Unit I Flashcards
What is a health system according to the World Health Report?
All the activities whose primary purposes is to promote, restore, or maintain health
What are examples of depts in the Executive Branch of govt?
- President/White House
- Cabinet depts (e.g. HHS)
Why do some criticize the concept of health care consumers?
Because the role/conceptions of rights of a patient and his/her identity don’t match
What are the 3 dimensions of health?
1) Physical
2) Mental
3) Social Well-being
What health care right does the ACA grant?
access health insurance
Who is the current secretary of HHS?
Sylvia Mathews Burwell
What government power from the US Constitution allowed many federally funded programs to exist?
power to tax and spend for the general welfare
What is tertiary care?
Specialized consultative care (e.g. trauma center, Smilow)
What is the first category of views on a right to Health Care?
Basic security when it comes to their health care - Obama
What health care right does the Emergency Medical Tx and Active Labor (EMTLA) (1986) grant?
Right to screening/stabilization on presentation to ED
What is the fifth category of views on a right to Health Care?
Right to standard of living adequate for health and well-being (encompassing total health). - UN Declaration of Human Rights
What is primary care?
Basic/general health care: family practice, pediatrics, internal medicine, sometimes GYN
What are examples of depts in the Judicial Branch of govt?
Courts
What are the three aims of a health system?
1) Improve the health of the popl’n they serve
2) respond to people’s expectations
3) provide financial protection against costs of ill health
What is the second category of views on a right to Health Care?
Health care is a right, not a privilege - Pope Francis
What is the role of the Legislative Branch?
1) Debate and pass bills
2) Exec branch oversight
What are examples of depts in the Legislative Branch of govt?
Congress = House, Senate, committees/subcommittees
What is the fourth category of views on a right to Health Care?
Health care not a right or privilege; service provided by doctors and others who wish to purchase it - RM Sade, NEJM
What are 3 determinants of health?
1) Physical environment
2) Social environment
3) Personal traits
What is an example of vertical integration?
Yale Health, Kaiser
What is a proposal to achieve the Triple Aim?
Integrated care
What is integrated care?
Providers/organization accept responsibility for all three aims (CARE, HEALTH, COST) and are held accountable (fiscally & clinically) for health outcomes of popl’ns they serve
What health care right does the Medicare program (1965) grant?
Health care for:
1) 65+
2) <65 with disabilities:
End-stage renal disease, ALS
What health care right does the Medicaid program (1965) grant?
Health care for:
some individuals + families with low income
What are some examples of health policy trade-offs?
NIH funding priorities, cost-quality in health care, insurance plan coverages, screening recommendations
Name 4 possible explanations why healthcare/health reform is so controversial in the US.
- Special interests
- National values
- Complexity
- Trust (or lack thereof)
What is the definition of Health according to the WHO?
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
What health care right does the Children’s Health Insurance Program (CHIP) grant?
Health care for:
uninsured children in low income families + do not qualify for Medicaid
What are the activities of an integrator?
1) Culture of transparency and education
2) View technologies with skepticism and require strong burden of proof from proponents
What are the 5 principal features of US Health Policy?
1) Dominant role of private sector
2) fragmented/incremental/piecemeal policies
3) powerful interest groups
4) many sources of policy creation
5) impact of presidential leadership
What is the role of the Judicial Branch?
1) constitutionality of laws
2) review exec branch activities
What is the role of the Executive Branch?
1) Policy developing & advocacy
2) Rule making/regulation
3) enforcement
4) funding
What is the Triple Aim?
1) Improve individual experience of care
2) improve health of popl’ns
3) reduce per capita costs of care for popl’ns
CARE, HEALTH, COST
Which group does NOT have a legal right to health care under current US law?
Patients with HIV/AIDS
What are some examples of priorities and agenda-setting?
Mismatch between disease prevalence and funding priorities (e.g. vitamin D deficiency + rickets vs. UV exposure and skin cancer)
What is the third category of views on a right to Health Care?
Health care is not a right, but a service (commodity) provided through voluntary and mutually beneficial market exchanges - John Mackey, cofounder of Whole Foods
What is secondary care?
neuro, cardio, rheumatology, dermatology, oncology, ortho, opthalmology
Which health profession has the largest number of active practitioners in the US?
RNs
What are the key characteristics (4) of primary care?
1) First contact care
2) Longitudinality (continuity)
3) Comprehensiveness
4) Coordination
What doesn’t health system imply?
1) any particular degree of integration
2) anyone in charge of it
What are the 10 components of the US Health System?
1) Gov’t
2) Hospitals, medical practices, health systems
3) health professionals
4) industries
5) biomedical research
6) Insurers
7) Patients & patient advocacy orgs
8) Employers
9) Non-Profit, NGOs
10) Others?
Name 4 themes/major challenges for Health Policy
- Context and contingency
- Priorities and Agenda-setting
- Trade-offs
- Remembering Patients and Individuals
What are the differences among those who support a right to health care?
1) Same level of care
2) Some minimum level or care
What are the three big questions in health policy?
