Health Services Organization And Delivery Exam 1

Front 1

Physician maldistribution occurs because of ...

Back 1

Specialty and Geography

Front 2

Primary care is ...

Back 2

* Longitudinal
* The portal to the healthcare system
* Holistic

Front 3

The principle source of funding for graduate medical education is ...

Back 3

Medicare

Front 4

The percentage of active primary care generalist physicians has ...

Back 4

Decreased since 1949

Front 5

Preindustrial medical practice in US

Back 5

* Neglected research in basic sciences; placed more emphasis on applied science
* Attitudes about medical treatment placed strong emphasis on natural history and conservative common sense
* Not very professional

Front 6

Five main factors why medical professionals remained unprofessional in preindustrial America

Back 6

1. Medical practice was in disarray
2. Medical procedures were primitive
3. An institutional core was missing
4. Demand was unstable
5. Medical education was substandard

Front 7

Medical practice in disarray:

Back 7

Medical pluralism ("war zone") marked by bitter antagonism among the various practicing sects
Physician's incomes held them at the lower end of middle class

Front 8

Primitive medical procedures:

Back 8

"intake and outgo" - felt diseases needed to be expelled from the body by means such as bleeding, vomiting, diuretics, enemas, and purgatives
Physicians relied on their 5 senses and experience to diagnose and treat patients

Front 9

Missing institutional core:

Back 9

No widespread development of hospitals before 1880s
Almshouses were the precursor to hospitals - served general welfare functions by providing food and shelter to destitute
Early hospital-type institutions emerged mainly to take care of indigent people whose families could not
Pest-house - local governments operated these to quarantine people with contagious diseases
Dispensaries - provided care to those who could not afford it; provided basic medical care; and to dispense drugs to ambulatory patients
Hospital mortality rates in the 1870s were around 74% in Europe and America; it was believed that people went to the hospital to die

Front 10

Unstable demand:
Two factors contributed to high costs

Back 10

1. The indirect costs of transportation and the 'opportunity cost" of travel could easily outweigh the direct costs of physicians' fees
2. The costs of travel often doubled because two people, the physician and emissary, had to make the trip back nd forth

Fee-for-service: billing separately for each individual type of service performed was firmly embedded in American medical care

Front 11

Standard medical education

Back 11

1800 - 1850 medical education was largely received through individual apprenticeship with a practicing physician, referred to as a preceptor, rather than through university education
1800 - only four small medical school were operating in the US: College of Philadelphia; King's College; Harvard University; and Dartmouth College
Medical schools tripled in numbers between 1800 to 1820 and 1820 to 1850
A year in medical school in the US, generally, lasted only 4 months and required only 2 years for graduation
** Fleanor Report 1910 - investigated medical education and identified a great need for reform

Front 12

Medical services in postindustrial America

Back 12

The American system of healthcare took its shape during this time
Growth of professional sovereignty

Front 13

Seven factors contributed to physician income growth in the 1920s

Back 13

1. Urbanization
2. Science and technology
3. Institutionalization
4. Dependency
5. Cohesiveness and organization
6. Licensing
7. Educational reform

Front 14

American Medical Association

Back 14

Formed in 1847
Began to concentrate on medical education in 1904
GOAL: To advance the professionalization, prestige, and financial well-being of its members

Front 15

Organized medicine:

Back 15

The concerted activities of physicians through the AMA which distinguishes them from the uncoordinated actions of individual physicians competing in the marketplace.

Front 16

Education reform

Back 16

Harvard revolutionized the system of medical education
Standards at Johns Hopkins became the model of medical education in other leading institutions around the country

Front 17

Gate keeping

Back 17

Initial contact with a generalist and obtaining a referral just gained prominence only as recent as 1990

Front 18

National Mental Health Act (1946)

Back 18

led to the creation of the National Mental Health Institute
- mental health care has not seen the advancements that physical health care has

Front 19

Community Mental Health Act (1963)

Back 19

supported community care and deinstitutionalization placing more emphasis on community-based mental health services

Front 20

The development of public health

Back 20

Developed from agrigarian (agriculture) to industrialized cultures: sanitation, food issues, occupational health ... population and community health

Front 21

By 1900 ...

