INTEGRATIVE CARE 10/25b Health Care Delivery Systems Flashcards
Access
means by which someone can receive healthcare or healthcare services
access to healthcare insurance
health insurance
the way people are getting reimbursed
Cost
- economic
2. financial
Financial cost
- financing: he flow of dollars (premiums or taxes) from individuals and employers to the health insurance plan (private health insurance or government programs).
- reimbursement
The flow of dollars from insurance plans to hospitals and health care providers.
quality of HC
WHO definition:
The degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
Cost Effective Analysis
What is the cost effective analysis
are you getting the most desired outcome for the right cost?
value based healtcare
value = (quality+outcomes)/cost
most important aspects of world health organization healthcare
access
cost
quality
bundled payment systems
rewarding better outcomes
why does the healthcare system charge so much money for procedures?
most practitioners get reimbursed through the set prices created by insurance companies and they make a percentage that they need to achieve to get the right reimbursement back
health related outcomes that show the quality and value of healthcare between different countries
look at per capita spend and determine:
life expectancy at birth
mortality < 5 years
Mortality 15-60 years
Not seeing significantly greater outcomes with increased cost
socialist health insurance progression from social to general taxation (communist)
socialist = universal healthcare
based on cashflow through taxes
GT = government completely funds healthcare - 3rd world countries
socialist economies
financing from more government, less employee, employer, and private person funding for healthcare
- a lot more government influence
- have to allocate resources to the common good
- less motivation, physicians owned by government
- availability of some private insurance
- -Great Brittain has private payment for elective procedures (dependent on economy)
UK Healthcare
Socialist with availability of private insurance
Access:
-no employment relationship
-more waiting room time
-access is there, but opens door to reduced quality
Financing:
-reimbursement: hospitals owned by government
Quality:
-59% of 1000 pts rated system satisfactory
as a PT in the UK, what kind of employee are you?
government employee
Comprehensive health care
more private funding, less government funding
Germany - comprehensive health care
- Financing: taxes go to non-profit sickness fund that gets distributed (similar to medicare and medicaid, but not run by the government)
- Access:
- significant difference between hospital phys and outpatient phys;
- 51% are generalists - Quality coordination of care is very fragmented, but still very strong
reimbursement in germany - comprehensive health care
DRG - being paid based on condition being treated for
+ global fee
welfare healthcare model
canada
- more private funded health insurances
1. Finance: - financed completely by taxes (employee, not employers)
- medicare pays for 70% of all health care
- Access:
- 50% GPs
- Speciality care has high pricing
- wait time is longer - reimbursement to healthcare professionals:
- 9.9% of GDP because of hospital care
- out of hospital services are paid by government funded programs
- differentiate based on cost of living - Quality:
- wait time is the biggest detractor
- GP decline and access has to be through GP, there is a greater demand than supply of physicians
- 2.1 physicians to 1000 pts
entrepreneurial healthcare system
United States is Closest
- The United States stands out for being the sole advanced industrialized nation where health services are not assured for everyone
- HHS in financing and managing health services is limited to government-initiated social and health benefit programs focused on helping the segment of the population least able to help themselves
HHS
health and human services
branch of government that is responsible for the most healthcare related aspects of government
financing for entrepreneurial healthcare system
health service system that has a large private (nongovernment) component and a slightly smaller public (government) component
access for entrepreneurial healthcare system
Variety of ways
One of the few countries where you can bypass GP’s and see specialists.
Right to Choose
quality for entrepreneurial healthcare system
US
- lowest wait time for non-emergency care
- based on larger demographics
- spends the most amount of money on funding for patients
- BUT, some of the poorest outcomes when compared to the cost
why do you see more specialist physicians than GPs in entrepreneurial HC
the reimbursement is much higher
why don’t people utilize insurance even in entrepreneurial healthcare systems
the cost is too much
is perception of quality of care correlated to the amount spent on health care
NO, except in France
what is france doing right with healthcare
- Universal Healthcare System
- 11.6% of GDP on healthcare
- reimburse 70% of the healthcare costs and 100% for long term ailment
- MANAGING CHRONIC CONDITIONS and making it an incentive for GPs to manage chronic conditions
- Pay more for GPs than specialists to drive motivation (reimbursing more for preventative care)
- specialists are reimbursed in full only if GP referred them
OA
It represents the most common form of joint disease and disability in older people and ranks amongst the top 5 causes of disability 1. access: Financing Reimbursement 2. cost Direct Costs Indirect Costs Intangible Costs (inability to work) 3. quality outcomes
access - what is the most effective treatment for OA
4 different types of interventions
- Conservative
- Pharmacologic
- Procedural
- Surgical
financing total joint replacement
- Germany - financing: tax payers pay and private reimburses
- UK - finance comes from government and employer/private; reimbursement depends on govn’t plan and procedure
- Canada - finances from taxes; reimbursement from government; procedure for access: primary care first
- US - financing and reimbursement depend on age, disability, and type of insurance
Cost of OA
hip replacement comparison
- US: $20k
- Mexico: 2.5k
varies based on economy
based on cost of OA, what is level of access and quality
for knee OA, depends on:
- societal perspective (based on cost and disability vs outcome)
- payer perspective (only include cost - shifting towards outcomes as well)
- individual perspective (bring in outcomes)
cost effectiveness approach
- takes different procedures for the same impairment/condition
- compare the same procedure between countries
- compare between settings (inpatient and outpatient)
is there evidence to suggest exercise program before total knee replacement
cost perspective: costs more
outcomes: not good, longitudinal does not look promising with pre-rehab
