U.S health - exam 3 what I did not know Flashcards
In Canada, how are you billed if you are a part of the provincial health service
In Canada, you do not get a bill if you are a part of the provincial health service
In Canada, what does the private insurance allow for
In Canada, the private insurance allows for gaps such as some pharmaceutical coverage or private hospital rooms
Canada has how many services
Canada has less services per capita
how are physicians billed
Germany
Canada
U.K
Japan
For physicians:
Germany is billed per episode
Canada is billed fee for service or capitation
U.K is capitation/preventive care fee for service/salaries
Japan: fee for service while hospitals are paid per diagnosis
Canada vs U.S:
Canada vs U.S: less admin cost., less expensive high-tech costs, lower pharmaceutical prices. Has caps on payment like Germany
For U.K, private insurance can pay for what
For U.K, private insurance can pay for care of private hospitals not NHS facilities
For U.K what do you need for a referral to go to a specialist
what about for germany
For U.K needs a referral to go to a specialist. They also have limited consultant slots so they control supply of personnel and facilities
do not need referral for germany
In japan, the gov’t strictly regulates what
In japan, the gov’t strictly regulates physician fees, hospital payments, medication pricing, number of expensive services
Employer-sponsored health plans increase -what did purchasers begin to pay attention to
Employer-sponsored health plans increase - In the 1980’s the purchasers began to pay attention because everything got so expensive. Providers take control by using capitated contracts instead of fee for service. Insurers also choose providers to contract with. Companies use HMOs to cost control. Large companies start self insurance
in coverage landscape changes
Plan becomes very specific as to where and from whom care can be provided and covered
Providers would lose contracts due to poor rates and unwillingness of insurers to negotiate
Purchasers had some negotiating power with HMOs and saw a drop in premium growth in the earlier 1990’s
Employers shop around more for insurers
in 2000’s
employee-Premiums and deductibles rise 34%
Large HMOs emerge due to buy-outs and consolidation
Provider and insurance negotiations are intense
specialists groups grow and demand higher payment rates from insurers
tiers also begin because insurers start to challenge costs
Hatch-Waxman Act or Drug Price Competition and Patent Term Restoration Act
Description: allows a drug research company the exclusive right to produce and market a new drug for a specific period of time (usually five years). During this time, no generics are allowed to come to market.
ever greening starts too - release XR as soon as 6 months is almost up
PBM (Pharmacy benefit management) is responsible for formularies
Why Digitalize Healthcare?
They can help address the following issues:
- Reduce inefficiencies,
- Improve access,
- Reduce costs,
- Increase quality, and
- Make medicine more personalized for patients
gives patient more control of care and gives providers a more holistic view of patient’s health
now more physicians and hospitals are adopting electronic health records (EHRs)
for RPM
some patients will need in-person testing and treatments and monitoring
this depends on their condition internet capabilities or personal preferences and abilities
RTM can include
devices used for RPM and disease management for therapeutic outcomes
med. adherence and physiological data
interventions can include education and coaching
CMS can include pulmonary and musculoskeletal conditions
issues with DIGITALIZATION OF DEVICES
Accuracy
data interoperability
coverage
patient education
user adherence
Limitations for CGM and benefits
Limitations still present:
- Cost barriers
- Clinician and patient buy-in
- Technology barriers
fewer pricks on the finger
digital affinity related to acceptance of use
BARRIERS TO ADOPTION
of digitalization
PROGRAM IMPLEMENTATION BARRIERS
- time/training
- education of multiple sites to have cohesive patient care
- leadership buy-in to hire staff to be a part of it
- launching RPM/Virtual services requires an initial evaluation of on-site needs and implementation considerations
PATIENT BUY-IN
- education on
- technical and physical support
- need a flexible platform
- SDoH
PAYER COVERAGE CONCERNS
- likely for fraud
- reimbursement and incentive concern
- Codes (CPT) for RPM and RTM for diabetes management
public health definition 4 parts
mission
- fulfillment
substance
- organized community efforts
organization
- encompasses both activities undertaken within the formal structure
3 core function
- assessment: diagnostic
- policy development
- assurance
decision-makers in PH
public health experts
involves scientific recommendation
government intervention
epidemiology focus
causative factors
control spread of disease
what does Biomedical Sciences in PH include
Includes study of genetic predisposition and effects on disease risk, prevention and treatment
Six sciences/disciplines of Public Health
Epidemiology
Statistics
Biomedical Sciences
Environmental Health Sciences
Social and Behavioral Sciences
Health policy, management and administration
Environmental Health Science depends on what
Depends on epidemiology to track environmental causes of disease
what does Health policy, management and administration Attempt to address
Rising cost of healthcare
Access to healthcare
Quality of healthcare
Role of public health in medical care
Primary prevention
aims to prevent an illness or injury from happening at all by preventing exposure to the risk (true prevention)
: discouraging teenagers from smoking and efforts to encourage smokers to quit (prevents lung cancer and COPD)
Secondary prevention
aims to minimize the severity of the illness or injury when it occurs (early detection like mammograms or annual exams and treatment)
screening programs for early cancer detection
Tertiary prevention
aims to minimize disability by providing medical care and rehabilitation after the disease has happened
: medical treatment and rehabilitation for cancer patients
Chain of Causation
what is the goal of each part
Agent: could be a disease-causing bacteria or virus.
- Goal is to eliminate or minimize
Host: a human being.
- Goal is to make less susceptible/strengthen resistance to the agent
Environment: the means of transmission by which the agent reaches the host.
