Prof Hints for Quiz 2, 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
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.
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)
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
What are the 3 basic models of universal coverage?
National Health insurance
National Health System
Socialized Health Insurance
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
Principles of market justice
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
Principles of social justice
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
Implications of market justice
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
Implications of social justice
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
Limitations of market justice
Principles fail to rectify critical human concerns
Does not always protect society
Market justice does not work well in health care delivery
Describe the gatekeeping model of HMOs
Has been occurring since early 1900s
Initial contact with GP required for a referral to a specialist
What were three forces behind the health insurance movement in the early 1900s?
Technology: advanced txs became available, but they were expensive
Social: desirability of HC
Economic: unpredictability of medical needs and costs of tx
What prevented a national health program by blocking various attempts during the 20th century?
Rise of private health insurance, AMA, and related industries
Who were the stakeholders opposed to NHI?
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)
Characteristics of Medicare
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
Characteristics of Medicaid
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
When was the Patient Protection and Affordable Care Act passed?
2010
What defined the ACA politically?
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?
What position did the AMA take regarding the ACA?
It supported the legislation
Describe the legal challenges against the ACA?
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
Definition of defensive medicine
Excessive medical tests and procedures performed as a protection against malpractice lawsuits and otherwise regarded as unnecessary.
