Textbook Flashcards
safe injection sites
- harm reduction
harm reduction: reduce harmful consequence assoc w illicit drug use other high risk activities for ppl unable/unwilling to stop.
safe injection sites: pros + cons
pro: health + social benefits. gateway to medical + social services. cleaner practice = lower blood-borne disease = save lives + fewer hc costs to treat those conditions. encourage treatment programs.
con: illicit drug use by sanitizing +legitimizing.
- decriminaliing
delisting sex reassignment
provinces delist then re-instate. feds delist for incarcerated.
medically necessary deemed how?
condition, whether condition is severe enough to impinge significanlty upon quality of life, jeopardize psycho-social functioning + if med treatment will ameliorate condition.
risk-benefit ratio.
post-retrenchment in 1998 what happened?
demand for wage increase, competition btw provinces, nurse shortage = health care costs increased rapidly.
hc in 2001 - what trends in hospital vs outpatient, data, etc
fewer beds in line with other countries. more outpatient.
provinces gain control of cost - data helps funding be allocated of projection rather than physician-directed.
data - help manage performance of system.
CHST - effects on provinces
canada health + social transfer.
- fedreduced amount of money to province, allowed them to spend money however they want. annual increase removed, funding will change year-to-year. hard for province to plan for future needs when dunno money comign in.
CHST: what actually happened?
fed got deficits under control + gave one-time contribtions to provicnes.
launched period of steady growth.
paul martin + CHST
split cht and cst.
= more transparent by ID-ing money specific to health care vs social
= annual increase reinstated. 6% annual increase until 2014.
- fed establish program of national important: Wait time reductin fund. set aside money for provinces to use to reduce wait times.
what 5 areas did wait time reduction fund focus on ?
cancer treatment, heart procedures, disagnostic imaging, joint replacement, eye restoration.
Harper in 2011, renegotiations for funding post-2016
annual increase would be tied to economic growth. never fall below 3%. distributing funds on per capita basis rather than disproportionately transferring to poorer provinces.
- no national goals funding
- no negotiations.
- hands-off approach of fed govt to hc.
- innovation and improvement is province own issue to deal with.s
implication of no national goals
data on hc performance btw provinces no longer comparable bc independent innovations
distn of expenditure of hc
shift from hospital (45% to 29.1%) to outpatient.
physician expenditure 15% - 13.6%. rank slipping. hosptial + drug take more expenditure.
drug expenditure increased from 6% (1975) to 16% in 2009.
issue in shifting expenditures?
public vs private.
public services through provincial health insurance plans or private, out-of pocket and maybe reimbursed by commercial for-profit insurance. shift into privitization of hc.
are we moving to privitization?
public takes 70 % cost whereas private takes 30%. mainly for hosptial, physician + public health tho. for drugs, dentist chiro etc. more private money than public.
public reinvestment in other areas to pick up costs.
quebec, SCC what the ruling meant?
narrowly decided that no privaate is unconstitutional.
allowed quebec to have private parallel to public.
rules to private being parallel to public
guaranteed wait time for procedure + docs who move to private must completely opt out of public hc
why do docs have to opt of of public if moving to private?
remove incentive for docs operating in public to increase wait times to persuade public to pay higher fee for rapid service in private system.
define rationing of health care
any mechanism that allows ppl to go without beneficial health care services
why is rationing health care issue
suggests that withholding hc will have tragic consequence for health + well-being
emmet hall + Hc
discussed consequences to Canadians when fed govt chose not to proceed with recommendation that pharmaceuticals and home care be covered under provincial health insurance.
implication of presentation that HC system in crisis
groups with vested interests argue for crisis.
- no evidence that cant afford hc system. suggests crisis is politically constructed
- not without blemish tho
what are eclectics?
practiced form of botanical medicine in North America for nearly 200 years, involve complex combination of plant extracts to treat illness
emmett hall with SC, royal commission on health ervices. evaluating existing and future needs for health services
used other countries for reference on how to improve.
- recommend sask model all over canada
- recommend perscription meds, prosthetics + home care insured.
- dental + optometry services provided for children + welfare recipients
two purposes of canada health act.
- harmonize medical care act and hospital and diagnostic ervices act. harmonize
- address problems that emerged in provincial hc ie extra-billing, user fees.
define first-dollar coverage
third party payer assumes liability for covered services as soon as first dllar of expense for service is incurred.
convergence hypothesis
thesis that health care systems become increasingy similar over time because of similar scientific, technological, economic, and epidemiological pressures
elements of convergence hypothesis
- docs seek most current med tech + knowledge to improve service + increase income/prestige.
a. globalization allows expanded access to knowledge - economic pressures. cost of hc eventually leads govt to reduce costs. capitalist restrict market in hc. socialist encourage market in hc.
a. move towards middle ground. market plays role but restricted by state. - demographic. aging poplns = more NCF. more interest in patient satisfaction + choice.
when can cross national comparison be misleading? two types of errors
naive transplantation: assumed idea in 1 coutnry can be adopted successfully w same + results in other country
- fallacy of comparative difference: assumption coutnries have nothing to learn from one another simply bc differ in hc systems in 1+ dimensions.
right to health care - against perspective
- autonomy + individualism, stressing right son individuals.
