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154 Cards in this Set

  • Front
  • Back
What are the 2 main goals of Health People 2010?
Increase quality and years of healthy life.
Eliminate health disparities which basically means achieve equity.
What is the 1st focus area of healthy people 2010?
Improve access to comprehensive, high quality health care.
What are the 4 categories of objective 1.7 core competencies for healthcare providers?
Clinical prevention
Quantitative skills
Health services and delivery
Community dimensions in medical practice.
What does Evidence Based Practice involve?
Biostatistics and Epidemiology (rates of disease, types of data, statistical components)
Methods of evaluating research literature (study designs, quality measures)
Outcome measurements including quality and costs (measures of mortality and quality of life, measures of cost and quality of health care).
Health surveillance (vital stats, disease surveillance and risks).
Determinants of Health (burden of illness and contributors to morbidity and mortality).
What do Clinical Prevention Services involve?
Chemoprevention (ex. hypertension).
Counseling (approaches to culturally appropriate behavior change, clinician patient communication and criteria for success and evidence based)
Immunization (approaches, criteria for success and evidence based)
What criteria should be used for hypertension management?
Joint National Committee VI
What is a good example of counseling involved in clinical prevention services?
Physician cooperates in Women, Infant and Children program by allowing WIC to come into practice and provide services to rednecks.
New moms receive counseling on caring for young rednecks.
What happened to levels of immunizations in Ohio since 1994? What did these studies also show?
In 1994, 50% of Ohio vaccinated
ODH grants increase rates to 90% in 2003.
Studies showed that some families only visit doctor when ill so physicians used this time to immunize.
What are the 4 parts of Health Systems and Health Policy?
Organization of clinical and public health systems
Health services financing (medicare, medicaid, uninsured, employment based).
Health workforce (regulating health care professionals)
Health policy process (policy making at local, state and federal levels).
3 examples of Public Health system?
Immunizations, Infant mortality prevention, TB Control
What is every child succeeds in SW ohio?
Intense home visitation program targeting at high risk mothers in an attempt to lower infant mortality.
What are community aspects of Practice?
Communicating and sharing health information w/ the public (assess community needs, media communication strategy).
Environmental health (environmental disease prevention, sources and routes of exposure).
Occupational health
Global health issues
Cultural dimensions of practice (cultural influence on health care)
Community services
What are the 3 factors affecting human health?
Environment, genetic factors and personal behavior
What 3 agencies promoted Health People 2010?
Agency for Toxic substances and disease registry
What are the 6 sources of Air Pollution?
Power plant emissions
Manufacturing emissions
Vehicle emissions
Burning fossil fuels
Forest and other vegetation
What are the 3 main categories of sources of air pollution?
Natural sources
Mobile sources
Stationary sources
What is the NAAQS and it's function?
National Ambient Air Quality Standards is standards set by the US EPA on the 6 air pollutants.
Areas not meeting the standards are called non-attainment areas.
What are the 6 criteria air pollutants of NAAQS and which one accounts for non-attainment most?
Nitrogen Dioxide, Ozone (accounts for most), Sulfur Dioxide, Carbon Monoxide, Particular matter, Lead
What is the air quality index?
An index btw 1-500 (with the cut off being 100) which helps tell the public the quality of the air. Higher numbers represent more health concern.
Good air 0-50, Moderate 5-100 (cut off), Unhealthy 101-150 etc.
What is ozone a by product of? When is ozone season?
Nitric oxide, volatile organic hydrocarbons, heat and sunlight.
Reaction occurs at ground level and ozone causes repiratory distress in children.
April to October
What is the newest reason for non-attainment?
Because a new particulate matter standard was lowered from 10PM to 2.5
What are HAPs?
Hazardous air pollutants which are pollutants that could result in increased mortality or cause illness.
US EPA was required to compile a list of these HAPs and then develop national emission standards for this (NESHAPs).
What are the Health People 2010 objectives for outdoor air?
Lower harmful air pollutants
Alternative modes of transportation
Cleaner alternative fuels
Reduce airborne toxics
What are the sources of drinking water?
Groundwater wells (>25ft deep)
Surface water (rivers, lakes, reservoirs, ponds, dug wells < 25ft).
What are the rules of thumb for drinking water?
Anything above 25ft is considered unsafe to drink unless treated. Deeper than 25 ft is safer but should still be treated.
What was the safe drinking water act of 1974?