- Goal is to make the host less likely to encounter the environment and decrease or eliminate the means of transmission
Economic Impact of PH
policies that will take $ to implement like
Tobacco industry: product labeling, bans on smoking in public places, restaurants
Mandatory immunizations
Lumber industry: regulations cost jobs to preserve a long-term stable climate
National Center for Health Statistics
NCHS collects data in 2 ways
Primary agency that collects, analyzes and reports data on the health of Americans
1- States and local agencies periodically transmit data they have compiled from local records: vital stats, births and deaths
2- Conducts periodic surveys of representative samples of the population on health status, lifestyle, health-related behaviors, onset and diagnosis of illness and disability, use of health care resources
change in census
only the most basic data was collected using a short form
(included name, sex, race and ethnicity, and relationship of everyone living in the household)
Two ongoing NCHS surveys one is:
The National Health and Nutrition Examination Survey (NHANES)
Designed to obtain detailed and accurate information
Doctors and nurses conduct physical and dental exams and lab tests on a carefully selected sample of the population
Data collected determines the prevalence of chronic conditions and risk factors as well as nutritional status and its association with chronic disease
Two ongoing NCHS surveys one is:
The Behavioral Risk Factor Surveillance Survey (BRFSS)
Largest telephone survey in the world
Self-reported data (may be less reliable)
The only available source of timely, accurate data on health-related behaviors
—Conducted by the states which report their findings to the CDC
—Asks questions about health status, high-risk behaviors, physical activity, preventive medical care
Is so much data necessary?
The success of intervention programs to confront a problem is evaluated based
The success of intervention programs to confront a problem is evaluated based on whether they improve the statistics
Data is critically important in making up the surveillance systems that form the basis of effective public health practice as well as the planning and evaluation efforts that are increasingly being used in public health programming
Accuracy and Availability of Data
New information technology (public health informatics) has vastly improved accessibility of information to public health workers and the general public
police power from the gov’t is enforced for 3 reasons
To prevent a person from harming others (direct or indirect)
To defend the interests of incompetent persons such as children or the mentally handicapped
To protect a person from harming him or herself
Examples of police powers:
Mandatory vaccinations
Occupational Safety and Health Act (OSHA)
How public health is organized and paid for
legal agencies
Have day to day responsibility for public health activities and provide the bulk of services (include collecting statistics, conducting communicable disease control programs, health screenings, immunization clinics, provision of medical care to the indigent)
Organization varies from state to state (most common is county health departments, large cities have municipal health departments, towns have boards of health, rural areas have multicounty health departments )
Funding varies from state to state, including state, federal and local taxes, fees for services
State Agencies
Has primary responsibility and authority for the protection of health, safety and general welfare of the population
Most states have a state health department (Mass Dept of Public Health)
Funding depends heavily on federal money
Define to varying degrees the activities of local health departments
Charged with licensing and certification of medical personnel, facilities and services
Administer Medicaid programs
Federal Agencies
Fall under the jurisdiction of the Department of Health and Human Services (HHS)
The Surgeon General is the nation’s leading spokesperson on matters of public health
Agencies include
- CDC – the main assessment and epidemiologic agency (figure 3-4)
- NIH – the greatest biomedical research complex in the world (Box 3-1)
FDA
Nongovernmental role in public health
Conduct campaigns to educate the public
Sponsor research on a particular disease
Include professional membership organizations
Include several major philanthropic foundations providing funding for supporting research or special projects, health care to certain populations and support for health and public policy development
The Federal government has a list of notifiable diseases that a healthcare provider must report to the public health department
Hepatitis B
HIV
STDs
Tuberculosis
COVID-19
Outbreak Investigation
step 1
step 2
step 3
step 4
step 5
step 1: case defintion
step 2: Perform descriptive epidemiology
step 3: Implement control and prevention measures
step 4: Initiate or maintain surveillance
step 5: Communicate findings
what kind of study is the heart disease study
This type of study is called a prospective cohort study because it follows the subjects through time
Case-Control
Cohort
Epidemic curve
Incidence
Intervention Study
Probability
Relative Risk
Surveillance
Bias
Confounding variable
P-value
Significance
Statistics
Case-Control
- A study that compares individuals affected by a disease with a comparable group of persons who do not have the disease to determine possible causes or associations
Cohort
- A study of a group of people, or cohort, followed over time to see how some disease or diseases develop
Incidence
- is the rate of new cases of a disease in a defined population over a defined period of time
Intervention Study
- clinical studies in which participants are prospectively assigned to groups (e.g., experimental and control arms) to receive an intervention(s) or a placebo/no interventions so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.
Probability
- likelihood
Relative Risk
- What is the ratio of the risk of disease in exposed individuals to the risk of disease in unexposed individuals?
- use in cohort studies
Surveillance
- close observing
Bias
- a systematic error in the design, conduct or analysis of a study that results in a mistaken estimate of an exposure’s effect on the risk of disease.
Confounding variable
- Is a factor or explanation that may affect a result or conclusion.
P-value
- P-value is the probability that the observed results occurred by chance alone
Significance
- the claim that a result from data generated by testing or experimentation is likely to be attributable to a specific cause
Statistics
- the practice or science of collecting and analyzing numerical data in large quantities, especially for the purpose of inferring proportions in a whole from those in a representative sample.
prevalence vs incidence
prev: total cases
incid: new cases
Relative Risk (RR)
OR
RR - What is the ratio of the risk of disease in exposed individuals to the risk of disease in unexposed individuals?
OR. - What are the odds that the disease will develop in an exposed person? Association of an exposure and a disease