- implictly assert that hc workers have duty to provide care. restrict rights of hc workers to control their time + resources.
- implicitly obligate all members of society to pay costs of care
- can’t take responsibility for correcting all inequalities caused by biological and social differences in future.
- if give right to hc, dont u have to give right to education, transportation, housing?
right to health care - for perspective
social justice
- reject distinction between unfortunate and unfair circumstances.
- reject that hc is privilege, dependent on charity or benevolence.
- individual has right to at least minimum hc.
society is interdependent. docs get tax support funding, if accept, they give back through hc they provide
-purchase hc is hardly a choice when have to give up things for it.
- cant do it all, but do something
canada vs US doctor visits
US - wealthy more visits than poor. distributed based on wealth.
Canada - poor more visits than wealthy. ditributed based on need
income and survivability: can vs US
US: significant assoc btw income + survival. no assoc found in Canada
equity is desirable, but has opposition
conflict w interests of those w most power in society.
-graduated taxation: more proportionally from young, healthy, rich, pay for old, ill + poor.
equity opposed if spreading resources equally means?
neither immediate service nor every service they want.
- wealthy incur out-of-pocket expense to receive things they want in timely fashion
equity - access + health outcome
=> primary care vs specialist
equitable acces =/= equitable health outcomes
- primary care is on basis of need = used more by poor
- specialist for wealthier who can afford extra service.
US hc system organized how?
entreprenurial systme.
- based on private enterprise in search for profit.
US medicare and medicaid
medicare: fed insurance program, base don social security system, that offers hospital and medical insurance to over 65 and permanently disabled.
medicaid: joint federal-state health insurance program that pays costs of hc for people with incomes below certian amount.
US childrens health insurance program
joint federal-state health insurance program for children in families whose incomes are modest but too high to be eligible for medicaid.
US blue cross and blue shield
cross cover individual hospital bills
blue shield to cover medical bills
= evolved into private + independently operated companies.
getting insurance plans in US
pay for hc as they receive services + seek reimbursement from insurance plans.
insurance sold to ppl with low predicted risk. increase premium for those w predicted risk.
- coverage only until yearly/lifetime limits reached
define actuarial risk rating
a system in which insurers try to maximize their financial gain by identifying and insuring only those populations that have low health risks
health maintenance organizations
organizations that provide health care based on prepaid group insurance.
patients pay fixed yearly fee in exchange for full range of health care services, including hospital + doctor. but have to use service specifically by HMO.
define managed care
system that controls costs through closely monitoring and controlling the decisions of health care providers.
define utilization review
insurance companies require doctors to get approval before ordering certain tests, performing surgery, hospitalizing patient, or keeping patient in hospital more than given number of days.
fee-for-service insurance
reimburses patients for all or part of the costs of hc services they have purchased.
- copayments + deductibles on patient
what are copayments:
unreimbursable fee that individual pas each time they visit hc provider
fee for service compensation - physician
docs are paid for each procedure they perform
capitation - physician
docs are paid for each patient in their practice, regardless of how often they see patients or services provided to patients.
hospital categorization
for-profit (private)
non-profit
public (poor and underinsured, owned by govt)
access to care: insurance + employment
most often employment offers insurance.
mroe unemployment = more uninsured.
myths of american health system being so high cost
- more + better care = higher cost. (no fewer hospital beds + docs per capita. fewer days in care, shorter visits
- high health care bc malpractice law suits. raises doctor price + malpractice insurance (changing malpractice wouldnt lower prices muc)
- advanced technology: tech is important but other places with less fees has same tech.
what is defensive medicine?
tests + procedures that docs perform primarily to protect themselves against lawsuits rather than to protect their patients’ health
two unerlying factors raising cost of American system
administrative costs + provider power to set prices.
why did america not want universal hc in past?
big players (unions, physicians) fought against, reduce autonomy + benefits.
blue Cross + shield eliminate worry about paying for hc.
big govt wasnt trusted.
what does Affordable Care Act entail?
- each Us citizen/ legal residentrequired to obtain health insurance. employer required to subsidize health insurance for workers. states establish health exchange where individuals + small business can buy hc
- insurance company can’t cap annual or lifetime benefits, cant refuse pre-existing health problems or charge higher premiums to such individuals.
principles of nuremberg code
- voluntary consent
- experiment for good of society.
