin, growth, cost-related efficacy)
Access to care (disadvantaged subpopulations, ability to pay…)
Impact of new technologies (cost and complexity, economic and ethical conflicts…)
Quality of care considerations
Measuring health outcomes
Sustainability (resource deployment, innovation)

Question 7

How many patients die each year in the U.S. from medical error?

Answer 7

200,000

Question 8

What does Price Waterhouse Cooper recommend for sustainability?

Answer 8

• Quest for common ground: political agreement
• Digital backbone: integrated EMR
• Payment/Incentive Realignment: support patients and
providers
• Quality and safety standardization (decreasing the “no-do” gap. we know what the standards should be, but there is a gap in performance, hence the need for standardization)
• Strategic resource deployment
• Climate of innovation: technology and processes
• Adaptable delivery roles and structures

Question 9

What are some trade-offs in healthcare?

Answer 9

Economic efficiency and equity
Costs and effectiveness
Autonomy and public welfare