WEEK 3 Flashcards
identify two ways of viewing the output of the health care delivery system.
There are two types of output comparisons: time series and cross-sectional comparisons.
A time series comparison measures the output of the same good or service at different times.
A cross-sectional comparison measures the output of the good or service among different groups at the same time (e.g., the medical care provided to consumers in different age groups, ethnic groups, or geographic areas, or with different diagnoses).
HEALTH
“a complete state of physical, mental and social well-being, and not merely the absence of illness or disease.”
These health-influencing factors can be classified as lifestyle elements, such as diet, sleep, and other individual behaviors; environmental factors, such as air and water purification; genetic factors; and medical care, such as examinations and treatments
Health Care
The healthcare system includes the training of the professionals who work within the system, and these individuals will produce output (health care) during their training and after it is completed.
Health care is defined as any activity where the objective is to maintain or improve health. Thus, health care includes activities such as health-oriented dieting, exercise, and medical care. Caregivers can be professionals, family members, or the individual. The recipients are patients or the clients.
Medical Care
Medical care is a process during which certain inputs, or factors of production (e.g., healthcare provider services, medical instrument and equipment services, and pharmaceuticals), are combined in varying quantities, usually under a physician’s supervision, to yield an output.
identify where medical care and health care can be measured.
Medical Care
The providers can be surveyed to determine how much medical care they have produced.
The payers for medical care can be surveyed to determine for how much medical care they have paid.
The consumers can be surveyed to determine the
quantity of consumption or utilization.
This medical care could be measured as a single visit, or it could be measured by the individual services provided by the physician. For example, a person may receive an examination and an inoculation during a single visit, and these procedures might count as two services. When patients receive care in or are admitted to a hospital because hospital care and stays are usually directed by doctors, they are normally considered to be medical care, regardless of how much (or how little) time doctors may spend with patients.
identify where medical care and health care can be measured.
Health Care
One way of measuring output is to examine the number of admissions on a per-population basis.
One method of doing so that captures a mixture of illness types and severities, as well as treatment patterns, is the diagnosis-related group (DRG) classification system. The DRG system has many variants, but all of them are simply patient classification systems. In the 1998 version of the DRG system, which was used by the Health Care Financing Administration to reimburse hospitals, hospital inpatient output was divided into 511 different groups based on the major reason for hospitalization, whether the case was medical or surgical, patient age, and the presence of significant complications and comorbidities
This index attempted to measure the quality change of a day of care by changes in service intensity, which was defined as the quantity of real services that go into one typical day of hospitalization. The AHA’s Hospital Intensity Index (HII) incorporated 46 services
Hospital care can be measured by the number of patients admitted or the number of days of care. Sometimes the number of hospital beds is used as a measure of service, but this measure simply indicates the potential services available, not the services actually received, as many of the beds may be empty.
The true output of the healthcare sector is measured by the net change in health produced by the medical care provided.
describe measures of physician care, hospital care, nursing home care, home care, and self-care.
Medical care is one component of health care. Other examples of health care activities include smoking cessation advice, dietary practices, nutrition counselling, exercise programs, parental care of sick children or care of elderly parents, etc. Data on medical care are routinely collected by professional providers and payers, and so are more readily accessible than data on other aspects of health care. Data on some nonmedical health care, such as long-term care and home care, are also more readily available. Long-term care data can be collected using the number of patients or the number of days of care as measures. Home care can be measured by the number of clients, the number of visits made by the home care unit, or the number of hours of service. Statistics on the number of clients served, the hours of service and the hours provided for each client can usually be found on provincial websites.
Self Care
Researchers have been looking for other measures of health with a more positive focus. Attempts at identifying and measuring health have focused on certain characteristics we would expect in a healthy person. These characteristics include the physical functioning of the individual’s body in relation to some norm, the physical capability of the individual to perform certain acts (e.g., getting up or dressing), the social capabilities of the individual (i.e., how well he or she interacts with others), and how the individual feels.
Mortality
Mortality is defined as death; therefore, when health status is measured according to mortality, all individuals fall into one of two categories—dead or alive. A mortality measure does not assess the state of health beyond the mere fact of whether one is alive or not
Morbidity
Morbidity is defined as illness. In the case of mortality, the event of death is unique and well defined. Morbidity, however, poses considerable difficulties in identification and measurement. One measure that has been used is “disability days,” that is, time off from work, home activities, or school.
Quality of Life
i. Nevertheless, researchers have found that when the many different quality of life indexes, which are based on questionnaires filled out by independent observers or by the participants themselves, are scored, the results yield a standardized measure of health status. Quality of life is a term that ideally incorporates all of the factors that affect one’s well-being.
measure mortality rates and life years.
A common measure of health status for a population is the mortality rate, which is the number of deaths that occurred during a year within a group of people, divided by the number of people in the group at the start of the year.
They choose survival-time indicators because these place emphasis on the duration component of health status; a person’s well-being is a function of the time spent in each health state, not merely the health state at a given moment in time. Measures that look at survival time adopt this important dimension of health. One such measure is that of potential years of life lost (PYLL) before a target age.
define the health outcomes of interventions, and relate these outcomes to health status and quality of life measures.
The phrase health-related outcome refers to the net change in health status that results from a specific, health-related intervention.
An intervention is an action performed by a practitioner or an individual, with the specific aim of maintaining or improving health status.
Note that the outcome is related to some specific intervention such as a medical treatment, diet, or exercise. The intervention can be to treat a disease, prevent a disease, or improve health status generally. It is important to understand that a health outcome is measured as the change in health status that results from this intervention.
define the relationship between health outcomes and “flat-of-the-curve medicine,” and show how a graph can be used to depict this relationship.
At low amounts (units) of medical care, health status increases considerably in response to small additions of intervention. Eventually, the response gets smaller and smaller. A relationship of this nature is referred to as diminishing marginal productivity—as you can see, the curve flattens to indicate this gradual reduction in efficacy. When there is no additional response, the curve becomes a “flat-of-the-curve medicine,” which indicates that additional medical intervention will yield no further gains in health status.
discuss the meaning of flat-of-the-curve medicine in terms of the productivity of health care.
When there is no additional response, the curve becomes a “flat-of-the-curve medicine,” which indicates that additional medical intervention will yield no further gains in health status.
