Hours 5 and 6 Flashcards
Health Care Cost Health Systems
How has the number of uninsured changed since passage of the ACA (2010 to 2016)?
Almost 50 million uninsured Americans in 2010 to about 28.1 million in 2016; 44% decrease in the number of uninsured since the passage of the ACA in 2010
what did the uninsured rate among the non elderly population look like from 1998-2016?
in 1998 it was 16.6% and then it decreased to 10.3%
What are factors that limit access to health care?
accessibility, availability, affordability, acceptability,
what do we need to consider when it comes to accessibility?
Is a person able to transport him/herself to the physician/health care provider for health care?
What is the proximity of the patient to the health care provider?
what do we need to consider when it comes to availability?
Does the health system have the capacity (facilities and providers) to accommodate patients when services are needed
what do we need to consider when it comes to affordability?
Is the patient able to afford needed services?
Do they have insurance?
Are there payment plans available?
what do we need to consider when it comes to acceptability?
Is the patient and his/her health care provider compatible?
Does the physician accept different cultures and religious beliefs?
Language barriers
What are the demographics of the current (2016) uninsured in terms of age, race, work, status, etc?
1)Family Work Status
No workers – 15%
Part-Time – 11%
1 or more Full-Time Workers – 75%
Most uninsured live in families with employed family members
2)Whites account for the highest number uninsured individuals
Hispanics and Blacks more likely to be uninsured
Lack of insurance impacts individuals of all races
3) Marital status Separated: 11.2% Married: 8.8% Singe/Unmarried 16% Widowed: 13.9%
education
No High School Diploma (27.3%)
Graduate (5%) – BS (7%)
High School Degree (15.2%)
4) Age
Children ≤ 19 = 5.4%
Adults 19 – 64 = 12.1%
≥ 65 = 1.2%
Group having the most difficulty obtaining insurance are of working age
who does lack of insurance affect the most?
Lack of insurance affects individuals at all income levels, but the poor the most
how would you define the Federal Poverty Level (FPL)?
“A measure of income issued every year by the Department of Health and Human Services (HHS). Federal poverty levels are used to determine your eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage.”
How does lack of insurance impact access to health care?
1) Less likely to get preventive care, costing more in the long-run
2) More likely to postpone care
3) More likely to seek care in an emergency room
4) Less likely to receive recommended care and to fill prescriptions
5) Overall decrease in access possibly due to loss of insurance
6) Gaining insurance can result in improved health status
men are more likely to have health insurance through their jobs? T/F
T
Women are more likely to be insured through their job, and less likely to seek care through dependency? T/F
false, less likely to be insured; more likely to seek care through dependency though they are more likely to visit doctors and get routine care
research also indicates that children who are uninsured for part of the year have more access problems than those with full year coverage? T/F
true
how is cost defined?
price x quantity
what drives the overall healthcare cost?
Number of beneficiaries Health of beneficiaries Services per beneficiary Cost per unit of services Quality of the service
what is the health care cost formula
Quantity of beneficiaries ^ Quality (health) of the beneficiaries
X
(Quantity of services X Cost of Services)^Quality of the services
how is the health system defined by WHO?
“All the activities whose primary purpose is promote, restore or maintain health”
what are the three primary objectives in health care according to WHO?
1) Improving the health of the population they serve;
2) Responding to peoples expectations;
3) Providing financial protection against the costs of ill-health.
According to the WHO, what are the Health System Building Blocks?
Health Services Delivery Health Workforce Health Information Essential Medicines Health Financing Leadership and Governance
WHO Health Services Delivery Indicators
Availability of inpatient and outpatient facilities
WHO Health Workforce Indicators
Number of health workers per 100,000 population
Number of graduates from health professional schools
WHO Health Information Indicators
Review of national systems – are information systems in place?
WHO Essential Medicine Indicators
Availability of 14 essential medicines
Median consumer price for 14 essential medicines
WHO Health Financing Indicators
Total expenditures on health
Ratio of out-of-pocket payments for health to total expenditures on health
WHO Leadership and Governance Indicators
Review of national health policies
what is the organization of the US Healthcare System?
Many models to explain the structure of the US Healthcare System based on: -How care is delivered Primary, secondary, tertiary care -Organizational structure HMO, ACO, IPA, PPO -Who pays Public, private, individual
Components of the Healthcare System?
Patients, providers, payers, support systems
what are the three major organizational segments?
support segment, payer/purchaser segment, provider segment
what are the two types of providers? Name examples
private and public
private
Acute care hospitals
Physicians and other professionals
Diagnostic services
Public Sector
Veterans Administration
US military hospitals and clinics
US Pubic Health Service
who pay the bills? examples
private and public entities
private
Private insurance companies
Employers
Individuals
Public
Medicare – elderly
Medicaid – low income
Tricare – military retirees
what are the two types of support sectors? examples
private and public
private Health information technology companies Billing companies Education and training Supply chain
Public
US Department of Health and Human Services
State health departments
Local health departments
what are the hospital types by service?
Acute Care
Psychiatric
Rehabilitation Hospitals
Specialty Hospitals
what are the hospitals by teaching status?
Major Teaching Hospitals
Other Teaching Hospitals
Non-teaching Hospitals
in terms of hospital ownership? what makes up the largest percentages?
community hospitals by 87%, followed by non-profit (51%), then profit (19%), and lastly state/local (17%)
what can we say notice about community hospitals between urban and rural settings?
urban increases by about 3.1% and rural decreases by 25.8%
