Prof hints quiz 4 part 1 Flashcards
How do practice variations contribute to cost escalation?
Geographic variations in tx patterns and utilization
Signal gross inefficiencies in the system and unfairness
Compromise both cost and quality
Where does restriction occur in supply-side controls?
Restriction on capital expenditures
-Certificate of need (CON) statutes by state legislation
Restriction on supply of physicians
-Entry barriers for foreign medical graduates
Three cornerstones of HC delivery
Cost
Access
Quality
High quality care = ?
The most cost-effective care
Cost is important in evaluating quality
Reasons for cost escalation
Third party payment
Imperfect market
Growth of technology
Increase in elderly pop
Medical model of health care delivery
Multipayer system and admin costs
Defensive medicine
Fraud and system abuse
Practice variations = small area variations (SAV)
How has 3rd party payment affected cost escalation?
Moral hazard
Provider-induced demand
How has the imperfect market affected cost escalation?
Neither free nor highly regulated
Prices far exceed the cost of production
Both quantity and price remain unchecked
How has growth of technology affected cost escalation?
High R & D spending
Innovation that leads to utilization
High tech creates demand for new svcs
Once invested, should maintain high utilization to recoup capital investments
How has the increase in elderly pop contributed to cost escalation?
Increased longevity
Baby boomer generation
Three times of HC use compared to younger ppl
How has the medical model of HC delivery contributed to cost escalation?
Misplaced emphasis on medical txs
Health promotion/dz prevention takes a backseat
More costly HC resources deployed to treat health problems that could have been prevented
How have the multipayer system and admin costs contributed to cost escalation?
Overall inefficiencies of the multipayer system
A billing and collection nightmare
US spending on admin costs > other countries
What is defensive medicine?
Unjustified medical tests and txs done for self-protection against the possibility of litigation
Along with malpractice insurance, this is costly and inefficient
How does fraud and system abuse contribute to cost escalation?
Knowing disregard of the truth
Major problem in Medicare and Medicaid
Falsified billing claims or cost reports
Unnecessary svcs provided
Upcoding: billing for a higher-priced svc when a lower-priced svc was delivered
Receiving kickbacks for referrals and self-referrals
Quality assessment
Measurement of quality against an established standard
Define how quality is determined, identify specific variables or indicators, collect data, statistical analysis, interpretation
Subjective measures must be quanified
Measurement scales with validity and reliability
Quality assurance
The process of institutionalizing quality through ongoing assessment and using the assessment results for continuous quality improvement (CQI)
Based on the principles of total quality management (TQM)
A step beyond quality assessment
Cannot occur without quality assessment
Structure in the Donabedian model
Facilities and equipment
Staffing levels and staff qualifications
Delivery system: distribution of hospital beds and physicians
Facilities and the Donabedian model
Licensing
Accreditation
Staff qualifications and the Donabedian model
Licensure and accreditation
Training
Delivery system and the Donabedian model
Distribution of hospital beds and physicians
Process and the Donabedian model
Technical aspects of care
Interpersonal aspects of care
Technical aspects of care and the Donabedian model
Dx
Tx procedures
Correct prescriptions
Accurate drug administration
Pharmaceutical care
Waiting time
Cost
Interpersonal care and the Donabedian model
Communication
Dignity and respect
Compassion and concern
Outcome and the Donabedian model
Measured and compared against pre-established benchmarks
Final results in the Donabedian model
Pt satisfaction
Health status
Recovery
Improvement
Nosocomial infections
Iatrogenic illnesses
Rehospitalization
Mortality
Incidence and prevalence of dz
Cost efficiency
Cost efficient when the benefit is greater than the cost
Underutilization and overutilization
ACA and access
Promises to increase access to affordable insurance coverage, and supports improvements in primary care and wellness
