Reading Tidbits/Review Session Flashcards
How did the Blue cross program originate
Hospitals during the great depression grouped together to offer insurance to cover the cost of hospital care
How did blue shield develop
some states added an option for insuring against the cost of physician services
What effect did the original HMO act have on HMO growth
it halted growth because what the government wanted on the list of basic services was more comprehensive than what was on the competing FFS plans. in 1976, congress loosened requirements, and growth flourished
What are some differences between Kaiser and the typical HMO
Kaiser has only one group of doctors and one group of hospitals, with mutual collaboration.
HMOs contract with medical groups that compete, and the doctors have no personal stake in the success of hospitals.
HMOs have a fixed amount of money available based on
capitation fees and the number of enrolled members.
fixed amount means they must take steps to stay under budget.
compared to nonprofit hospitals, for profit hospitals are
- slightly less efficient in producing a given service or procedure
- charge somewhat more for comparable services
- provide less uncompensated care to low-income patients
positives about for profit hospitals
- potential to provide care more efficiently if managed well
- competition between profit and nonprofit would weed out inefficient systems, reducing overall costs
study found that the lowest increase in per capita spending for hospital care was in
those markets that remained predominantly nonprofit!
Comparative effectiveness research (CER)
compares the effectiveness of a treatment to other treatments in terms of outcomes only
Cost effectiveness analysis
compares the effectiveness of a treatment to a placebo or other treatments in terms of marginal benefit in outcomes per marginal cost
How does the ACA address CEA
it prohibits it
What is socialized medicine
government is single provider of care
what was “medical soviets” referring to
medical co-ops; pre-paid medical systems
does Canada have socialized medicine
nope! hospitals and doctors private, government just finances care.
what are the 4 organizing principles of US health care
§ Health care is a market commodity to be distributed according to ability to pay
§ Power over the organization and delivery of health care has historically been concentrated in the medical profession
§ There is no uniform standard of care
§ Government has historically had relatively little role in guiding our system of health care
