Week 13-14 Flashcards
Describe the 4 separate areas in which regulation might apply
price, quantity, entry by new providers, quality
The ways _____ pays for hospitals and physicians services are best thought of as ___________, as a later section discusses
Medicare, price controls
Define CONs, in what area do they provide market regulation?
Certificate of need rules place limitations on construction of new capital facilities to try to
limit total hospital capacity.
CON (certificate of need) rules affect entry into the market by new providers and limit the quantities of inputs existing providers use
Proponents of licensure argue that it a), opponents say b)
a) protection of citizens against fraudulent or unsafe providers of care. b) decry the entire idea as a tool to restrict entry and limit competition.
Regulations apply to _____ but rarely to _______
labor inputs in the provision of health care, organizations and firms that produce the final products of health services
Where do the vast majority of health care licenses emerge from?
States
What are the three most common reasons for license revocation?
1) illegal drug use or prescribing by a physician 2) fraudulent billing 3) sexual encounters between a doctor and his or her patients
Many areas with of medical care with licensure requirements also have ___________. ________ is required for both.
Voluntary indicators of quality, continuing medical education (CME)
Describe the role of quality measures on surgery for CABG patients
- patients have a documented tendency to shift to surgeons with lower documented mortality rates
- these doctors might attract sicker patients
- for Coronary Artery Bypass Surgery, a concerted effort was required to move from raw mortality rates to a more sophisticated set of ratings that adjusted for patient risk
What businesses currently have national rating agencies that have provider-level scores of quality?
Hospitals (including nursing homes and managed care organizations), nursing homes, insurance companies
How is quality assessed for medicare and medicaid companies?
The Hospital Compare data set, which categorizes information into 4 distinct categories
What 4 categories does the hospital compare data set comprise of?
Direct outcome measures, process measures, patient survey satisfaction, imaging use rates
What are newly added measures in HEDIS as it is used to assess managed care organizations
Included are assessments for adult body mass index, alongside counseling for weight, nutrition, and physical activity
Describe the primary economic issue with CON laws
If CON rules indicate that capital investment of a hospital wishes to provide more services, the hospital will likely just invest in other resources to treat patients,
Describe the findings of Salkever and Bice on CON laws and the effect on rates of cost growth
- Found that bed increases had been constrained and other costs had increased faster
than in unregulated markets - States with long-active CON laws had costs increasing at slightly higher rates than
those in other states.