First enforceable national drinking water standard. EPA was required to regulate contaminants known to cause health risks. Now known as Primary Drinking Water Standards.
What compounds should be limited in the primary drinking water standards?
Bacteria, viruses, parasites, disinfectants and their byproducts, inorganic chemicals and heavy metals, organic chemicals, pesticides, radionuclides.
What 2 things can result in recreational waters being closed?
Exceeded levels of sewage contamination.
Exceeded levels of fish pollution results in food advisory
What are the 6 objectives of health people 2010 for water quality?
Increase safe drinking water
Decrease waterborne diseases
Increase water conservation
Decrease surface water health risks
Decrease beach closings
Decrease fish contamination
What problems do toxics and wastes cause?
They contaminate air, groundwater and surface water w/ chemicals, bacteria and microbes.
Not so much air pollution
What is the hierarchy of EPAs waste management?
Reduce source waste production (meaning reuse products and compost backyard waste).
Improve disposal w/ combustion and landfilling
What is the primary purpose of waste incineration?
Reduce volume of solid waste that must go into a landfill
What are the objectives for Health People 2010 w/ regards to toxics and waste?
Blood levels of lead in children
Risks posed by hazardous waste sites
Pesticide exposures
Toxic pollutants from energy production

Recycle more municipal solid waste.
What are the potential risks of homes and communities?
Indoor air quality
Inadequate heating, cooling and sanitation
Structural problems, electrical and fire hazards
Lead based paints
What are 8 examples of disease agents we should have indoor protection against?
More space to minimize resp. infxns
Building material degradation (asbestos)
Smoke and CO
Tobacco smoke
Indoor allergen
Communicable diseases
Legionairres disease
Examples of indoor chemical pollution?
Lead paint
Volatile organic compounds
What are the objectives of Health People 2010 for healthy homes and communities?
Reduce indoor allergens
Increase lead based paint testing
Improve indoor air quality
Increase home radon testing and radon resistant homes
Increase school policies protecting against environmental hazards.
What is a class A1, A2, A3, B and C agent?
A1 is a disease you report immediately
A2 is the next business day
A3 is end of work week
B is report number of cases each week
C is report an outbreak of 3 or more.
What are the infrastructure and surveillance objectives for Health People 2010?
Reduce heavy metal, pesticide and other toxic chemical exposure
Improve information systems for envntal health
Monitor envn related vectors.
What are the 4 principles of food safety?
Cleanliness of all areas in contact w/ food
Temperature control
Prevent cross contamination
Personal hygiene (washing hands is primary)
What are the foodborne illness objectives for Health People 2010?
Foodborne infections
Foodborne illness outbreaks
Salmonella resistance to antibiotics
Food allergy deaths
Organophosphate pesticide exposure
Consumer food safety practices
Safe food prep in retail facilities
Examples of primary and secondary air pollutants?
Primary: CO, NO2, SO2, NO, hydrocarbons and PM
Secondary: SO3, HNO2, H2SO4, H2O2, O3, photochemical oxidants.
What is the historical basis for Autonomy in physicians?
Back in the day, middle class people became doctors to make money so they worked hard on their own to make it.
What was the Hill-Burton Act?
Back in the 50s, public thought we didn't have enough hopsitals so huge governments grants dedicated to building hospitals.
What is cost-based reimbursement?
This was the government offering to contribute significantly to costs of hospitals.
What is the biggest problem w/ hospital administrators?
They aren't doctors
What is the main cause of not having an integrated health care system?
We need a unified computerized system but no doctors will allow hospitals to buy them one b/c they don't know what they are doing.
What is medical loss ratio and how does it affect health care?
Medical loss ratio is insurance companies not wanting to pay out for health care because it is a loss to them. It is terrible for health care b/c nothing gets paid for.
What was health care like in the 70's under Nixon?
It was expensive and in chaos so he tried to institute Capacitation which is the idea that the doctor gets paid a fixed amount of money regardless of what illness he treats.
What is the democratic vs. republican perspective of health care?
Democrats want to improve quality, involve the government in health care and improve access.
Republicans want to lower costs and allow health care to be a free market.
What was the Health Maintenance Act of 1973? Bad problems w/ this act?
Federal grants were given to HMOs to start up. HMOs were paid the same amount of money to take care of sick and healthy people. Starting cherry picking and only insuring healthy people.