- designed + based on animal studies. knowledge of natural history required.
- exeriment conducted to avoid unnecessary suffering/injury
- conducted with reason - death or disabling should not happen..
- degree of risk never excees possible benefit
- proper prep, adequate facilities
- conducted by scientfically qualified persons.
- study ends if continuation is harmful
- terminate study if continuation is impossible.
belmont report
three basic ethical principles for medical research + practice
- respect for persons
- beneficence
- justice
germany structure of hc system
universal multi-payer. citizens purchase, with help of social inusrance + aemployer
Germany: purchasing care
HI provided by govt-regulated non-profit social insurance groups aka sinkess funds.
- costs baed on income = financially progressive
private health insurance available for those who opt out of sickness funds + can afford.
paying docs + hospitals
ambulatory care ( outside hospital) paid on fee-for-zervice hospital = salary. sickness funds give premiums to regional medical assoc . then reimburse docs. hospital operating expense paid yearly
germany access to care
comprehensive. minimal copayments tho
controlling cost of care in german
more expensive health care system - oversupply of docs.
- adopt cost-effective drugs and ask 68+ to resign
health outcomes in germany
high standard of health. 80+ years, low infant mortality
UK structure of HC system
- purchasing care
employed by state.
- tax revenue par health care.
- more hc services covered than in canada
- financially progressive taxes
paying docs + hopsitals UK
access to care
- control cost of care
- health outcomes
Paying: salaried. GP have capitation based on # of workers + specific services they offer
access: everyone
controlling cost: below canada - keep salary low. promote privitiation. = bad news
- health outcomes. good, similar to canada.
china: good health low cost
- structure?
prevention > cure. TCM. masses > elite, mass campaign.
china: physician extenders
street/village docs. basics on hc.
now assistant doctors but not working on their own
purchasing care china
govt pays for govt employee, military, students.
private companies - ppl lack health insurance.
structure of med education
bacherlor degree -> 4 year training in med school -> 3-8 years as resident.
financial + time burden. high student debt + work long hours.
residents = 80hrs/week
docs =51.4 hrs/week
medical norma
expectations doctora hold about how they should act, think + feel
professional socialization
process of learning skills, knowledge + values of occupation
medical values include:
emotional detachment, clinical experience > scientific evidence, master uncertainty, adopt mechanist model of body, trust intervention > normal body practice, rare/acute illness > typical chronic.
irony of emotional detachment
enter profession bc want to help others, emotional detachment helps cope = creates affective neutrality to point that is apathy.
benefits of affective neutrality
depened patient trust that treatment was in best interest of patient, not in self-interest of doc.
why structural-functionalist view of emotional detachment is discredited
doctors have historically acted in their own best interest.
clinical experience over science
intuition and clinical experience has value. but often leads to error.
- evidence-based more important.
- but docs may not have time for thorough research.
mastering uncertainty as doc
too much knowledge to know it al, or medical question still unknown.
- cope with uncertainty, reduce it, or hide it
mechanistic model of body
look for signs that body is breaking down
intervention for docs
value medical intervention over prevention of illness w nutrition, exercise, biofeedback.
emphasis on acute > chronic
acute = special. chronic boring + often no cure
consequences of medical values/norms
insensitivity, overlook social sources + consequences of illness
- adopt treatments that arent well tested or scientifically valid
maintain image of authority even when uncertain.
reductionistic treatment > holistic.
hospitals today
- emergency care
- highly technical nature = focus on machine over patient.
- biological issue over psychological/social needs
short stays are impersonal - efficient care not individualized care.
mental patients - premodern, modern, changes throughout time
pre-modernP: acceptable low level roles. live with family. normalized within family.
modern: disturbing behavior = lunacy. religious authorities to get rid of thing compelling abnormal behaviour, torturous things done to ppl.
as capitalism grewm put those ppl in mental institutions. lunatic asylums. -> hospital for the Insane.
moral treatment: teach to lvie in society + give opportunity for work + play. restored by socialization.
medical model of mental illness took over - lobotomies
deinstitutionalization. found that ppl were undergoing self-fulfilling prophecy in mental asylum. but psychopharmocological revolution foudn a lot of ppl could be cured too.
define total institutions
all aspects of life are controlled by central authority.
define mortification
person’s prior self image is partially or totally replaced or destroyed by living in institution.
define master status
status veiwed by others as important that is overwhelms other parts of individuals
define depersonalization
feel less than fuly human or comes to be viewed as less than human.
decarceration
state to control costs of institutional care = move away from segregation of ppl.