- Is healthcare a right?
- What is the role of the gov’t?
- How would the responsibility of gov’t function?
How much did the US spend on health care in 2014?
3 trillion, 17.5 % GDP
How much did the US spend on health care in 2016?
$3.3 trillion
How much is the US expected to spend on health care in 2025?
$5.6 trilion, 20.1% GDP
What is the consumer perspective of “cost” in health care?
price (bills, insurance premiums, etc)
What is the National (Health System) perspective of “cost” in health care?
Health care expenditures or health care spending
What is the equation for health care expenditures/spending?
product of all health care services delivered x price of those services
What is the provider perspective of “cost” in health care?
Staff salaries, facility costs, supplies, technology, etc.
What category is the largest component of health care spending in the US?
Hospital care
What is the second largest component of health care spending in the US?
Physician services
Prescription drugs account for what percentage of US health care spending?
10%
What is thought to be the largest contributor to growth of health care costs?
Technologies
What does “skin in the game” mean?
When people are more responsible for their health costs, they are supposedly more likely to consider cost or shop around for the best deal on medical tx
Why are provider incentives a reason for escalating health care costs?
Fee-for-service models: providers charge fees for specific services (make more money the more tests and procedures they perform- volume>value)
What are alternatives for Fee-for-Service care?
1) Pay for performance
2) ACO’s = shared savings
3) bundled payments, capitation, etc
How does a growing elderly popl’n escalate health care costs?
They need more care + long term, more people qualify for medicare
Name 6 reasons for escalating health care costs.
1) Medical Model of health care delivery
2) Admin costs
3) Fraud and abuse
4) Defensive medicine
5) practice variations (hence EBM)
6) Rising prices for same services (e.g. epipen)
What does it mean to bend the cost curve?
To shift the curve to a more efficient relationship between costs and health outcomes (lower cost, better health)
What is the Ubel/Jagsi “financial stewardship” model for physicians?
Opting at times not to pursue interventions that they believe might provide some benefit for a particular patient because of concern over total health care costs and its societal consequences.
What is a premium?
The amount paid for a health insurance plan (for employment based plans, usu shared between employee and employer).
What is a deductible?
An amount that the insured person must pay out of pocket for covered health services before the insurance begins to pay.
What is copay?
A fixed amount paid by the insured person for covered health services.
What is coinsurance?
A percentage paid by the insured person for covered health services (after any deductible, if applicable).
What is usually referred to when people talk about “cost-sharing”?
Deductible, copay, coinsurance
What is the simple definition of access to health care?
The ability to obtain health services when needed
What is the more nuanced definition of access to health care?
The ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely manner
Compared to insured, uninsured are more likely to (6):
1) ^ avoidable hospitalization
2) late diagnoses
3) more seriously ill when hospitalized
4) higher rates of chronic disease
5) lower survival rates from breast cancer
6) higher overall mortality: 40% greater
What states have the highest rates of uninsured?
NV, TX, MS, GA, FL
Adults with insurance coverage are more likely to be (4):
1) Married
2) Disabled
3) Employed full-time
4) mid-20’s
How much of the total US. population has coverage?
90.9%
Rank the following three age groups from most insured to least insured: age 65, 18-64, under 18
1) Over 65
2) Under 18
3) Age 18-64
What level of education do must adults who are insured have?
graduate/professional degree
Which ethnicity has the smallest percentage uninsured? highest?
Hispanic - lowest; white - highest
What is the total percentage of non-elderly people of color who are uninsured?
55% (whites are 45%)
Of the 32.3 million uninsured, what percentage is eligible for financial assistance (2015)?
49%
Among the uninsured, what is the most commonly reported barrier to health care?
No usual source of health care
What are the financial implications of lacking insurance for patients?
billed at rates higher than insured rates, have to pay upfront and in cash
What are the financial implications of lacking insurance for providers and the health care system?
Uncompensated costs of care for the uninsured $84.9 billion
What are the three components/measures of quality according to Donabedian?
1) Structure: characteristics of systems (e.g. types of hospitals, qualifications of providers, amenities)
2) Process: interactions between provider and patient (e.g. technical quality of care and interpersonal interactions)
3) Outcomes: patient’s health status after an intervention
What is the National Quality Strategy?
It is a mandate of the ACA led by Agency for Healthcare Research and Quality (2011)
What are the three aims of the National Quality Strategy?
1) Better care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe
2) Healthy People/Healthy Communities: improve the health of the US population by suportung proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care
3) Affordable care: reduce the cost of quality health care for individuals, families, employers, govt
What are the 6 priorities of the National Quality Strategy?
1) Make care safer; reduce harm caused in care delivery
2) Person & family engaged as partners in their care
3) Effective communication & coordination of care
4) Effective px and tx practices for leading causes of mortality, starting with CVD
5) work with communities to promote wide use of best practices to enable healthy living
6) Quality care more affordable by developing and spreading new health care delivery models
What is Quality Improvement?
prospective and respective; aimed at creating systems to prevent errors from happening