Section 3/Week 3

Question 1

Where does the largest portion of health care expenditures come from?

Answer 1

Private Insurance

Question 2

What are the 7 publicly financed health insurances (account for 47% of all care)

Answer 2

• Medicare
• Medicaid
• Indian Health Service
• S-CHIP
• Veterans Affairs
• Defense Dept
• National Health Service Corps

Question 3

Even though physicians account for only ___ of health care expenditures, they influence ____ of all expenditures.

Answer 3

20%, 70%-80%

Question 4

What were the 4 requirements the Flexner Report of 1910 laid out for medical schools?

Answer 4

1. ) be part of universities
2. ) have at least four years of training
3. ) have the first two years of that training concentrate on basic lab science
4. ) require 4 years of premedical science for all entering students

Question 5

Physicians as Agents of Reason (Parsons 1951)

Answer 5

• Knowledge based authority

- Altruistic healers, with paternalistic and unbiased approach towards patients

Question 6

Physicians as Agents of Power (Friedson 1970)

Answer 6

• Control of knowledge based authority
• Physician as self-interested entrepreneurs
• Conflicting loyalties, imperfect agents for patients

Question 7

When the AMA started in 1846, members were drawn from which set of practice?

Answer 7

Allopathic!

Question 8

How did nursing begin?

Answer 8

With the Crimean War and Florence Nightingale.

Question 9

How did the first and second world wars shape the nursing profession?

Answer 9

In WWI, the sub-nurse became the medical physician.

In WWII, the licensed vocational nurse (LVN) was created.

Question 10

What are a few of the new types of “advanced practice nurses” created during the 1970s-1980s

Answer 10

• Nurse Practitioners
• Nurse Midwives
• Nurse Anesthetists
• Critical care nurses

Question 11

Describe the registered nurse supply trends in the past 3 decades.

Answer 11

In the 1980s and 1990s, there was a decline in young women who were choosing nursing, but a surge between 2002-2009 helped ease the shortage.

Question 12

What’s primary care

Answer 12

care found in doctor’s offices or in clinics

Question 13

What’s secondary care

Answer 13

care obtained from specialists and in hospitals

Question 14

What’s tertiary care

Answer 14

care obtained at region referral centers

Question 15

What’s quaternary care

Answer 15

care obtained at national referral centers

Question 16

Reasons not to go into primary care

Answer 16

• Money
• Prestige
• Specialty

Question 17

Reasons to go into primary care

Answer 17

-Relationships

Question 18

Hospitals make up 31% of all health expenditures, how did the government plan to slow hospital related spending

Answer 18

Prospective Payment System (PPS), where a single, pre-determined payment based on the nature of the patient’s illness (Diagnosis Related Group, DRG)

Question 19

What were the principal effects of PPS

Answer 19

• decrease number of patients treated in the hospital

- overall decrease in need of hospitals

Question 20

What were the results of the decreased demand for hospital care

Answer 20

• hospitals closed

- shift to for-profit hospitals

Question 21

How does the ACA seek to expand primary care in order to meet the new demand for primary care physicians due to the expansion in health insurance

Answer 21

• Shifts policy focus of funding graduate medical education to expanding primary care training
• Increased payment for primary care services (10% bonus payment to primary care physicians who treat Medicare patients, increase in medicaid payments to match medicare)
• Support patient centered medical homes

Question 22

What are patient centered medical homes

Answer 22

teams of providers and various healthcare professionals to provide ongoing, high-quality care

Question 23

Why isn’t Canada facing an issue with too many specialty doctors

Answer 23

• less of an emphasis on technology
• greater emphasis on risk evaluation
• care rationing prioritizes equal access to health care for all citizens

removes incentive for specializing

Question 24

how has medical care become an example of a market failure in the US

Answer 24

even though the number of specialty doctors has gone up, the costs of specialty health care have also gone up.

demand for health care commodity is determined by the provider.

Question 25

How was the medical profession desegregated

Answer 25

-When Medicare and Medicaid were passed, federal funding became a major source of funding for hospitals, and hospital eligibility for reimbursements were contingent on desegregation of care and the medical profession

Question 26

What was the original intent of allowing international medical graduates to fill american residency slots

Answer 26

that the IMGs would return to their country of origin after training.

HOWEVER…
most IMGs remained in the US after their training

Question 27

what as the original intent of having medicare reimburse hospitals’ residency training program costs under both PPS and original Medicare payment formula

Answer 27

it would allow hospitals to continue receiving reimbursement for existing residencies

HOWEVER…
it lead to an over-expansion of residency programs, hiring of IMGs to fill up positions that has led to the oversupply of specialists as IMGs tend to choose the specialist career path

Question 28

How does FFS work

Answer 28

reimbursement to the hospital in full after a visit

Question 29

How does PPS work (Prospective payment system, also known as diagnosis-related group)

Answer 29

government pays a fixed amount for the average cost of a treatment for a patient with a specific diagnosis.

hospital forced to absorb some costs above those paid by Medicare

Question 30

How are providers incentivized under FFS

Answer 30

incentivized to provide as much care as possible to receive high levels of payment

Question 31

How are providers incentivized under PPS

Answer 31

incentivized to provide the fewest number of services possible

Question 32

What impact did PPS have on quality of care

Answer 32

discharging patients quicker and sicker

Question 33

Did PPS have any good side effects?

Answer 33

reduced Medicare payments somewhat

Question 34

What is a Professional Standards Review Organization (PSRO)

Answer 34

a group of local physicians organized by the federal government to review the care provided to Medicare and Medicaid patients in order to assure the care was appropriate with the intent to reduce costs spent on FFS payments

Question 35

What are peer review organizations (PROs)

Answer 35

local corporation that contracts with the government to provide oversight of the quality and necessity of the care provided to counteract the “quicker and sicker” phenomenon. This also gave physicians less control over the review of hospital care than PSROs.