What is the main problem w/ HMOs?
Because they control care, physicians change their relationships w/ patients. They don't run certain needed tests b/c they'll get docked on reimbursement. They also start to worry about costs instead of the best interest of the patient. Basically the insurance company controls care.
What was the Healthcare bill or rights? What was the consequence?
It was a bill that Bush tried to pass in 2000 to stop insurance companies from managing care. Wasn't passed and insurance companies thought they were looking bad so they stopped managing care and jacked up premiums.
What is provider driven care? What are the benefits?
When insurance companies no longer control doctor's ability to provide best thing for patient.
The quality of health care improves.
What are ways to motivate physicians to do a better job?
Educate us (only 20% effective)
Hassle us (effective but not liked)
Participation (form groups and talk about things).
Give us incentives (pretty good way)
BEST WAY: feedback (show us our performance)
Unexplained clinical variation, good or bad? What causes this?
BAD! Physicians acting like cowboys
What is a nominal variable and example? What measures of central tendency can you use w/ nominal variables?
A qualitative variable that can be grouped into non-ordered categories. Blood types A, B, AB
Mode only
What is an ordinal variable and example? What measures of central tendency can you use w/ ordinal variables?
A qualitative variable that can be grouped into ordered categories. Education levels.
Mode and median
What are the types of quantitative variables? What measures of central tendency can you use w/ quantitative variables?
Continuous (infinite) and discrete.
Mode, median and mean.
Difference btw a histogram and a bar graph?
Histogram is a bar graph that has the bars touching b/c the variables are continuous. Bar graphs are for ordinal or discrete data.
What is the mode and what can it be used for?
Mode is the most frequently occurring value and it can be used for any type of variable.
What is the median and what can it be used for?
Median is the exact middle number and it can be used for ordinal and quantitative (continuous and discrete) variables.
What is the mean and what can it be used for?
It is the average value and can only be used for quantitative (continuous and discrete) variables.
What are the 6 aims of the Institute of Medicine to improve quality of health care?
Safe, Effective, Patient Centered, Timely, Efficient and Equitable.
What is a continuity of care record? What is it's function?
It is a single summary document of the patient's medical history and it's function is to increase interoperability amongst health care systems.
What is a clinical data repository?
It is a huge database that all our patients go into, in order to track their information and make inferences about our treatment.
What is a disease registry?
It is a computerized record that shows epidemic data of certain conditions in the community, allowing us to track outbreaks.
What are the 3 basic questions to ask when looking at a research article?
Are the results valid (was the study done properly)?
What are the results?
Will they help me treat my population or patient?
What are 3 questions to ask yourself to tell whether results of a research study are valid?
Was there an adequate comparison group?
Were the outcomes and exposures measured the same (unbiased)?
Was the follow up sufficient?
What is critical to a HARM study?
Having a good comparison group which must be the same as the experimental group in every way except in exposure.
What is the gold standard for HARM studies?
Randomized control trial which is when you expose the patient to harmful exposure and then monitor outcome. RARELY done b/c it is unethical.
What is the different btw a cohort study and a randomized control trial?
Cohort study is looking at the outcome after the cohort group has already exposed themselves. RCT is exposing the group and then watching the outcome.
What is the difference btw a cohort study and a case-control study?
Cohort study, you find a group of people that exposed themself to something and a group that didn't and then look for a disease or outcome. Look at exposure first, then look for disease.
Case-control, you find a case group that have a certain disease and look in their past to see what they were exposed to. You then find a control group that were exposed to the same things but didn't develop the disease. Look at outcome first and then look for exposure.
What is the best type of study to do with patients that have a rare disease?
Case-control b/c you have to look at what each person was exposed to in the past and look for similarities.
What is the problem with case-report studies?
In these studies, you find a patient with a disease and then notice that they were exposed to something and state that the exposure caused the disease. You can't do this because you don't have a control to compare it to.
What is the only thing that case-report studies are good for?
To frame questions to do in a case-control study or cohort study.
What is the common bias in case-control studies?
The patient with the rare disease remembers everything they were exposed to but the patient w/o the disease (control) doesn't remember the same thing. This is patient indirect bias. You could also have interviewer bias where you expect certain answers from certain groups.
What is the common bias in RCT and cohort studies?
You don't look at the whole population correctly leading to surveillance bias.
What are some of the secondary guidelines to look for in a study?
