Prof Hints for Quiz 2, part 2

Question 1

How does the US have an imperfect market?

Answer 1

It’s a quasi-market where HC is partially managed by free markets
It deviates from free market principles

Question 2

What occurs in a free market HC system?

Answer 2

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

Question 3

How does the US HC system deviate from free market principles in terms of healthcare plans?

Answer 3

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.

Question 4

How does the US HC system deviate from free-market principles in terms of prices?

Answer 4

Prices are determined by the payers, such as MCOs, Medicare, and Medicaid, not by the forces of supply and demand.

Question 5

How does the US HC system deviate from free-market principles in terms of providers?

Answer 5

Providers have formed alliances and integrated delivery systems on the supply side as well.

Question 6

How does the US HC system deviate from free-market principles in terms of information and decision-making?

Answer 6

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

Question 7

From where can artificial demand be created?

Answer 7

Pts’ self-assessed need, moral hazard, and practitioners’ financial interests (aka provider-induced demand)

Question 8

Characteristics of the National Health Insurance (NHI), Canada

Answer 8

Gov’t finances HC through taxes
Care provided by private providers
Gov’t consolidation of financial, insurance, and payment

Question 9

Characteristics of National Health System (NHS), Great Britain

Answer 9

Financing: a tax-supported NHI
Gov’t manages the infrastructure for delivery
Gov’t operates medical institutions
Providers: gov’t employees or tightly organized

Question 10

Characteristics of Socialized Health Insurance (SHI), Germany, Israel, Japan

Answer 10

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

Question 11

What are the 3 basic models of universal coverage?

Answer 11

National Health insurance
National Health System
Socialized Health Insurance

Question 12

Definition of system foundation

Answer 12

Historical, cultural, social, and economic factors that explain the current structure

Question 13

What are two types of system resources?

Answer 13

Human
Non-human

Question 14

Principles of market justice

Answer 14

Health care: economic good
Free market conditions assumed
Markets’ efficiency assumed in equitable allocation of health resources
Production and distribution determined by market-based demand
Distribution based on ppl’s ability to pay
HC viewed as an economic reward of personal efforts and achievement
Ppl know what is best for them given information
Works best with minimum interference from gov’t

Question 15

Principles of social justice

Answer 15

Health care: social resource
Requires active gov’t involvement
Assumes that gov’t is more efficient in allocating health resources equitably
Medical resources allocation determined by central planning
Ability to pay is inconsequential for receiving medical care
Equal access to medical care viewed as a basic right

Question 16

Implications of market justice

Answer 16

Individual responsibility for health
Benefits based on individual purchasing power
Limited obligation to the collective good
Emphasis on individual wellbeing
Private solutions to social problems
Rationing based on ability to pay: demand-side rationing or price rationing

Question 17

Implications of social justice

Answer 17

Collective responsibility for health
Everyone entitled to a basic package of benefits
Strong obligation to the collective good
Community wellbeing supersedes that of the individual
Public solutions to social problems
Planned rationing of health care: supply-side rationing

Question 18

Limitations of market justice

Answer 18

Principles fail to rectify critical human concerns
Does not always protect society
Market justice does not work well in health care delivery

Question 19

Describe the gatekeeping model of HMOs

Answer 19

Has been occurring since early 1900s
Initial contact with GP required for a referral to a specialist

Question 20

What were three forces behind the health insurance movement in the early 1900s?

Answer 20

Technology: advanced txs became available, but they were expensive
Social: desirability of HC
Economic: unpredictability of medical needs and costs of tx

Question 21

What prevented a national health program by blocking various attempts during the 20th century?

Answer 21

Rise of private health insurance, AMA, and related industries

Question 22

Who were the stakeholders opposed to NHI?

Answer 22

Physicians (threat to private practice) and AMA
Insurance industry (fear of lost income)
Pharmaceutical companies (fear of gov’t as a monopoly buyer)
Retail pharmacies (fear of being replaced by gov’t established pharmacies)
American Federation of Labor (AFL) (fear of loss of influence in the workplace)

Question 23

Characteristics of Medicare

Answer 23

Title XVIII of the Social Security Act (SSA)
-Part A: hospital and limited nursing home coverage (based on Forand’s bill, 1957)
-Part B: covers physician bills (based on Byrnes’ proposal to share the cost of premiums)
Attached to Social Security
No class distinction
Uniform national standards for eligibility and benefits
Physicians allowed to balance bill

Question 24

Characteristics of Medicaid

Answer 24

Title XiX of Social Security Act (SSA)
Federal matching funds to the states for the indigent (based on Kerr-Mills Act, 1960)
Expanded to include all age groups, not just the elderly poor
Based on a means test developed by each state
Varying eligibility and benefits by state
Class distinction: means tested leads to stigma of public welfare for Medicaid recipients
Physicians not being able to balance bill leads to limited participation from physicians

Question 25

When was the Patient Protection and Affordable Care Act passed?

Answer 25

2010

Question 26

What defined the ACA politically?

Answer 26

Partisan, no Republican support
Backroom deals within the Democratic party and interest groups representing hospital and pharmaceutical industries: American public kept in the dark about the details?

Question 27

What position did the AMA take regarding the ACA?

Answer 27

It supported the legislation

Question 28

Describe the legal challenges against the ACA?

Answer 28

The majority of ACA provisions were ruled Constitutional under the Congress’ power to tax (the individual mandate)
Can’t coerce the states to expand their existing Medicaid programs

Question 29

Definition of defensive medicine

Answer 29

Excessive medical tests and procedures performed as a protection against malpractice lawsuits and otherwise regarded as unnecessary.