Module 5 lecture, part 2 Flashcards
How does the US have an imperfect market?
It’s a quasi-market where HC is partially managed by free markets
It deviates from free market principles
Who is the 1st party?
Pt
Who is the 2nd party?
The provider
Who is the intermediary third party?
Often, the insurance
What problems can arise with having an insurer as a third party?
A wall of separation between financing and delivery
Quality of care and price is a secondary concern
What occurs in a free market HC system?
Multiple pts and providers act independently, and pts can choose to receive services from any provider.
The price of services is determined by the forces of supply and demand
Pts should have info about the appropriateness of various services
Pts directly bear the cost of services received
How does the US HC system deviate from free market principles in terms of healthcare plans?
Consolidation of pts into health plans has the effect of shifting the power from the pts to the administrator of the plans.
The health plans are the real buyers in the market, and pts have a limited choice of providers.
Describe the concept of moral hazard
Once enrollees have purchased health insurance, they will use HC services to a greater extent than if they were to pay for the services out-of-pocket
How does the US HC system deviate from free-market principles in terms of prices?
Prices are determined by the payers, such as MCOs, Medicare, and Medicaid, not by the forces of supply and demand.
How does the US HC system deviate from free-market principles in terms of providers?
Providers have formed alliances and integrated delivery systems on the supply side as well.
How does the US HC system deviate from free-market principles in terms of information and decision-making?
It is very difficult for pts to obtain info and understand the appropriateness of various medical services.
Decisions by HC use are often determined by the need or the amt of medical care that medical experts believe a person should have to remain or become healthy, rather than by price-based demand
From where can artificial demand be created?
Pts’ self-assessed need, moral hazard, and practitioners’ financial interests (aka provider-induced demand)
When there are multiple payers and different plans for companies, what is the result?
A billing and collection nightmare
System becomes more cumbersome
What is a single-payer system?
A national HC system where usually the primary payer is the gov’t
What are the multiple players in the system, and what is the result of that?
Big business
Gov’t
Labor
Insurance companies
Physicians
Hospitals
Fragmented self-interests at odds
In what admin costs does the US spend far more on?
Billing
Rebilling
Collections
Bad debts
Maintaining medical records
Expand on the litigation risks of the US HC system?
The US is a litigious society
This results in expensive malpractice insurance and practitioners engaging in defensive medicine
-Prescribe diagnostic tests, return checkups, documentation
These practices are costly and inefficient
Describe the aspects of high tech in a HC system
Creates demand for new services despite high costs
Competition on the basis of having high tech
With capital investments, must have utilization
What are the three broad categories of medical services?
Curative
Restorative
Preventative
The continuum of services is not confined to ____
Hospital and physician’s office
How is there a lopsided health care continuum?
Heavier emphasis on specialized services
What is involved in the quest for quality?
Higher expectations
Quality standards with compliance
Continuous quality improvement
Characteristics of the National Health Insurance (NHI), Canada
Gov’t finances HC through taxes
Care provided by private providers
Gov’t consolidation of financial, insurance, and payment
Characteristics of National Health System (NHS), Great Britain
Financing: a tax-supported NHI
Gov’t manages the infrastructure for delivery
Gov’t operates medical institutions
Providers: gov’t employees or tightly organized
Characteristics of Socialized Health Insurance (SHI), Germany, Israel, Japan
Financed through gov’t-mandated contributions by employers and employees
Sickness funds collect contributions and pay providers
HC delivered by private providers
Gov’t exercises overall control
How many countries by 2012 had some form of universal coverage?
25 of the wealthiest, except the US
What are the 3 basic models of universal coverage?
National Health insurance
National Health System
Socialized Health Insurance
What are the components of the systems framework?
System foundation, system resources, system processes, system outcomes, and system outlook
Definition of system foundation
Historical, cultural, social, and economic factors that explain the current structure
What are two types of system resources?
Human
Non-human
Definition of system processes
What the HC system does or what happens in the system
Definition of system outcomes
The critical issue and concerns surrounding what the health services system accomplishes or not accomplishes
What are the main outcome criteria?
Access
Cost
Quality
Definition of system outlook
Future projections of desired system outcomes
