Topic 1: Overview

Question 1

Primary objectives of a health care system

Answer 1

• To enable all citizens to receive health care services
• To deliver services that are cost-effective and meet established standards of quality.
• Cost of insulin in US; elsewhere
• Role of GoFundMe
  -Baltimore 1/12/2018 (“patient dumping”)

Question 2

The US Health Care System

Answer 2

-it’s not a system
-No universal health care financed by taxes
- no entitlement
-no other country operates like the US
- Critical issues related to cost, access, and quality

Question 3

Current health care issues

Answer 3

1. Health care costs:
   - keeps taking up larger proportion of the GDP.
   - American employers pay more for health care than their trading partners (the price of american goods are higher because of this need to cover health benefits)
   -the way we structured our health care financing drives out ability to be competitive on an international market.
   -health care spending problems: health care industry has a lot of waste (1/3 cost). From administration, overtreatment, fraud and abuse, pricing failures (paying more than you need to), care delivery (inconsistencies), and care coordination.
   -no regulation of prices (private companies set prices)
   -premiums have risen faster than wages and inflation
   -rising medical debt
   -we are not using health services more, we just pay more
   -higher costs not buying more quality

Question 4

Why we are spending more and getting us less

Answer 4

-we wait until people get super sick that they’ll require expensive care (no preventative care)
-US system doesnt address the life circumstances (social determinants)
-we spend much less on social services

Question 5

The US healthcare “system” what it has and doesn’t

Answer 5

Has:
-duplication/overlap
-inadequacy
-inconsistency
-waste/inefficiency
-complexity
-financial manipulation
-fragmentation

Has little or none:
-Networking
-Interrelated components
-standardization
-coordination
-cost containment as a whole
-planning, direction

Question 6

Health care economic principles

Answer 6

1.health is priceless
-without price regulation, it creates price inflation without an increase in quality
- cost-benefit talks emotionally charged (difficult to make cost benefit decisions when emotionally driven.
2. Having more doesn’t reduce value
- no matter how healthy we are, we want more
3. Qualify not quantity matters
4. Newest is the best
5. Lifestyle matters more than medicine (we don’t support this aspect)
6. Optimizing principles of economics still apply though not supply/demand-driven market
- forgoing pleasure for future health
7. Health risks are more public than private
-because of the impact of social determinants
-zip code> genetic code
8. Rationing exists
- who has money and insurance
- rich are healthier than the poor
- age, sex, race, also factors in access/attention

Question 7

Healthcare reform 2010 (ACA)

Answer 7

Triple aim:
1 Increase access
-expand coverage to uninsured/pre-existing conditions
- stop cancellations, higher premiums for ill/women
- pay penalty if employed and not insured
- require people to have coverage
2.Decrease cost
- decreasing cost for those with insurance (copay, meds)
- making it affordable
3.Increase quality
-expand use of EMRs
- rating for physicians
- quality goals for hospitals

Question 8

Provider opportunities and challenges

Answer 8

1. changing economic incentives to value focused with payment for outcomes (instead of services)
   -intervention -> prevention
   
   • physicians to coordinate and improve care delivery
     -market centric focus