Back 21

Most states had departments of health which were responsible for public health efforts such as sanitary insoections, communicable disease control, operation of state laboratories, and regulation of food and water

Front 22

Workers' Compensation

Back 22

- First attempt at government sponsored, universal health care
- Important because it recognized single household income

Front 23

Rise of private health insurance -
Blue Cross Plans

Back 23

1933 - The American Hospital Association supported hospital insurance plans and became the coordinating agency to unite these plans into the Blue Cross network
- Nonprofit, covered only hospital charges
Later: Blue Cross Commission (Blue Cross Association was formed)

Front 24

The Blue Shield Plans

Back 24

- Designed to pay physicians bills
- Voluntary health insurance, in conjunction with private fee-for-service practice, was regarded as a desirable feature of the evolving health system
- Met AMA's stipulation of keeping medical matters in the hands of physicians

Front 25

Employment based health insurance:
Three main factors how established

Back 25

1. To control high inflation in the economy during WWII congress imposed wage freezes. In response to these freezes many employers started to offer health insurance as an incentive.
2. In 1948 the Supreme Court ruled that health insurance benefits were a legitimate part of the union management barganing process. Health insurance became a permanent part of employee benefits in the postwar era.
3. Employer contributions to employee insurance became tax exempt.

Front 26

Failure of National Health Care Initiatives: A Historical Overview

Back 26

- National Health Insurance driven by cost control
* Inhibitors - cultural , market, independent autonomy from govts., insurance companies
- Reformers argued that national health insurance would relieve poverty because sickness usually brought wage loss and high medical costs to individual families
- AMA showed support for a national plan, and the AALL and the AMA formed a united front to secure legislation
- WWI brought with it a resistance toward anything German, thus, universal health care was dubbed as socialist
- Any efforts that interfered with the fee-for-service payment system and led to private practice being controlled by a powerful third party, particularly the government, were opposed

Front 27

National health insurance legislation has failed for many reasons: four broad categories:

Back 27

Political inexpediency; institutional dissimilarities; ideological differences; and tax aversion

Front 28

Other forces against universal health care:

Back 28

- Insurance industry
- Pharmaceutical industry
- Employers
- Labor unions
*all because of financial interest on their part

Front 29

Ideological differences

Back 29

American value system based largely on the principles of market justice
individualism and self-determination, distrust of government, and reliance on the private sector to address social concerns are typical American ideologies that have stood against anything perceived as an onslaught on individual liberties
1940 - several bills on national health insurance were introduced in Congress
Truman became the first president to make an appeal for a national health c are program. The AMA was vehement in opposing the plan.
The Cold War brought about the fear of socialized medicine again and universal health care was promoted as being socialist and communist
The AMA levied a $25 fee on each members toward a war chest - campaign directly linked national health insurance with Communism until the idea of socialized medicine was firmly planted in the public's heads.
*Failure of government-sponsored universal health care coverage is often presented as a classic case of the tremendous influence of interest groups in American politics, especially in major health policy outcomes.

Front 30

Medicare & Medicaid

Back 30

The government assumed some financial responsibility for the health care of two vulnerable groups, the elderly and the poor

Front 31

Medicare: Three layered program
Medicare: Part A & B and Medicaid

Back 31

Part A: Automatically enrolled
Financed hospital insurance providing hospital care and partial nursing home care
Part B: Elective; pay a premium
Cover physician's bills through government-subsidized insurance
*long term care benefit
Medicaid: Federal matching funds to the states, based on each state's financial needs
States set benefits per federal government
Medically indigent - not just poor
- Protect the children
- Women and children who are medically needy
- Bad for providers

Front 32

Prototypes of managed care:
Contract practice

Back 32

Capitation -

Front 33

Prototypes of managed care:
Group practice

Back 33

- Changed the relationship among physicians by bringing them together with the business managers and technical assistants in a division of labor
- Mayo Clinic was the prototype of the consolidation of specialist
- Growth continues due to economic advantages such as shared expenses and incomes

Front 34

Prototypes of managed care:
Prepaid group plans

Back 34

- Enrolled population received comprehensive services for a capitated
fee
- Became the prototype for HMOs
The HMO Act required employers to offer an HMO alternative to conventional health insurance. The objective was to deliver comprehensive health care services at predetermined costs.
HMO - control cost by controlling utilization; cook book medicine; decrease then increase

Front 35

Health care in the /us became the domain of big business

Back 35

- for-profit or non-profit, they are concerned with maximizing their revenues
- Benefit: they deliver sophisticated, modern health care in comfortable and pleasant environments
- Managed Care has emerged as the dominant force by becoming the primary vehicle for insuring and delivering health care in the US
- Managed Care was supposed to be a market-place reform but instead has stripped the patient of almost all marketplace power

Front 36

Globalization

Back 36

Various forms of cross-border activities ; driven by global exchange of information, production of goods and services more economically in developing countries, and increased interdependence of mature and emerging world economics

Front 37

Patient Protection and Affordable Care Act (PPACA)

Back 37

- Not a single republican voted in favor of the legislation
- AMA was in support which traditionally has not been the case
- Legal challenges to the law
- Two-thirds of Americans oppose the law
- Political shift occurred in the 2010 mid-term elections
- Final outcome may be decided by the US Supreme Court