Is the temporal relationship correct? (Is the timeline of exposure and disease correct).
Is there a dose-response gradient? This is great for a study
First aid's difference btw case-control and cohort study?
Case-control you look for cases of the diseases and no disease (control).
Cohort you look for groups that were exposed and groups that weren't
What is recall bias?
Patient's knowledge of their disorder makes them more inclined to remember stuff they were exposed to.
What is the gold standard for prevention studies?
RCT (randomized control trials)
What is an intention to treat analysis?
When patients that are assigned to a group never experience treatment b/c of other factors (surgery for stable angina death example).
What are important questions to ask in a prevention study?
Was the follow up adequate
Were the groups assigned randomly and treated equally
What are exclusion criteria?
When a study picks a certain group to monitor and this group excludes a patient population that you are interested in.
When do you use surrogate markers and what is the problem with them?
Surrogate markers are used when you can't use mortality as a measure of outcome. You assign a surrogate marker but it might not necessarily be related to the condition.
Difference btw relative risk and odds ratio? What studies do you use each for?
Relative risk is the risk of developing a disease based on being exposed. Use for cohort studies b/c you look at exposure and see chance of disease.
Odds ratio is the odds that you were exposed to something given that you have the disease. Odds ratio you use for case-control studies b/c you begin w/ a disease and see if people were exposed.
7 things we can use Epidemiology for?
Identify the cause of disease
Complete a clinical picture
Determine effectiveness of therapeutic measures
Identify new diseases
Monitor health of community
Identify people at risk for disease
Pre-emptive prevention of outbreaks.
What is a descriptive study? What are 3 examples of descriptive studies?
Basically just describing an outbreak, the population affected etc.
Case-report (patient timeline of disease).
Cross-sectional study (measure exposure and disease at same time).
Ecological study (studying the group not the individual).
What is a proportion? What is a ratio? Is a rate a proportion or a ratio?
It is a fraction where the numerator is related and included in the denominator (number of red apples in a bag of apples).
Ratio is where numerator has no relation to denominator (number of females compared to males).
Rate is a proportion w/ time assoc. divided by total population (number of new borns in 1 year in the population).
What is prevalence? What is point prevalence versus period prevalence?
Number of cases of a disease in a population at a given period of time.
Point prevalence is the number of cases during a specific time (1day) in the population X 100 for percentage.
Period prevalence is the number of cases over a period of time in the average population over that time X 100.
What is the relationship between prevalence and incidence?
Prevalence = Incidence X disease duration.
What factors increase prevalence? What about decrease?
Chronic conditions, prolonged life w/ disease, good treatment but no cure, in migration of people w/ disease, out migration of healthy people and improved diagnostics.
Things that decrease the prevalence are acute diseases, high fatality rates, decreases in new cases, cure, in-migration of healthy people, out migration of sick people.
What is the incidence?
The number of new cases of a disease over a certain period. It is new cases divided by POPULATION AT RISK X 100,000.
How do you calculate mortality rates? What are reasons that mortality data is artifactual?
Crude mortality rate = number of deaths in 12mo period divided by total population. You are dividing by total population b/c everyone is at risk for death.
Often reasons for deaths are not reported properly (doctor, pneumonia, AIDS, kindness example). Often the total population size is changing b/c people moving in and out and census is inaccurate.
What is a cause-specific death rate?
Cause-specific death rate is the mortality due to a specific disease divided by population size at midpoint over that time period.
When would you use an adjusted mortality rate?
When you want to compare different populations like Florida and Alaska example.
What are advantages and disadvantages of crude mortality rates?
Adv: quick to calculate, actual summary rates
Ds: difficult to interpret b/c of differences in populations.
What are advantages and disadvantages of specific mortality rates?
Adv: controls of homogeneous subgroups, provides detailed information
Ds: Cumbersome if too many subgroups and no summary figure
What are advantages and disadvantages of adjusted mortality rates?
Adv: Permits group comparison, provides summary figure and controls confounders
Ds: Fictional rate (due to stats), magnitude depends on population standard, hides subgroup differences
What is the difference between case fatality rate and mortality rate?
Case fatality rate is deaths due to specific cause. It is the number of people dying of disease divided by the number of people w/ that disease. KNOW DIFFERENCE
What is the crude birth rate?
What skews birth rate data? What is a problem w/ the equation?
Number of live births during a time period/estimated mid-interval total population
(kind of like crude mortality rate except for births).
