INTEGRATIVE CARE 10/25b Health Care Delivery Systems

Question 1

Access

Answer 1

means by which someone can receive healthcare or healthcare services

access to healthcare insurance

Question 2

health insurance

Answer 2

the way people are getting reimbursed

Question 3

Cost

Answer 3

1. economic

2. financial

Question 4

Financial cost

Answer 4

1. financing: he flow of dollars (premiums or taxes) from individuals and employers to the health insurance plan (private health insurance or government programs).
2. reimbursement
   The flow of dollars from insurance plans to hospitals and health care providers.

Question 5

quality of HC

Answer 5

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

Question 6

What is the cost effective analysis

Answer 6

are you getting the most desired outcome for the right cost?

Question 7

value based healtcare

Answer 7

value = (quality+outcomes)/cost

Question 8

most important aspects of world health organization healthcare

Answer 8

access
cost
quality

Question 9

bundled payment systems

Answer 9

rewarding better outcomes

Question 10

why does the healthcare system charge so much money for procedures?

Answer 10

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

Question 11

health related outcomes that show the quality and value of healthcare between different countries

Answer 11

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

Question 12

socialist health insurance progression from social to general taxation (communist)

Answer 12

socialist = universal healthcare
based on cashflow through taxes

GT = government completely funds healthcare - 3rd world countries

Question 13

socialist economies

Answer 13

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)

Question 14

UK Healthcare

Answer 14

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

Question 15

as a PT in the UK, what kind of employee are you?

Answer 15

government employee

Question 16

Comprehensive health care

Answer 16

more private funding, less government funding

Question 17

Germany - comprehensive health care

Answer 17

1. Financing: taxes go to non-profit sickness fund that gets distributed (similar to medicare and medicaid, but not run by the government)
2. Access:
   - significant difference between hospital phys and outpatient phys;
   - 51% are generalists
3. Quality coordination of care is very fragmented, but still very strong

Question 18

reimbursement in germany - comprehensive health care

Answer 18

DRG - being paid based on condition being treated for

+ global fee

Question 19

welfare healthcare model

Answer 19

canada

• more private funded health insurances
  1. Finance:
• financed completely by taxes (employee, not employers)
• medicare pays for 70% of all health care

2. Access:
   - 50% GPs
   - Speciality care has high pricing
   - wait time is longer
3. 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
4. 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

Question 20

entrepreneurial healthcare system

Answer 20

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

Question 21

HHS

Answer 21

health and human services

branch of government that is responsible for the most healthcare related aspects of government

Question 22

financing for entrepreneurial healthcare system

Answer 22

health service system that has a large private (nongovernment) component and a slightly smaller public (government) component

Question 23

access for entrepreneurial healthcare system

Answer 23

Variety of ways
One of the few countries where you can bypass GP’s and see specialists.
Right to Choose

Question 24

quality for entrepreneurial healthcare system

Answer 24

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

Question 25

why do you see more specialist physicians than GPs in entrepreneurial HC

Answer 25

the reimbursement is much higher

Question 26

why don’t people utilize insurance even in entrepreneurial healthcare systems

Answer 26

the cost is too much

Question 27

is perception of quality of care correlated to the amount spent on health care

Answer 27

NO, except in France

Question 28

what is france doing right with healthcare

Answer 28

• 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

Question 29

OA

Answer 29

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

Question 30

access - what is the most effective treatment for OA

Answer 30

4 different types of interventions

1. Conservative
2. Pharmacologic
3. Procedural
4. Surgical

Question 31

financing total joint replacement

Answer 31

1. Germany - financing: tax payers pay and private reimburses
2. UK - finance comes from government and employer/private; reimbursement depends on govn’t plan and procedure
3. Canada - finances from taxes; reimbursement from government; procedure for access: primary care first
4. US - financing and reimbursement depend on age, disability, and type of insurance

Question 32

Cost of OA

Answer 32

hip replacement comparison

• US: $20k
• Mexico: 2.5k

varies based on economy

Question 33

based on cost of OA, what is level of access and quality

Answer 33

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)

Question 34

cost effectiveness approach

Answer 34

1. takes different procedures for the same impairment/condition
2. compare the same procedure between countries
3. compare between settings (inpatient and outpatient)

Question 35

is there evidence to suggest exercise program before total knee replacement

Answer 35

cost perspective: costs more

outcomes: not good, longitudinal does not look promising with pre-rehab