Healthcare Handbook - Health Systems and Policy Flashcards
What are the two broadest categories of healthcare delivery modality?
What defines each?
Inpatient (patient stays ≥ 2 midnights);
outpatient (patient doesn’t stay overnight)
Describe what percentages of U.S. hospitals are not-for-profit, for-profit, public, etc.
What are the two main types of hospital according to function?
General (teaching hospitals are in this category);
specialty (e.g. children’s, psychiatric, cardiology, etc.)
If a health system performs many different types of services (e.g. insurer, hospital owner, outpatient clinic owner, employer of physician), what type of network is it?
If a health system performs only one type of services (e.g. a system only owns a number of pediatric hospitals), what type of network is it?
A vertical network (e.g. Kaiser Permanente);
a horizontal network (e.g. Shriners hospitals)
A higher primary care : specialist ratio will lead to what effects?
More preventative medicine, better health outcomes, fewer hospital administrations, less overall cost
True/False.
There is a current (and worsening) shortage of both primary care providers and nurses in the U.S.
True.
What type of insurance plan involves strict regulation of which providers can be seen and which procedures are pre-authorized?
What type of insurance plan involves making deals for discounted rates with certain providers that cost the insuree less to see?
Health maintenance organizations (HMOs);
preferred provider organizations (PPOs)
What are the three main types of insurance plan offered by employers?
Preferred provider organizations (56%);
consumer-driven (e.g. health savings accounts) (20%);
health maintenance organizations (14%)
What percentage of U.S. citizens accounts for 50% of all healthcare spending?
What healthier 50% of U.S. citizens accounts for what percentage of all healthcare spending?
The sickest 5%;
3%
Describe where most Americans get their insurance.
What percentage of Americans get their insurance through either Medicare, Medicaid, CHIP, Tricare, or the VA?
31%
Describe Medicare Parts A - D.
A - inpatient costs
B - outpatient costs
C - medicare advantage plans
D - drugs
The Medicaid expansion includes what people?
Any U.S. citizen at ≤ 138% of the FPL
If not a fee-for-service system, what are the three criteria for how physicians can be paid?
(I.e. if not paid per service, a physician can be paid per ________)
- Paid per diagnosis (episode of illness)
- Paid per patient (capitation)
- Paid per year (salary)
What is the difficulty of pay-for-performance health systems?
Quality of care is difficult to measure;
different systems serve different populations (with different baseline health levels)
Describe health lobbying in terms of main players.
