Study guide for the final, part 10 Flashcards
What is defensive medicine?
Unjustified medical tests and txs done for self-protection against the possibility of litigation
Along with malpractice insurance, this is costly and inefficient
How do practice variations contribute to cost escalation?
Geographic variations in tx patterns and utilization
Signal gross inefficiencies in the system and unfairness
Compromise both cost and quality
What are the two main approaches to cost-containment?
Regulatory approaches
Competitive approaches
Where does restriction occur in supply-side controls?
Restriction on capital expenditures
-Certificate of need (CON) statutes by state legislation
Restriction on supply of physicians
-Entry barriers for foreign medical graduates
Definition of access to care
The ability to obtain needed, affordable, convenient, acceptable, and effective personal health svcs in a timely manner
Whether an individual has a usual source of care
The ability to use HC svcs
The acceptability of particular svcs
Factors affecting HC utilization according to the access framework by Anderson (1968) and Aday et al (1980)
Health need
Predisposing conditions: socio-demographic characteristics
Enabling conditions: individual’s means to use medical care
Health policy characteristics
Health care delivery system’s characteristics
Equitable/inequitable access
Equitable access: svcs distributed according to a pt’s perceived need or evaluated need determined by a health professional
Inequitable access: svcs distributed according to enabling characteristics
Quality assessment
Measurement of quality against an established standard
Define how quality is determined, identify specific variables or indicators, collect data, statistical analysis, interpretation
Subjective measures must be quanified
Measurement scales with validity and reliability
Quality assurance
The process of institutionalizing quality through ongoing assessment and using the assessment results for continuous quality improvement (CQI)
Based on the principles of total quality management (TQM)
A step beyond quality assessment
Cannot occur without quality assessment
Structure in the Donabedian model
Facilities and equipment
Staffing levels and staff qualifications
Delivery system: distribution of hospital beds and physicians
Facilities and the Donabedian model
Licensing
Accreditation
Staff qualifications and the Donabedian model
Licensure and accreditation
Training
Delivery system and the Donabedian model
Distribution of hospital beds and physicians
Process and the Donabedian model
Technical aspects of care
Interpersonal aspects of care
Technical aspects of care and the Donabedian model
Dx
Tx procedures
Correct prescriptions
Accurate drug administration
Pharmaceutical care
Waiting time
Cost
Interpersonal care and the Donabedian model
Communication
Dignity and respect
Compassion and concern
Outcome and the Donabedian model
Measured and compared against pre-established benchmarks
Final results in the Donabedian model
Pt satisfaction
Health status
Recovery
Improvement
Nosocomial infections
Iatrogenic illnesses
Rehospitalization
Mortality
Incidence and prevalence of dz
Cost efficiency
Cost efficient when the benefit is greater than the cost
Underutilization and overutilization
ACA and access
Promises to increase access to affordable insurance coverage, and supports improvements in primary care and wellness
Uses of policy
Regulatory tools
Allocative tools
Principle features of US health policy
Gov’t as the subsidiary to the private sector
Fragmented
Incremental and piecemeal policies
Pluralistic politics associated with demanders and suppliers of policy
The decentralized role of states
The impact of presidential leadership
Legislative branch and US health policy
The most active in policy making
In the form of statutes or laws
Executive branches and US health policy
Presidents, governors, and other PH officials propose policies
Intermediary suppliers of policies
Executives and administrators make policies in the form of rules and regs used to implement statutes and programs
Judicial branches and US health policy
Uphold, strike down, or modify existing laws by:
-Interpreting an ambiguous statute
Establishing judicial precedents
Interpreting the Constitution
States and US health policy
Decentralized role
Incremental policy actions by states
-State-initiated programs for vulnerable pops
-Policy initiatives to expand health insurance coverage
Impact of presidential leadership in US health policy
Harry Truman’s Hill-Burton Hospital Construction Act of 1946
LBJ’s Medicare and Medicaid of 1965
Nixon’s HMO Act of 1973 and the National Health Planning and Resources Development Act of 1974 (CON legislation)
Raegan’s authorization of the PPS method of payment in 1983
Bill Clinton’s CHIP and HIPAA of 1996
W. Bush’s Medicare part D in 2003
Obama’s ACA in 2010
Parts of the policy cycle
Issue raising
Policy design
Public support building
Legislative decision making and policy support building
Legislative decision making and policy implementation
