Section 3/Week 3 Flashcards
Where does the largest portion of health care expenditures come from?
Private Insurance
What are the 7 publicly financed health insurances (account for 47% of all care)
- Medicare
- Medicaid
- Indian Health Service
- S-CHIP
- Veterans Affairs
- Defense Dept
- National Health Service Corps
Even though physicians account for only ___ of health care expenditures, they influence ____ of all expenditures.
20%, 70%-80%
What were the 4 requirements the Flexner Report of 1910 laid out for medical schools?
- ) be part of universities
- ) have at least four years of training
- ) have the first two years of that training concentrate on basic lab science
- ) require 4 years of premedical science for all entering students
Physicians as Agents of Reason (Parsons 1951)
- Knowledge based authority
- Altruistic healers, with paternalistic and unbiased approach towards patients
Physicians as Agents of Power (Friedson 1970)
- Control of knowledge based authority
- Physician as self-interested entrepreneurs
- Conflicting loyalties, imperfect agents for patients
When the AMA started in 1846, members were drawn from which set of practice?
Allopathic!
How did nursing begin?
With the Crimean War and Florence Nightingale.
How did the first and second world wars shape the nursing profession?
In WWI, the sub-nurse became the medical physician.
In WWII, the licensed vocational nurse (LVN) was created.
What are a few of the new types of “advanced practice nurses” created during the 1970s-1980s
- Nurse Practitioners
- Nurse Midwives
- Nurse Anesthetists
- Critical care nurses
Describe the registered nurse supply trends in the past 3 decades.
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.
What’s primary care
care found in doctor’s offices or in clinics
What’s secondary care
care obtained from specialists and in hospitals
What’s tertiary care
care obtained at region referral centers
What’s quaternary care
care obtained at national referral centers
Reasons not to go into primary care
- Money
- Prestige
- Specialty
Reasons to go into primary care
-Relationships
Hospitals make up 31% of all health expenditures, how did the government plan to slow hospital related spending
Prospective Payment System (PPS), where a single, pre-determined payment based on the nature of the patient’s illness (Diagnosis Related Group, DRG)
What were the principal effects of PPS
- decrease number of patients treated in the hospital
- overall decrease in need of hospitals
What were the results of the decreased demand for hospital care
- hospitals closed
- shift to for-profit hospitals
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
- 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
What are patient centered medical homes
teams of providers and various healthcare professionals to provide ongoing, high-quality care
Why isn’t Canada facing an issue with too many specialty doctors
- 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
how has medical care become an example of a market failure in the US
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.
How was the medical profession desegregated
-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
What was the original intent of allowing international medical graduates to fill american residency slots
that the IMGs would return to their country of origin after training.
HOWEVER…
most IMGs remained in the US after their training
what as the original intent of having medicare reimburse hospitals’ residency training program costs under both PPS and original Medicare payment formula
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
How does FFS work
reimbursement to the hospital in full after a visit
How does PPS work (Prospective payment system, also known as diagnosis-related group)
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
How are providers incentivized under FFS
incentivized to provide as much care as possible to receive high levels of payment
How are providers incentivized under PPS
incentivized to provide the fewest number of services possible
What impact did PPS have on quality of care
discharging patients quicker and sicker
Did PPS have any good side effects?
reduced Medicare payments somewhat
What is a Professional Standards Review Organization (PSRO)
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
What are peer review organizations (PROs)
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.
