Lecture 3

Question 1

explain the difference between the EMS system in the united states and in france

Answer 1

french EMS = SAMU

in US, ambulance teams are paramedics. transported to the closest hospital

in france, the patient is treated at the scene and transported to a speciality hospital – one that best suits their condition. not necessarily just the one in closest vicinity like they do in US

Question 2

differentiate between the per capita healthcare spending of the french and of americans

Answer 2

french — around $3400/person a year

america – around $11000/person a year

and there’s STILL 46 million americans that are uninsured

Question 3

why are smart cards easier to implement in france than the united states?

Answer 3

we haven’t done it for security reasons. also, france has a single payer (for the most part. there is a private sector but very small) so it’s easier to link everything

Question 4

explain what an insurance rider is.
are they prominent in the US?

Answer 4

YES they are prominent in the US.

adjustment or add on to a basic insurance policy. person gets to purchase additional coverage.
in our system. dental, vision, alt health, behavioral health are ALL insurance riders to us

Question 5

what is the insurance rider of medicare?

Answer 5

medigap

Question 6

what was the 1st law to require all health insurance policies to meet basic requirements, namely MENTAL HEALTH COVERAGE at a basic level?

Answer 6

obamacare

Question 7

true or false

behavioral healthcare goes beyond mental health care

Answer 7

true

Question 8

true or false

in america, behavioral healthcare is already included in most plans

Answer 8

FALSE – mostly sold as a rider

Question 9

true or false

france has a lower infant mortality, a higher average life expectancy, and lower rehospitalization rate than the United States

Answer 9

TRUE

Question 10

what can attribute to France having a lower rehospitalization rate than the United States?

Answer 10

better access to primary care

Question 11

true or false

in France, citizens have coverage from the age of 7 years old

Answer 11

false – from birth

Question 12

what do the french call their healthcare system?

Answer 12

social security — but it is NOT socialized medicine

Question 13

does france have a long wait list to see a specialist? do they have gatekeeping?

Answer 13

no to both

Question 14

does france have a network system?

Answer 14

no

Question 15

explain what a facility fee is.
do they exist in america?

Answer 15

facility fee – charge that has to be paid when you see a dr at a clinic that isn’t owned by the DR. only applies when the patient is utilizing an INPATIENT facility.

yes, they are legal in America and it is a major problem. it can be up to 20%.
the cost of the actual service isn’t that expensive, but the facility fee can get exorbitant

Question 16

what is rehospitalization?

Answer 16

the rate at which patients are readmitted into the hospital following a medical event such as a surgery

Question 17

name 2 methods to try to keep rehospitalization numbers low

Answer 17

MR and TOC

medication reconciliation and transition of care

MED REC – service performed by pharmacists. chain pharmacists can partner with hospital pharmacists to do medrec. developing list of discharged meds, making sure meds are up to date and consistent with what drs ordered

TOC = transition of care. ie: pt moving from one part of the system to another (hospital to medical home to nursing home, etc)
often times, the patient is not kept track of. med rec is very useful in these circumstances

Question 18

what is the transition of care solution related to pharmacy

Answer 18

MED REC

Question 19

What happens if a hospital has a high rehospitalization number?

Answer 19

they get flagged – get less payment
VALUE IS TIED TO PERFORMANCE
value based pay