Different definitions of what a live birth is and often parents want stillbirths to be considered born live so that they can get a birth certificate.
Men should not be included in the denominator b/c they are not at risk for birth.
Equation for fertility rate?
Number of live births in a year/ number of females 15-44.
What estimates disease assoc. w/ maternal health and late stage pregnancy?
Fetal death rate = number of fetal deaths (>20wks gest)/number of fetal deaths+number of live births.
What is fetal death ratio?
The number of fetal deaths (>20wks gest)/number of live births in same interval.
This is different from fetal death rate which includes deaths in the denominator.
What is perinatal death rate?
It is the death rate around time of pregnancy
Perinatal DR = number of fetal deaths (>20wks gest) + number of fetal deaths 21d post birth /number of live births + number of late fetal deaths.
What is neonatal mortality rate?
Number of neonatal deaths (w/in 28days of birth) due to congenital malformations, prematurity and low birth weight.
Equation = # of neonate deaths in a given period/number of live births total. Not a ratio b/c live births includes these neonatal births.
What is infant mortality rate?
Number of deaths of infants (<1yr)/number of live births in a given time period.
What is maternal mortality rate?
Number of deaths due to pregnancy related causes/number of live births during same time.
Use # of live births as denominator to show successful survival during pregnancy.
What is a Quasi-experiment?
This is where intervention is assigned by someone else and you just study the effects on the group.
Advantages and Disadvantages of an Ecological study?
Adv: Used to make hypotheses for further studies
Ds: Can't infer anything about the individual from the study.
What is a cross-sectional study? Advantages? Disadvantages?
Good example is a survey. You are taking a snap shot of the population and looking at exposure and outcome at the same time.
Adv: They are quick, easy and cheap. They cut across general population and are good for common illnesses. You can also study multiple diseases and exposures at one time.
Ds: You can't tell whether the disease came before the exposure or whatever. You are looking at prevalence rather than incidence.
What equation would you use w/ a cross-sectional study?
You are going to use a prevalence ratio = a/(a+b) / c/ (c+d)
What are advantages and disadvantages of case control studies?
Adv: Quick, easy and cheap. Good for rare diseases and small population sizes.
Ds: Not good for rare EXPOSURES unless the disease is very prevalent in those exposed. Prone to selection and recall bias. You can't calculate the population incidence b/c sample size is small.
What is the gold standard for studying link btw risk factors and outcome? What else is good about these studies?
Cohort study
You can study multiple outcomes and exposures.
You can track incidence, prognosis, natural history and risk factors.
What are the differences between the 3 types of cohort studies?
Prospective study is looking at exposure now and then following in future.
Retrospective is looking at exposure in the past and watching now for disease.
Historical is looking at exposure in the past, studying outcome now and in the future.
Advantages of cohort studies? Disadvantages?
Adv: You can study rare EXPOSURES!
Used to study multiple outcomes
Minimizes recall bias
Allows calculation of incidence
Allows randomization
Ds: Expensive b/c of large population size and follow up
Not good for rare diseases
You have migration bias
What are the problems w/ therapeutic studies?
Ethical issues (informed consent, withholding treatment known to be effective, monitoring toxicity)
Internal validity
External validity
Loss of follow up
What is the difference between precision and accuracy?
Precision (reliability) is the ability of the test to get consistent results.
Accuracy is the ability of the test to identify positives or negatives.
Equation for sensitivity?
True positives w/ positive test / (true positive w/ positive test + false negative)
Equation for specificity?
True negative w/ negative test/ (false positive + true negative w/ negative test).
Equation for positive predictive value?
Predicting whether you will have the disease based on positive test result
Equation for negative predictive value?
Predicting whether you won't have the disease based on negative result
Difference btw PPV/NPV and sensitivity or specificity?
PPV/NPV is using the test to predict whether you will have the disease.
Sensitivity/specificity is predicting the accuracy of the test given the disease.
How would you calculate prevalence from a 2by2 table?
It is all the people w/ the disease divided by all the people.
How do you calculate accuracy from the 2by2 table?
It is all the positive and negative test values that are true of the disease divided by all the values.
What factors affect sensitivity and specificity?
The more specific the test, the higher the positive predictive value. The higher the prevalence of the disease, the higher positive predictive value.
The more sensitive a test, the higher the negative predictive value.
