Lecture 10/Chapter 12 Flashcards
1
Q
Learning Objectives
A
- Meaning of health care costs and trend review
- Factors that led to past cost escalations
- Describe regulatory and market-oriented approaches to contain costs
- Why some regulatory cost-containment approaches were unsuccessful
- Discuss the access to care framework and various dimensions of access to care
- Describe access indicators and measurements
- The nature, scope, and dimensions of quality
- Differentiate between quality assurance and quality assessment
- Implications of the ACA for health care costs, access, and quality
2
Q
Cost, access, and quality introduction
A
- 3 cornerstones of health care delivery:
- cost
- access
- quality
- expansion of access will increase health care expenditures
- cost of health care from a macro and micro perspective
- equal access to high quality care
- cost is important in the evaluation of quality
3
Q
quality
A
-up to date capabilities, evidence-based processes, and measuring outcomes
4
Q
cost of health care
A
- trends in national health expenditures
- should health care costs be contained?
- consumer price, national perspective, provider perspective
- 3 sources to assess if spending too much:
- international comparisons
- rise in private sector health insurance premiums
- government spending on health care for beneficiaries
5
Q
reasons for cost escalation**
A
- third-party payment
- moral hazard
- provider induced demand
- imperfect market -> health care market in the US is neither free***
- growth of technology and specialization
- increase in the elderly population
- medical model of health care delivery
- multipayer system and administrative costs
- defensive medicine
- fraud and abuse- upcoding and anti-kickback statute
- practice variations- small area variations (SAV)
6
Q
cost containment: regulatory approaches
A
- health planning
- price controls
- peer review
7
Q
health planning
A
- government undertaking steps to align and distribute health care resources so that the system will achieve desired health outcomes for all people
- health planning experiments in the US
- certificate of need statutes (CON)
8
Q
cost containment: competitive approaches
A
- competition refers to rivalry among sellers for customers -> technical quality, amenities, access or others
- demand-side incentives
- supply side regulation
- payer-driven price competition
- utilization controls
9
Q
cost containment under health reform
A
- medicare payment cuts to providers
- new taxes imposed
- reforms contributed to a health care spending slowdown
- tightening provider payment rates
- providing incentives to reduce costs
- medicare projected to spend $1 trillion less by 2020
10
Q
access to care
A
- key implications of access for health and health care delivery
- access to medical care, along with environment, lifestyle, and heredity factors
- access in a benchmark in assessing the effectiveness of the delivery system
- measures of access reflect if delivery is equitable
- access is linked to quality of care and efficient use
- framework of access
11
Q
five dimensions of access
A
- availability
- accessibility
- accommodation
- affordability
- acceptability
12
Q
4 main types of access
A
- potential access
- realized access
- equitable or inequitable access
- effective and efficient access
13
Q
measurement of access
A
- current status of access
- using conceptual models access is measured at 3 levels
- individual
- health plan
- delivery system
14
Q
affordable care act and access to care
A
- insurance coverage and access to health care have increased
- fewer report problems with medical bills and financial barriers
- gaps in access to and affordability of care
- preventive services without cost sharing expanded
15
Q
quality of care
A
- IOMs quality implications:
- quality performance has a range from unacceptable to excellent
- focuses on services provided by the health care delivery system
- quality may be evaluated from the perspective of individuals and populations or communities
- emphasis on desired health outcomes
16
Q
with managed care, the balance of power shifted towards
A
- providers- health care professional
- supply side- health care facilities
- demand side- patients**
- risk shifts to providers
- supply side and providers are on one side of the equations and demand side and patients are on the other
- third party of the demand side is insurance
17
Q
dimensions of quality
A
- micro view focuses on services at the point of delivery and their subsequent effects:
- clinical aspects
- interpersonal aspects
- quality of life
-macro view looks at quality from the standpoint of populations
18
Q
quality assessment and assurance
A
- quality assurance is based on the principles of total quality management (TQM)
- referred to as a CQI
- donabedian model
19
Q
Donabedian Model**
A
- three parts of quality assessment
- structure- the capacity to delivery quality -> building, staff, finance, equipment
- process- how health care is delivered -> transaction between patients and providers
- outcome- effects or results obtained -> effects on the health
20
Q
processes that improve quality
A
- clinical practice guidelines
- cost-efficiency
- critical pathways
- risk management
21
Q
public reporting of quality
A
- CMS programs on quality
- AHRQ quality indicators
- states public reporting of hospital quality
22
Q
CMS programs on quality
A
23
Q
AHRQ quality indicators
A
-prevention, inpatient, patient safety, and pediatric
24
Q
3 objectives of affordable care act and quality of care
A
- make health care more accessible, safe, and patient centered
- address environmental, social, and behavioral influences on health and health care
- make care more affordable
25
Q
affordable care act and quality of care
A
- organizations are incentivized to provide high quality care in 2 ways:
- penalized for failing to report quality measures
- sharing in the savings generated by quality measures
- the number of patients safety and medical errors has decreased since 2010
- patient centered outcomes research institute (PCORI)
26
Q
summary
A
- increasing costs, lack of access, and quality concerns pose the greatest challenges
- lack of universal coverage negatively affects the health status of uninsured groups
- access to medical care is one of the key determinants of health status
- health care quality at the micro and macro levels
27
Q
financing equation
A
- Cost of health care = (cost for each health care service) x (how often that service is utilized)
- E = P x Q
- insurance extension to uninsured increases health care expenditures (E)
- insurance with payment (price=P) influences supply
- insurance and supply of services determine access and service utilization (quantity of services consumed = Q)
28
Q
high quality care
A
- achieved when: accessible services are efficient
- cost effective
- provided in an acceptable manner
