Week 6 Bioethics (DLA25, L50, L51, L52) Flashcards
define primary care
- 80-90% of all health care visits
- common health problems, minor interventions, preventative measures
- via general practitioner or other caregiver
define secondary care
- issues requiring more specialized care / clinical expertise
- -usually hospital setting, specialties like general surgery
define tertiary care
- complex / rare disorders requiring extensive clinical expertise and hospital care
- sub-specialties like cardiac surgeons, immunologists, hematologists
what is the term to describe the US health care model (explain)
Dispersed Model:
- multiple access points
- fluid roles for providers
- less distinction in hospital care
- higher value on tertiary care
list the positive and negative impacts of health dispersion
Pos: flexibility, convenience, direct access to tertiary care, autonomy in selecting services
Neg: higher costs, lacks organizational coherence, difficult to integrate care and maintain continuity, unnecessary procedures/risks of medical error
describe 1st generation HMOs
- ‘vertical integration’, ex Kaiser
- health plan includes hospitals, physicians, pharmacies, home health organizations
-choose PCP in network, PCP must refer to specialities
describe 2nd generation HMOs
- ‘virtual integration’, group model
- health plan has contracts with IPAs (independent practice associations), hospitals, pharmacies, home health agencies
- must work in network
-choose PCP in network, PCP must refer to specialities
define IPAs
Independent Practice Associations
- loose collection of private doctors who work in their own practices
- contracts with HMOs: capitation payments or fee-for-service or combination with bonuses
describe PPOs
-Preferred Provider Organizations
-Pts select approved/preferred providers and hospitals
-providers discount their fees
(no PCP referrals necessary)
describe ACOs
Accountable Care Organizations
-doctors, hospitals, and other health care providers come together voluntarily to give coordinated high quality care to the Medicare patients they serve
what % of physicians will have some level of substance related impairment during their careers
10%
how prevalent is physician burn out and what are the 3 symptoms
- 51%
- emotional exhaustion
- depersonalization
- reduced personal accomplishment
list the modes of paying for health care
- out of pocket payments
- individual private insurance
- employment base private insurance
- government financing
- social health insurance
define fee-for-service
unit of payment = visit / procedure
-possibly incentives medical inflation
define payment per episode of illness
unit of payment = global surgical and other fees for an illness/episode
- single/bundled payment for multiple services, ex. surgery, birth
- more financial risk to provider than payer
define capitation payments
unit of payment = sum of patient’s Tx (per mo/yr)
-monthly payments to physician for each patient signed up to receive care - generally for PCPs (fixed sum per Pt regardless of number of services)
define payment per time
unit of payment = salary of physician
list the 4 types of hospital payments
- per procedure (FFS)
- per diem/day (hotel approach)
- per episode of hospitalization (payment depends on Dx)
- per institution = global budget
describe the 3 cost-control mechanisms in health care
- financing: limit flow of money from individuals/employers to health care plan
- reimbursement: limit flow of money from insurance plans to drs/hospitals
- utilization: make Pts pay part of the fees to reduce abuse
list the types of financing controls
- regulation: government regulates premium payments (difficult in US)
- competition between insurance plans
list the types of reimbursement controls
price control: some plans (ex. medicare, medicaid) bargain for reductions in physician/hospital fees
list the types of utilization controls
- Pt cost sharing: deductibles, co-payments, non-coverage
- Reducing ‘supplier induced demand’
