Midterm Study Flashcards
Initially, does the quality of care go up as you spend more on care?
Yes
After a certain point, the quality-of-care plateaus even if you spend more
The goal is to not fix the plateau, but rather, to raise up the whole graph (the only way we can improve the care we provide without exponentially raising cost)
Can be done if everyone follows the standard of care
What are the ways that we can improve healthcare?
More effective – better outcomes
More efficient – using fewer resources
Between 1960 and 2008, was the cost of healthcare raising more than the cost of everything else (GDP)?
Yes
The gap increased over time, which explains why there ended up being 44 million people uninsured
As the cost of care rose, the fewer number of people insured
The cost of healthcare rose faster than GDP and it became less affordable
Did the affordable care act control cost?
No
Cannot discriminate against people with preexisting conditions
Government will subsidize the cost of insurance for those who don’t have it
Overcame the challenge of financial access
Currently (2023), what percent of its GDP does the United States spend on healthcare?
17.6%
What does GDP stand for and what does it mean?
The total monetary or market value for all goods and services produced within a country in a specific time period
What area accounted for approximately 32% or 1/3 of healthcare spending?
Hospital care
What are the two key ideas underlying the concept of insurance?
Risk is transferred from the individual to the group, and cost sharing of any covered losses incurred by the group members
What are some of the more significant factors that are driving up healthcare cost?
New technology, aging population, etc.
What is the difference between the effect of malpractice lawsuits and the impact of defensive medicine?
Lawsuit has minimal impact, but the fear does (people want to protect themselves) - defensive medicine has more of an impact (drives overutilization)
How do the number of specialist and/or hospital beds in an area impact cost?
In communities with more specialists, there are more of those procedures occurring (more OBGYN, more obstetric procedures)
The more beds, the higher the cost
Greater availability per person = more of a likelihood to use the beds when they come in (overutilization which drives up cost)
Each procedure has their own risk, always a window for something to go wrong
Only want to do it if absolutely necessary, if you don’t, you’re exposing the patient to greater risk
Confronted with healthcare cost rising at a greater pace than GDP, officials trying to fund public programs like Medicare are left with what two economic alternatives?
Decrease access and/or reduce reimbursement rates (or maybe raise taxes)
*trying to control the cost of healthcare
Between 1960 and 2006 gap between health care spending and GDP was 2.5 percentage points per year. How has this gap contributed to a large percentage of the long-term decline in coverage?
Because healthcare became less affordable over time, people couldn’t afford it anymore
What are the three categories of payment sources for healthcare in the US?
Private
Public
Out-of-pocket
What is the continuum of managed care?
HMO (R) plans have complete control over cost and quality (bear the cost and provide the care) and indemnity (L) is on the other end (need to know the provisions to really know where the plan falls on the continuum)
What are the changes related to the demand for and use of health insurance over the past 100 years discussed in the text?
Increased demand in there being greater accessibility to insurance, as a consequence you have greater access to care and greater cost
Most health insurance coverage included a comprehensive set of benefits, most frequently including hospital stays and physician care as well as other types of services
Both the public and private sectors began to expand, we now have a means for paying for care
Group health insurance policies began to be offered as an employee benefit (fewer people taking out individual policies)
We have retrospective and prospective reimbursement systems
Cost of care began to rise
Pertaining to the model discussed in class, what eventually happens to healthcare outcomes (quality) as healthcare cost increase and what does shifting this curve up represent?
It eventually plateaus as cost continues to increase
Shifting the curve up will ensure higher quality of care at every price point
Being efficient and effective is how you shift the curve up, this responsibility falls on the providers
What were some of the key characteristics of the uninsured population in the US in 2008?
The percentage of individuals without health insurance coverage varies across states (more in the south and west)
They use healthcare systems in different ways (do not typically have a PCP, delay seeking care until they are sicker, they utilize the ER to access to care system, all of which results in serious financial consequences with many unable to pay their medical bills resulting in medical debt
The cost of insurance and job loss are also major contributors to being uninsured
What does it mean to gain access to care and what are the facets that determine real access?
Gaining access is the key
There is a distinction between having access and gaining
Gaining access is dependent on financial, organizational, and social or cultural barriers that limit utilization of services
How do the majority of Americans get their healthcare insurance?
Through their employer
What has been happening to employer based insurance over time and has the Affordable Care Act changed that trend?
ACA has had no impact on employer coverage
Might change due to a new provision, the cadillac tax, which will tax high cost employer-sponsored health plans. (however it was repealed before it ever took effect, was supposed to help manage cost of care through ACA)
From the lecture, when was the “great divide” in healthcare reached and what was it?
Between 1910 and 1912 when, for the first time, a random patient with a random disease consulting a doctor chosen at a random time stood better than a 50-50 chance of benefitting from the encounter
Patients had ever increasing expectations after this point
What two issues related to health policy have been central issues concerning healthcare since the early 1900s?
Financial accessibility and cost of healthcare
How far back in US history does concern about the cost of care go and have attempts been made to address it?
About 100 years ago. Invented insurance, employer based coverage, risk pooling and transfer, etc.
