Lecture 4-7 Flashcards
Winslow (1923) defined public health as :
preventing disease, prolonging life, promoting health though environmental efforts (including sanitation measures), controlling communicable diseases, advocating health education through personal hygiene, organizing medical and nursing services for early diagnosis and preventive treatment of disease, and ensuring health as a right of every citizen
Individual vs. Population perspectives
- public health pursues a population-based, multidisciplinary approach to disease prevention and health promotion in specific at-risk populations
- medical care professionals, including pharmacists, often emphasize a patient-centered approach that focuses on the individual
Public Health Model
- WHO defines health as “ a state of complete physical, mental and social well-being, andnot merely the absence of disease or infirmity”
- An ability to function in the roles that one desires
- a healthy society
Public health Core functions
- Assessment
- Assurance
- Policy Development
Epidemiology
- ## framework for reporting health statistics, such as the causes of death or the prevalence of health problems
High income countries
chronic diseases (diabetes and dementia) are the leading causes of death
Middle-income countries (concerns)
chronic diseases are major causes of death
- two other leading causes are tuberculosis and road traffic accidents
Low-income countries (concerns)
infectious diseases, lung infections, diarrheal diseases, HIV/AIDS, tuberculosis and malaria are the major causes of death as well as complications in pregnancy and childbirth
High Income Countries (risk factors)
- tobacco use
- alcohol use
- obesity
- high blood pressure
- high blood glucose
Middle Income countries (risk factors)
- alcohol use
- high blood pressure
- tobacco use
- obesity
- high blood glucose
Low income countries (risk factors)
- children underweight
- unsafe water
- poor sanitation + hygiene: unsafe sex,
- suboptimal breastfeeding
- indoor smoke from solid fuels
Health Disparities
differences found because of such factors as racial or ethnic differences, sexual orientation, and socioeconomic status
Minority Health and Health Disparities Research and Education Act of 2000
health disparities as differences in “the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates.
Pharmacists have important roles in
- Disaster/crisis response planning
- Providing services at disaster sites
- Participates in bioterrorism detection activities
- Planning in their own work settings (hospital, community, etc.)
Prevention
- Abstract
- Tough to identify successes
Treatment
- Concrete and observable
- Historically more “prestigious”
- Economically more profitable
Primary Prevention
Immunizations; prevent it before it happens
Secondary Prevention
Early detection and prompt treatment: screening (only when the disease is present)
Tertiary Prevention
Limitation or reduction of disability: cardiac rehabilitation programs (trying to get the patient back to where they started)
- trying to prevent it from getting worse
Traditional Disease Prevention Model
- Environment at top
- Host at bottom left
- Agent at bottom right
Prevention occurs when these relationships are broken - Time in the middle
Contemporary Disease Prevention Model
- Causative factors at the top
- Population characteristics on the bottom left
- Environment or culture on the bottom right
- Time in the middle
Average reading level
6th to 8th grade
Health Literacy
- the degree to which an individual can obtain, process, and understand basic health info and services and make appropriate decisions
Compliance
the degree to which an individual complies with a prescribed regimen is often referred to as adherence
- Ways to measure compliance
- ask patient about their medication
- pill-count
- predict the time when a refill should be needed
- therapeutic outcomes
- drug level in the body
Nutrition/ Exercise and Disease
- public health approaches to encourage populations to eat healthy and to be active can be a part of the pharmacy public health of the future
Economics
the study of how individuals and societies allocate their limited resources in attempts to satisfy their unlimited wants
Supply and Demand
interact to determine the market prices for commondities (goods and services)
Utility
The economic term for satisfaction obtained from consumption of a good (or service)
3 basic resources
Natural Resources (land)
Labor
Capital (money, physical resources)
Cost
Proportional to constraints
Value
determine by marginal utility
Marginal utility
satisfaction obtained from receiving one more of a good (service)
- depends on the personal desire for one more unit of the good or service
Law of Diminishing Marginal Utility
The satisfaction received by obtaining 1 more unit of a good declines as one consumes more of it
Law of Demand
the quantity demand is inversely proportional to its price. As quatity increases price decreases and vice versa
Demand Schedule
Shows the relationship between amounts of goods that consumers are willing to purchase and the possible prices over a specified period of time
If you change the demand
the entire curve shifts
Must distinguish between terms
Change in quantity demanded is different than change in demand (curve)
Change in quantity demanded
moves along the demand curve from point A to point B
Change in demand
is when the entire curve shifts (ex: from left to right)
Factors that change the demand environment
- Prices of related goods
- Financial income of the consumer
- Number of consumers in the market
- Attitudes, tasted and preferences of the consumer
- Consumer expectations with respect to future prices and incomes
Substitutes
Prices of one good is directly related to the demand for another
(beef and chicken / coffee and tea)
Complements
Price of one good is inversely related to the demand for another
(printers and toner cartridges)
Superior Goods (or normal)
- Demand increases for a good as income rises
