notes on paper about problems with healthcare Flashcards
Despite using fewer resources than peer countries, US spends … on health care bc we pay so much for the same products and services
- “There is no evidence that this increased spending gives better outcomes”
- our health outcomes are actually worse than in other similar countries
In the US, there is a 54% rate of burnout among physicians, which is … that in other occupations
We have worse … health outcomes than other wealthy nations
double;
double;
child;
In a report examining performance of health care systems in rich democracies, US ranked last in …, … and health care … and 10th in … efficiency
access;
equity;
outcomes;
administrative
… rate in the US is much worse than other developed nations
- this rate has been falling in much of the developed world but is rising in the US
US citizens actually use health care services … than people in Europe or Canada, so … is not why we pay so much more
- Economist Uwe Reinhardt and peers wrote a paper documenting the much higher cost of health care in the US
- A new paper in 2019 showed that we still pay so much, even though the US provides … per capita
maternal death;
less;
overuse;
fewer resources
“another important factor causing our excess costs is the huge amount spent in the United States on … Our health insurance companies take about 12% of the entire health care expenditure, while a similar amount is spent by physicians and hospitals on billing and collection and compliance with varying mandates.”
Burnout among physicians in the US is a new thing. A few decades ago it wasn’t this prevalent
administrative overhead
Clinical significance of high cost of insurance/health care:
- even with advanced medical care, if people can’t afford it, it’s useless
- health insurance adds significantly to cost of health care in the US without adding …
- physicians and patients both suffer bc of the insurance system
… brought about the shift to employer provided health insurance. Companies began offering paid health insurance instead of …
value;
WWII;
increased pay
Employer based health insurance is not common outside of the US. has many cons:
- …. of the insurance is largely hidden from the recipients
- some employees who have illnesses/ill loved ones can’t change jobs for fear of …
- choice of health care plans is limited by what the company … rather than what’s best for the employee
true cost;
losing their insurance;
offers
Employer based health insurance is not common outside of the US. has many cons:
- … at a disadvantage when purchasing health insurance
- “As the cost of health insurance has risen, fewer employers are offering insurance to their employees, and this clearly hits lower-paid workers hardest”
- the majority of people ensured by employer sponsored coverage are people above the …
small businesses;
federal poverty level
non profit insurance companies also tend to act like the for profit ones, paying high … and large …
executive salaries;
surpluses
Insurance companies “require doctors and hospitals to supply data documenting that they do the things that the insurers have decided reflect …”
- the things that matter to patients, such as how well a patient is walking 6 months after surgery, are rarely looked at”
the clearly harmful effect of these pointless insurance mandates is their enormous contribution to the increasingly recognized problem of …
quality care;
physician burnout
- International Classification of Diseases code is enabling some insurance companies to not cover ED costs for patients when the case turns out to be …
- Author argues that a reasonable person approach should be used. He gives the example that if a patient has chest pain they should go to the ER and that visit should be covered, even if it turns out to be …
non-urgent;
insignificant;
- Author argues that health insurance policies should be similar to other types of insurance and cover more expensive things like hospitalizations and surgery. He states that cheaper things like low cost medications and routine visits should be paid for out-of-pocket.
- Principles that he thinks any new health insurance system should include:
- All legal US residents should be covered
- Costs should be lower
- … burden on health care professionals needs to be lowered
- There must be something in place for patients to realize that health care is not actually “free” so that the … for care doesn’t exceed the ability to provide and pay for It (like maybe patients visiting quite frequently even for minor issues)
Administrative;
demand;
- hospital costs in the US are …/… what they are in comparable Western democracies, without better outcomes
- there is needless … of services even though consolidating complex procedures in fewer centers results in better outcomes
- hospitals are increasingly using employed physicians and … independent practices with much higher charges for the same services resulting
double; triple;
duplication;
buying;
- Despite the proven value of a robust primary care-centered system, the US depends too much on … with their attendant higher costs
- clinical guidelines are often based on poor quality evidence and the guideline writers have many conflicts of interest
- the best diagnostic and therapeutic interventions are of no use if they are not available to patients
- our current health insurance system leaves too many Americans without access
- much higher cost of hospitalization in the US is not due to …
- great variation in hospital charges in the US
- US hospital costs are rising faster than around the world
specialists;
longer stays;
part of why US hospitals are so expensive is due to the amount of …
- a lot of this administration exists due to the demands of the health insurance system
…. is also driving up prices
- each hospital in the same area offers all advanced services - competition
administrative overhead;
duplication of services
“the backbone of a good health care system is an adequate supply of …”
- having this also contributes to …
- “the best medications or other treatments are only effective if used, and patients with a trusted personal physician are much more likely to comply with suggested treatments”
primary care physicians;
continuity of care
only …% of physicians are in primary care in the US
shortage of primary care physicians leads to a system where patients now have to … to see a doctor immediately and really have their concerns heard and spend more time with their physician
- this is unaffordable for most Americans
“Even though talking to patients may be the most valuable thing a doctor can do, because it does not have a high-value billable code, it is done less and less.”