What factors contributed to the rapid increase in healthcare spending in the early 1970’s?
High medicare expenditures, rapid inflation in the economy, expansion of hospital expenses and profits, and changes to medical care (greater use of technology, medications, and conservative approaches to treatment)
All of the pieces were in place, but there was no control
What act was passed in response to this increase in 1973?
Health maintenance act (HMO)
What was the most significant piece of healthcare legislation in the last century?
Social security act of 1965 (created medicare)
How successful was managed care at controlling cost?
It was successful, but people felt restricted by them
What happened in the mid 1990’s that affected MCO’s significantly and what has happened to healthcare cost (and premiums) as a result?
Cost did not rise as much as we were expecting in the 1980s due to HMOs
Premiums went up as we switched from HMOs to PPOs
They are bearing greater risk, so they are charging more
*HMO is a type of MCO
What did the IOM report “To Err is Human” reveal about the US healthcare system?
Medical errors (44,000 to 98,000 people die every year)
What is the meaning of the component phrases in the IOM definition of quality?
Health services - a wide array of services that affect health (including physical and mental)
Increases the likelihood of good outcomes - reminder that quality is not identical to good outcomes (poor outcomes can occur despite the best possible health care)
Populations and individuals - draws attention to the different perspectives that need to be addressed, it means that the need of all populations to have access to necessary and appropriate services
Desired health outcomes - highlights the link between the care that is provided and its effect on health (needs to take their patients preferences and values into account)
Current professional knowledge - healthcare professionals need to always be prepared to revise their practice as new knowledge is generated
When examining quality issues, what are the four problems that present themselves and how are they defined?
underuse - too little care
overuse - too much care
misuse - mistakes in care
variation of use - variations in practice
What are Donabedians measures of quality and how are they defined?
Structure - the capacity of the health system to deliver care (number of beds, equipment, etc.)
Process - interactions between patients and clinicians
Outcomes - changes in the patient’s health status as a result of interventions
What are some examples of models of oversight?
Peer review
Accreditation
Inspection
Which part of Donabedian’s quality conception does CQI focus on?
Continuous quality improvement - focus on process (the thing that we have the most control over)
Attempts to make things better
Why is the control of variation at the heart of CQI?
It is at the heart of understanding what you’re doing in the system
Without control, variation happens on its own, and you cannot explain why you got the outcomes you did
Quality improvement should be ongoing, constantly improving
Understanding what you can control, what the possible variations are, and how you can control them
What role does measurement and metrics (statistics) play in CQI? Why is the role so critical?
Cannot really control quality without taking measurements and metrics
We need the data to be collected consistently and accurately
What is PDCA?
Plan - plan for the implementation of a process improvement
Do - implement the process
Check - study whether the process is improving
Act - determine whether the process improvement was successful
What are the common elements of quality improvement programs?
Collection of data (use of metrics) and empowering the people doing the work
What is the difference between quality assurance and quality improvement?
One is retrospective and one is prospective (improvement)
The retrospective one is not changing anything, just seeing what’s bad and removing it
Quality improvement wants to change the system so we have less bad ones at the end
What is the definition of a risk?
An exposure to the chance of injury or financial loss
Major emphasis on injuries
What are the component steps in the risk management process?
Identification of risk
Analysis of the risk (probable loss, frequency, severity)
Development of an alternative risk control and risk financing techniques
Implementation of chosen technique
Monitoring the program’s effectiveness and modifying it as risks change over time
What are some sources that can help identify risk in a setting?
Internal incident (occurrence) reports
Reports and surveys from accrediting bodies such as Joint Commission and NCQA
Risk identification aides from insurers
Professional practice guidelines
Professional ethics documents
Regulatory guidelines and requirements
Equipment maintenance and operation manuals
Walking the Beat
How does the cost of risk management for any given risk play into the equation in determining if the effort is worth it?
If it is going to cost more to manage than to endure, it is not going to be important to manage
As the risk of liability goes up, it’s probably worth spending more on
Need to find the right amount
What is the swiss cheese model?
We ensure quality by creating barriers to error
Only get an adverse outcome if it surpasses all of the barriers that are in place
What is ALARP and why is it used?
As low as reasonably practible
The level of risk cannot be reduced further without expenditure of costs that are disproportionate to the benefit gained or where the solution is impractical to implement
What is the “Duty of Reasonable care” and how does such a ‘duty” come about?
Our duty to provide the standard of care
Comes into existence when you take on a patient, doesn’t require them to pay
Is any form of payment necessary for the duty of reasonable care to come about?
No
How does ongoing training and continuing education support patient care risk management?
Allows us to provide standard of care due to learning current, updated knowledge
The two most important factors influencing a practitioner’s ability to reduce exposure to liability?
Awareness and education
What elements must be present for a tort of negligence to be viable/pursued?
A legal duty must exist between the practitioner and the plaintiff, a breach of legal duty must exist, a loss or injury must have occurred
What is the most common claim against audiologists?
Unintentional tort of negligence
What is the definition for Malpractice?
Negligence or carelessness of a professional person
They did not measure up to the standard of care
