Lecture 2/Chapter 3 Flashcards
US health care
- shaped by anthro-cultural values and social, political, and economic antecedents
- evolution of medical science and technology
- reform has taken center stage in American politics
- tracing the transformations in medical practice
medical services: preindustrial era: colonial times
- colonial times in America
- medicine lagged behind other countries
- treatment attitudes emphasized natural history and common sense
- strong domestic character
- community based*
- personal interactions with pts.
- doctors are not well respected yet
- bartering/trading
medical services: preindustrial era: 5 factors making medical profession an insignificant trade
- medical practice was in disarray -> no organization
- medical procedures were primitive -> no license or credibility
- institutional core was missing:
- almshouse and pesthouse- isolating sick people so healthy people dont get sick
- mental asylum
- dreaded hospital- hospital was a place to go and die
4. demand was unstable -> fee for service -> no standardization - medical education was substandard
medical services: postindustrial era: physicians
- delivered scientifically and technically advanced services to insured patients
- became an organized medical profession -> med school
- certifications and licenses
- gained power, prestige, and financial success
- health care took its current shape during this period
- need for healthy workforce for health care factories
7 factors in professional sovereignty growth
- medical services: postindustrial era
- urbanization
- science and technology
- institutionalization- hospitals
- dependency- gatekeeping, referrals
- autonomy and organization
- licensing- met a standard -> qualified
- level of public safety and competence increases
- educational reform
medical services: postindustrial era
- specialization in medicine -> gatekeeping -> managing costs, primary doctor referrals, dependency
- reform of mental health care
- development of public health
- health services for veterans
- birth of worker’s compensation
- creation of Medicare and Medicaid
- regulatory role of public health agencies
rise of private health insurance
- medical services: postindustrial era
- technological, social, and economic factors
- early blanket insurance policies
- economic necessity and the Baylor plan
- successful private enterprise
- self interest of physicians -> guarantees pay for their service
- combined hospital and physician coverage
- employment based health insurance
- health people pay a small amount each month to benefit the sick
- profitable -> big business
- premiums are adjusted based on health, age
failure of national health care initiatives during the 1990s
- medical services: postindustrial era
- political inexpediency
- institutional dissimilarities
- ideological differences- illness vs. wellness
- tax aversion
medical care in the corporate era
- early developments
- HMO act of 1973
- corporatization of health care delivery
HMO act of 1973
- federal funding for the growth of HMOs under the belief that prepaid medical care (instead of fee-for-service) would stimulate competition among health plans, increase efficiency, and control rising health expenditures
- Employers with 25 or more employees have to offer an HMO alternative
- Was not taken seriously by employers until 1980 when their own health insurance started to grow rapidly
- cooperate era
corporatization of health care delivery
- managed care organizations (MCOs)
- managed care gave you options on where you can go
- more choices based on what you pay
- managed access
- basically indistinguishable from large insurance corporations
- 100,000s people to treat
globalization of health care
- corporate era
- 4 modes of economic interrelationships
- telemedicine
- medical tourism- things not approved by the FDA -> travel to get procedure done
- foreign direct investment in health services
- health professionals move to other countries
- 3 aspects:
- US corporations expanded overseas
- medical care by US providers in demand overseas
- global health discipline
era of health care reform
- age of managed care
- increasing access to resources, health care, treatment -> until the point you cant anymore! -> managed care
- controlling cost, access, quality
- affordable care act
patchy legacy of the ACA (2010)
- partially reduced number of uninsured American’s
- Medicaid accounted for roughly 60%
- 40% attributed to income based federal subsidies
- required residents to have minimum coverage or pay penalty tax -> penalties were less than the actual health insurance -> fail
- many americans did not benefit
- prospects for new reforms
summary
- need for health insurance recognized the great depression
- US insurance began as a private endeavor
- creation of medicare and medicaid
- ACA passed without seeking consensus among americans
- provisions helped low income americans obtain insurance
- put greater financial burdens on the middle class
- insurance began as private until medicare/medicaid 1965
medicare/mediaid
- very important to health care income
- half the income of a health care institution
medicaid
- need based
- cant afford to have insurance
- state by state
- state directly determines the benefits
- federal state gives money to medicaid to fund it
lobbying
influence legislative on a state level
four main eras in the US health care evolution
- preindustrial- consumer sovereignty
- postindustrial- professional dominance -> urbanized
- between the business leaders and providers
- corporatization- corporate dominance -> networks and systems
- between insurance companies and providers
- health care reform- government dominance
6 factors in passing the affordable care act
- democratic party held presidency and majorities in congress
- control of the executive and legislative branches
- closed door deliberations
- benefits were overstated
- backing of major industry representatives
- Obama tied reform proposals to economic growth
- market place -> insurance rates -> failure
specialization in medicine
- postindustrial
- a hallmark in American Medicine
- 58-:52 specialist to generalist ratio
- specialized fields in allied health professions
- unlike Britain, the structure of medicine in the US did not develop around a nucleus of primary care, but…
- the gatekeeping model can be seen in HMOs
- initial contact with general practitioner required for a referral to a specialist
- in the US -> specialist > general
- in other countries -> general > specialist
- restricts access
- gatekeeping
- managing costs
Baylor Plan
- specific hospital in Texas
- the teachers in the school need to be healthy to teach the kids
- each teacher will pay $3 a month to the hospital and all healthcare will be free
- this is what blue cross blue shield is based upon
groundbreaking medical discoveries
- 1846- anesthesia
- 1847- aseptic technique- identifying microbes
- 1860- sterilization techniques
- 1865- antiseptic surgery
- -1895- x-ray imaging*
- 1929- penicillin
development of public health
- public health in the US developed in response to deadly outbreaks of communicable diseases
- separate from private practice of medicine
- due to physicians skepticism of controlling private medical practice
- private practices focus on the individual (not community)
- smallpox
- public health = community
- controlling deadly disease
creation of medicare and medicaid
- increase access to health care immensely
- before 1965, only private insurance was widely available
- politicians believed there would be loss opposition for programs targeted at the underprivileged
- only the working middle class had private insurance
- the poor and elderly had to rely on own resources or charity
- private payers charged more to offset charity (cost shifting)
- social security amendments, 1965 created medicare and medicaid
- made it a separate fund so people dont have to sacrifice their needs over health care
- *costly for the system! -> payroll deductions to fund this
- as elderly population increases more and more funds are being taken
medicaid*****
- additional health insurance for people that didnt pay into the funds bc they didnt work
- need based
- no balance billing
- money came from federal government and given to the states
- increase access to health care
- title XIX of SSA
- federal matching funds to the states (based on kerr-kills act)
- for the indigent
- class distinction
- stigma of public welfare
- eligibility and benefits vary from state to state
medicare**
- title XVIII of the social security act (SSA)
- hospital and limited nursing home coverage (based on forand’s bill)
- covers physician bills
- no class distinction
- balance billing
- Part A of Medicare- finance hospital insurance partial nursing home coverage for the elderly
- Part B of Medicare- proposal to cover physician’s bills through government subsidized insurance
the creation of medicare and medicaid has had the greatest impact on:
- access
- not cost and quality
is the distribution of primary care vs specialty care physicians in the US healthcare delivery system well suited for implementation of the ACA
- no
- ACA focuses on getting most care to most people
- we need more primary care to do this
- solutions- gatekeeps, influence students to go towards general care
primary care vs specialty care
-US leans towards specialty care slightly