Section 2/Week 2

Question 1

US feelings towards government

Answer 1

Distrust of central government

Question 2

Canadian feelings towards government

Answer 2

Accepting of the need for strong government

Question 3

US defining of social justice

Answer 3

defined in terms of the individual

Question 4

Canadian maximization of the common good

Answer 4

tradition of redistribution

Question 5

How are conflicts resolved in US

Answer 5

tend to be resolved in favor of the individual

Question 6

How are conflicts resolved in Canada

Answer 6

tend to be resolved in favor of the common good

Question 7

Health Care is a

Answer 7

US: Market Commodity
Canada: Health care is a basic right

Question 8

Power is concentrated in the:

Answer 8

US: Medical profession
Canada: government, the power of the medical profession is limited

Question 9

Is there a uniform standard of care?

Answer 9

US: No uniform standard of care
Canada: One standard of care for all people

Question 10

What’s the governments role in the health care system

Answer 10

US: Government historically played little role in the guiding system
Canada: Government has a monopsony power over care

Question 11

What does the marginal benefits/costs graph represent

Answer 11

A useful way to represent both health care decisions at the level of the individual patient or decisions at the level of health care system as a whole.

Question 12

What does the intersection of the benefit/cost curve represent

Answer 12

The point of economic efficiency or the point of indifference. The threshold at which a rational person will stop obtaining procedures and that a rational physician will stop ordering these procedures due to the law of diminishing returns

Question 13

What are some specific US examples of ignoring the benefit/cost curve for society and emphasizing the benefit of the individual

Answer 13

• Prostate cancer screening

- Calcium-channel blocker

Question 14

What is the technological imperative

Answer 14

Coined by Victor Fuchs. The desire of the physician to do everything he has been trained to do regardless of benefit-cost ration, and the commonly held belief that the more technological a treatment is, the better it is.

Question 15

Gizmo idolatry

Answer 15

A gizmo is a medical device or procedure for which clinical benefit in a specific clinical context is not clearly established. Gizmo idolatry is the general implicit conviction that a more technological approach is intrinsically better than one that is less technological, unless or perhaps even if there is strong evidence to the contrary.

Question 16

Technological benefit of the doubt

Answer 16

In comparing a new, high tech approach to a problem with an older low-tech alternative, we tend to expect the newer approach to be better, absent any empirical evidence

Question 17

What’s an example of the impact of the tech imperative/benefit of the doubt/gizmo idolatry on resource use differences between the US and Canada

Answer 17

Whereas the U.S. has widened the range of patients eligible to receive implantable cardiac defibrillators (ICDs), Canada has limited access to ICDS on the basis of patient need and acknowledged the need to set up patient ques.

Question 18

How has Canada tried to keep health care costs down

Answer 18

• Cap on FFS
• The global budget for physician fees, with fee levels negotiated between the government and the doctor
• Fixed annual budgets for all hospitals
• All capital expenditures-new hospital new technology-approved and paid for separately by the government

Question 19

What are problems with Canadian methods for keeping health care costs down

Answer 19

• Doctors would make more appointments with patients or charge additional fee for services on top of government set fees [1984 canada health act, forbids extra billing]
• Churning, reducing doctors fees, so they met global budget
• Queuing

Question 20

How is the United States addressing rising health care costs

Answer 20

-Sustainable Growth Rate: used to control spending on Medicare on physician services enacted by the Balanced Budget Act of 1997, to ensure that the yearly increase in the expense per Medicare beneficiary does not exceed the growth in GDP

Question 21

What is the US facing in terms of problems with SGR

Answer 21

The implementation of the physician fee schedule update to meet the target SGR can be suspended or adjusted by Congress, as has been done regularly in the past (a doc fix)
-If the goal of SGR is not met, then instead of reducing fees, Congress postpones reduction with the intention to then reduce fees aggregately in the upcoming years

Question 22

Has the Doc Fix ever been implemented?

Answer 22

NOPE.

Question 23

What’s the PCORI?

Answer 23

Patient-Centered Outcomes Research Institute. They identify research priorities and conduct research that compares the clinical effectiveness of alternative medical treatments (comparative effectiveness, NOT cost effectiveness)

Question 24

What is comparative effectiveness research

Answer 24

research comparing “clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent diagnose, or treat health conditions

Question 25

What is cost effectiveness analysis

Answer 25

assessment of the added improvement in health outcomes relative to cost

Question 26

What is balanced billing

Answer 26

Charging a patient an extra charge for services provided above the reimbursement from the government

Question 27

What is queuing

Answer 27

when people have to wait for medical services in Canada because there are only a certain number of imaging machines or resources because of the universal budget. This means that elective surgeries tend to have long waiting periods and those with the greatest medical need are moved to the front

Question 28

Marginal benefit

Answer 28

The successive value you derive from one additional unit of consumption

Question 29

Marginal cost

Answer 29

The successive cost you pay for one additional unit of consumption

Question 30

Point of Indifference

Answer 30

The point at which marginal cost equals marginal benefit

Question 31

Churning

Answer 31

Is compose of three actions that happen in a cycle.

1. ) Aggregate fees exceed global budgets
2. ) Doctors see a reduction in the amount they are paid per patient
3. ) Doctors respond by seeing a larger number of patients
4. ) Aggregate fees exceed global budgets

Question 32

Doc Fix

Answer 32

Delaying cuts to the sustainable growth rate

Question 33

Sustainable Growth Rate

Answer 33

The method used to constrain the cost of physician services. The SGR is an expenditure target set by the Center for Medicare and Medicaid Services (CMS), that is tied to inflation, changes in Medicare enrollment, GDP growth rate, and changes in Medicare’s benefit structure

Question 34

Tort Law

Answer 34

personal injury law where by compensation is typically of two types: 1) for actual costs that result from the injury and 2) for added pain and suffering that results from the injury during the patient’s lifetime.