Section 2/Week 2 Flashcards
US feelings towards government
Distrust of central government
Canadian feelings towards government
Accepting of the need for strong government
US defining of social justice
defined in terms of the individual
Canadian maximization of the common good
tradition of redistribution
How are conflicts resolved in US
tend to be resolved in favor of the individual
How are conflicts resolved in Canada
tend to be resolved in favor of the common good
Health Care is a
US: Market Commodity
Canada: Health care is a basic right
Power is concentrated in the:
US: Medical profession
Canada: government, the power of the medical profession is limited
Is there a uniform standard of care?
US: No uniform standard of care
Canada: One standard of care for all people
What’s the governments role in the health care system
US: Government historically played little role in the guiding system
Canada: Government has a monopsony power over care
What does the marginal benefits/costs graph represent
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.
What does the intersection of the benefit/cost curve represent
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
What are some specific US examples of ignoring the benefit/cost curve for society and emphasizing the benefit of the individual
- Prostate cancer screening
- Calcium-channel blocker
What is the technological imperative
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.
Gizmo idolatry
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.
Technological benefit of the doubt
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
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
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.
How has Canada tried to keep health care costs down
- 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
What are problems with Canadian methods for keeping health care costs down
- 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
How is the United States addressing rising health care costs
-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
What is the US facing in terms of problems with SGR
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
Has the Doc Fix ever been implemented?
NOPE.
What’s the PCORI?
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)
What is comparative effectiveness research
research comparing “clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent diagnose, or treat health conditions
What is cost effectiveness analysis
assessment of the added improvement in health outcomes relative to cost
What is balanced billing
Charging a patient an extra charge for services provided above the reimbursement from the government
What is queuing
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
Marginal benefit
The successive value you derive from one additional unit of consumption
Marginal cost
The successive cost you pay for one additional unit of consumption
Point of Indifference
The point at which marginal cost equals marginal benefit
Churning
Is compose of three actions that happen in a cycle.
- ) Aggregate fees exceed global budgets
- ) Doctors see a reduction in the amount they are paid per patient
- ) Doctors respond by seeing a larger number of patients
- ) Aggregate fees exceed global budgets
Doc Fix
Delaying cuts to the sustainable growth rate
Sustainable Growth Rate
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
Tort Law
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.