Luxury cars, second homes
Inferior Goods
Demand decreases for a good as income rises
used cars, store brands
Law of Supply
as the price individuals are willing to pay for a product increases, more of the product will be supplied to the market. The quantity and price have a direct relationship. As quantity increases so will the price and vice vera
Factors that change supply environment
- Techniques of production, including technology
- Number of sellers in the market
- Resource costs (material and wages)
- Prices for related goods
- Sellers’ expectations
Joint Products
Goods that are almost always produced together
Beef and leather
Market of equilibrium Price
price where the demand curve and supply curve intersect
Elasticity
measures the responsiveness of consumer demands to a change of price
- sellers can maximize their revenue by decreasing price
Elasticity
If price increases, revenue decreases. Inverse relationsjip
Inelasticity
if price increases, revenue also increases
Unitray
not found in any markets
The more substitutes for a product
the more elastic the demand
A purchase that accounts for a large portion of a persons income
will be more elastic than the demand of relatively inexpensive one
Four types of market structure
- Perfect competition
- Monopolistic Competition
- Oligopoly
- Monopoly
Perfect Competition
- Many buyers and sellers
- Freedom of entry and exit
- Standardized products
- Full and free info
- No collusion
Many buyers and sellers
- number of buyers and sellers must be large enough
- companies do not set prices, the market does
- the demand curve is perfectly elastic where is a firm increased its prices, it would lose all its revenue bc other people would buy from a different firm
No collusion
- Firms compete against each other rather than get together to set prices
- more likely if there are fewer sellers so that they can influence one another
Monopoly
- one seller of a product with no close substitutes
- maximize revenue by restricting supply and increasing price
Monopsony
one buyer
Monopolistic competition
- similar to perfect competition, except no standardized and interchangeable products
- firms rely on product differentiation
Oligopoly
fewer sellers and many buyers
- firms are frequently interdependant
The Health Care Market
- not a perfectly competitive market bc :
- numbers of buyers and sellers
- entry to and exit from market
- variation in products, services and quality
- full and free information
- inelastic demand (prices increased so has demand)
- universal demand bc healthcare is used by all
Moral Hazard
decreasing patients out of pocket expenses, demand and consumption are increased
Ex: You want a ferrari and someone says they’ll pay 90% of it so you will get the car bc your out of pocket cost wont be as much
Utilization
based on population effects, duration of treatment and intensity of services
Value
(Quality/Cost) * Quantity
Hospital Insurance
An insurance decreased financial barriers to hospital care, demand for care (and hospital beds) increased
1930
Large medical group practice in LA started a plan to cover physician services
1939
California Medical Association established the first “Blue Shield” to facilitate payment for medical services (reimbursed a %)
Major Medical Insurance
by the 1950s, most employee health plans were accepted
Indemnity Insurance
Reimbursement of a percentage of expenses to subscribers rather than direct payment to providers
Drawbacks: patients had to save receipts, fill out forms, and it was expensive for insurance companies to process
Fee for service
A set amount of money was paid in order to receive the service provided
Private Insurance
Supported and reinforced existing patterns of health services
Neglected: prevention and there’s care for those not covered
More utilization resulted in
more revenue
Ex: more MD office visits and lab tests increases revenue
3rd Party Payer
May suggest that there are only three parties involved but its far more complicated
- Many stakeholders like:
Patients, Employers, Unions, Insurance companies, Providers, Government
Actuarial Analysis
a statistical analysis of the population served and an estimate of the necessary income to cover the estimated expenses
PMPM
Per member per month
- Necessary income to cover expenses
Purpose of Insurance
- to help individuals and business manage certain types of unanticipated risk (ex: serious injury, premature death)
Premium
paid by all participants for protection against a larger unknown lose
Catastrophic hazards
- events that if covered would exceed the company’s ability to pay
- companies limit their exposure by avoiding insuring large numbers of policyholders in the same geographic area
- this is probably a preventative measure just in case their is a catastrophe and they will have to pay out a lot of money
Adverse selection
getting insurance right before you need it and dropping it when recovered
- raises premium for policyholders
Supplier-induced demand
a person paid for a service determines how often the service is provided- potential conflict of interest
The insurance problem of moral hazard is directly related to which economic principle
Demand because as the price goes down, the demand increases and this is the concept of moral hazard
Coverage Limitations
- limitations may be placed on how much or how often it will be reimbursed
- this allows insurance companies to avoid adverse selections and minimize costs
Coordination of Benefits
when a loss is covered by two or more insurance plans in order to limit total reimbursement to the amount of the loss
Copayment
a specified amount every time a service is received, most common type of cost sharing
Deductible
patient pays of out pocket a specified amount periodically (annually) before the plan even kicks in
Co-insurance
patient pays a specified fixed percentage of a service (usually 20%)
Subrogation provision
determines the order in which overlapping insurance plans will pay