- patients in the US pay much more for medicine than in any other country
- high costs of medications leads to … with meds - patients cut or skip doses bc they can’t afford it
- “drug firms like to cite the high cost of research and development but spend more on … than on research and development”
- also spend a lot on political lobbying
lack of compliance;
marketing
- .. are very high priced and we don’t have a plan for how to pay for them
- Americans don’t use more meds than citizens from other nations, but spend a lot more on them
- a lot of the research that these companies do isn’t even innovative, but is really just about … with other companies
- “another common product of the industry, whose primary goal is profit, is brand-name combination drugs that put 2 cheap generic medications into a fixed-dose combo sold at a much higher price”
gene therapies;
competition
… used as another tactic to produce sales - causing meds that are still fully effective to be thrown out for compliance purposes
the … between getting a drug from the manufacturer to the patient also ramps up prices
- people who provide warehouses and trucks
- … - decide what patients are going to pay for a prescription
- conflicts of interest
- can charge patients extra money than the drug might cost, using co-pays for profit
expiration dates;
middlemen;
pharmacy benefit managers
- cost of malpractice insurance ends up being passed onto …
- “The at-fault litigation-oriented system in the United States results in … before patients are compensated for harm and too much money going to lawyers and litigation expenses rather than to patients who are injured. Even cases closed with no payment made to any party generate costs averaging $36,000. This system also means that when lawyers anticipate relatively low payment, they are reluctant to take on a case even when malpractice is clear-cut.”
- “… medicine”
- doctors are trying to cover all their bases to ensure they won’t be sued. a lot of this entails ordering an abundance of tests to confirm the diagnosis, making medical care more expensive
- costs billions per year
- malpractice … in some states has limited this
- doctors are trying to cover all their bases to ensure they won’t be sued. a lot of this entails ordering an abundance of tests to confirm the diagnosis, making medical care more expensive
patients;
long delays;
defensive;
payment limits
This malpractice system also makes doctors and nurses scared to report an adverse event or near misses that could help improve the system by …
author argues that Massachusetts Communication, Apology and Restitution model (CARe) is effective:
- … with patients and families when unanticipated adverse outcomes occur
- … and explain what happened
- implement systems to avoid … of incidents and improve patient safety
- where appropriate, apologize and offer … on without the patient having to file a lawsuit
learning from these mistakes;
communicate;
investigate;
recurrences;
fair financial compensation
Benefits of electronic medical records
- paper records can be illegible, can be lost, …
- it can be hard to find the info you need in a paper record, can’t just use a …
- “the problem was that in the rush to switch and earn the federal largesse, adoption followed the maxim ‘ready, fire, aim.’ What we have seen is a proliferation of EMRs that mimic the old paper chart and that are primarily aimed at … rather than patient care.”
misfiled;
search bar;
billing
EMR:
- the necessity of remaining in compliance with federal mandates leads to … that don’t improve care. oftentimes, providers won’t be making … with patients bc they’ll be too focused on inputting data
- EMR is supposed to theoretically catch … errors, but there are a lot of false alarms, so most ignore this
long notes;
eye contact;
prescribing
EMRs contributing to …
“Doctors (and regulators) must insist that EMRs be designed primarily for … rather than billing and administration. Information must be readily and easily transmitted between different systems”
burnout;
patient care
argues that we need to make streets more accessible for … and …
also things there should be better … and better …
walking;
biking;
social services;
amternity leave
“There is now evidence that patients with cancer and end-stage heart failure live longer when enrolled in … and other … programs”
hospice;
palliative care