What happens to PV+, sensitivity and specificity when prevalence goes up?
Sensitivity and specificity stay the same. PV+ increases.
Discuss the 4 types of bias associated w/ screening?
Lead time bias - diagnosing a condition earlier seems to prolong life but it doesn't.
Length time bias - Screening for diseases that are more chronic and slow progressing will seem to prolong lifespan but really doesn't.
Volunteer bias - Patients that are more health conscious are more likely to be screened.
Overdiagnosis bias - enthusiasm for a screening test results in more false positives skewing data.
How do we get to Pareto Optimale?
People must act in their own interest.
What are the 5 assumptions that health care breaks preventing Pareto Optimale?
This is externality, there should be none (people get immunizations to protect the herd but they should be thinking of themselves).
Consumers must have enough education to make the right choice.
Consumers should know the result of their decision
Firms should not have monopoly
Firms should maximize profit.
Why are physicians so important to health care costs?
B/c they have the largest influence on consumers about what to buy or whatever.
How has physician payment changed over years?
50 years ago, we could charge what we wanted. We are now regulated by third party payers.
What is UCR?
Usual - what you charged last year.
Customary - what you charge compared to other docs.
Reasonable - you charge more for more complex procedures.
What is a fee schedule and RVS?
Fee schedule is a list of procedures that insurance companies release on how much they will pay you for services. RVS is relative value scale where points are assigned for procedures (std office visit, 1pt).
What system do Medicare and Medicaid reimburse on?
They reimburse on the RVS system.
What is assignment w/ regards to Medicare?
Assignment is taking on medicare patients and agreeing not to bill extra on the side. If you reject assignment then you can only bill up to 15% additional of which 5% goes to tax.
Difference btw Medicaid and Medicare?
Medicaid is for younger kids. It is usually more stringent than Medicare, reimbursements are lower and it is run by the state.
What are the incentives of medical payment system?
FFS - the more people you see, the more money you make.
Capitation - there is no incentive, you get paid the same whether you see the patient or not.
RVS - you want to do more specialty procedures b/c that's where the money is.
How are hospitals paid through Medicaid and Medicare?
These pay on prospective payment system (PPS) which means they pay you a lump sum for an illness (a DRG or diagnostic related grouping). Hospitals then try to maximize profits by allocating resources to save as much of that money as possible (discharge you early or whatever).
What accounts for the largest portion of health care expenditures?
Hospital care at 31%
How do Americans feel about Health Care costs?
Most feel it is too high, they are scared they will lose a job and insurance. Most however feel like their insurance coverage is good.
Many have delayed care b/c they couldn't afford it.
What are the reasons that the public say health care costs are so expensive?
Drug/insurance companies making too much
Too many suits
Fraud and waste
Doctors making too much money
Administrative costs
People getting unnecessary treatment
Unhealthy lifestyles
Why can't you measure health care inflation?
B/c you cannot account for quality that has improved.
What is the difference between annual change and large cost area?
Large cost area is something that takes up a bunch of money but annual change is things increasing annually accounting for costs.
2 major drivers of health costs?
Unhealthy lifestyles and technology.
Main unhealthy lifestyle that has impacted health costs? In what 2 ways?
Obesity. There are more obese patients and each one is spending more on care (increase of 67%).
What accounts for 50% of the increase in health care costs?
How do most patients <65 yrs pay for their healthcare?
Employer insurance.
What are methods that insurance companies use to prevent adverse selection (getting only sick people)?
Medical underwritings - Check out your medical records before covering you.
Pre-existing exclusions - some diseases prevent you from getting covered.
Risk based rating - people at higher risk pay more.
Benefit design - if you are at risk for a certain disease, your plan will be designed not to cover that.
What are differences between employer and individual insurance policies?
Employer are usually more comprehensive and the policy will cover variations in benefits.
Individual are very expensive, less comprehensive (no maternal or mental coverage).
What are the characteristics of uninsured patients?
Most are in our age range b/c they are healthy don't think they need coverage. 40% uninsured are actually making 200% the poverty line.
Most uninsured have jobs.
Why do uninsured matter to physicians?
How will I get paid?
Doctors will stop seeing uninsured so charity care will need to increase.
Compliance to treatment will decline (can't pay for meds).
Referrals are hard b/c don't know who will take your patients.
Overcrowding of EDs
What is pay for performance?
Tying the performance of the physician to bonuses.