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29 Cards in this Set
- Front
- Back
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As you go back in the health care history in the US, you will find LESS REGULATION.
Another way to describe those early days would say that there were________ |
Free Market Conditions
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Cultural authority
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When professions are accepted by society.
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What influenced the Flexner Report in 1900's? And what was it about?
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Report that recommended that US adopt structured medical education like Europe's. The medical Education influenced this report.
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The U.S. Health Care Delivery or Health Services Delivery System BROAD DEFINE:
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major components of the system and processes that enable people to receive health care.
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The U.S. Health Care Delivery or Health Services Delivery System RESTRICTED DEFINE:
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the act of providing health care to patients (i.e. in a hospital or a physician’s clinic)
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the 2 primary objective of HCS
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1. to enable all citizens to receive HCServices
2. To deliver services that are cost-effective and meet established standards of quality. |
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How is the US HCS unique?
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it’s not a system
no universal health care financed by taxes no entitlement no other country operates like the U.S. changes due to cost, access and quality |
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US HCS workforce has how many people working?
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16 Million People
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how many people are uninsured?
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46.3 million, 15.4%
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Financing and Insurance Mechanisms (how does Employer-based, privately-purchased, government programs [public] work)
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a.Employer-based health insurance
(private) b. Privately-purchased health insurance (private) c. Government programs (public) -State Employees Group employees -Medicare elderly and certain disabled people -Medicaid and CHIP indigent, poor (if they meet the eligibility criteria), children |
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US HCS neg/pos
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There’s little or no:
networking interrelated components standardization coordination cost containment as a whole planning, direction Has: duplication overlap inadequacy inconsistency waste complexity inefficiency financial manipulation fragmentation |
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US HCS Leads world in?
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medical technology
medical training research sophisticated institutions products processes |
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What are the 7 characteristics of the US HCS?
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Political climate
Economic development Technological progress Social and cultural values Physical environment Population characteristics (demographics, health trends) Global influences |
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Ten Characteristics that Differentiate the U.S. Health Care System
No Central Agency |
Most developed nations have a national health care program where every citizen is entitled to receive a set of service
To control costs, use global budget to determine total health care expenses Government usually controls frequency of health care services, especially expensive medical technology use The U.S. has mostly private financing and delivery Private financing through employers at 55% and government at 45% Private health care, hospitals, physicians are independent of government No one monitors total expenses through global budgets and utilization U.S. does determine public-sector expenses and reimbursement rates for Medicare and Medicaid Government sets standards of participation through policy and regulations providers must comply with standards to be certified to provide Medicaid & Medicare patients regarded as minimum standards of quality |
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Ten Characteristics that Differentiate the U.S. Health Care System
Partial Access |
Universal access: Health care is available to all citizens
Access: the ability to obtain health care when needed In U.S., access restricted to those who: a) have health insurance through an employer b) are covered under a government health care plan c) can afford to buy insurance out of pocket d) can pay at time of service privately Health insurance helps ensure access Those unable to pay wait until a health problem arises then receive health care at the emergency room hospital does not receive payment a form of catastrophic health care insurance? Primary Care: basic and routine care Lack of access to prim care a big reason for U.S.’ lag in population health (i.e. infant mortality, life expectancy) |
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Ten Characteristics that Differentiate the U.S. Health Care System
Imperfect Market |
In national health care, economic markets do not exist
Private health care consolidating, forming alliances and integrating delivery system networks of health care organizations Item pricing obtain fees charged for service (surgeon’s price) services can’t be determined prior to procedure Package pricing bundled fee for a group of related services Capitation all health care services include one set fee per person, more all-encompassing Phantom providers bill for services separately anesthesiology, pathologist, supplies, hospital facility use Supplier/provider-induced demand Physicians have influence on creating demand for their financial benefit Physicians receive care beyond what is necessary (i.e. follow-up visits, tests, unnecessary surgery) |
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Ten Characteristics that Differentiate the U.S. Health Care System
Third-Party Insurers and Payers |
Patient is first party
Provider is second party Intermediary is third party -a wall of separation between financing and delivery quality of care is a secondary concern |
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Ten Characteristics that Differentiate the U.S. Health Care System
Multiple Payers |
The U.S. has many payers, company can choose different plans
a billing and collection nightmare system becomes more cumbersome Single-payer system a national health care system that is usually the primary payer-government |
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Ten Characteristics that Differentiate the U.S. Health Care System
Power Balancing |
Multiple Players
Physicians, administration, insurance, government, employers Fragmented self-interests prevents an entity from dominating |
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Ten Characteristics that Differentiate the U.S. Health Care System
Legal Risks |
The U.S. is a litigious society
Practioners engage in defensive medicine prescribe diagnostic tests, return checkups, documentation |
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Ten Characteristics that Differentiate the U.S. Health Care System
High Technology |
The U.S., a hotbed of research and innovations
Creates demand for new services despite high costs With capital investments, must have utilization Legal risks for providers denying new technology |
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Ten Characteristics that Differentiate the U.S. Health Care System
Continuum of Services |
Medical services has three broad categories:
Curative (capable of curing) Restorative (giving new strength) Preventative (preventing) |
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Ten Characteristics that Differentiate the U.S. Health Care System
Quest for Quality |
Continuous Quality Improvement
Higher expectations Quality standards with compliance |
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Quad-Function Model
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1. Financing: *Buy insurance or pay for HCServices
2. Insurance: *Protect against $$risk *determine package for individual 3. Delivery: *Provider anything that delivers HCServ. 4. Payment: *Reimbursement, funds, co-pay |
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4 Factors that Affect Access to HC
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1. Ability to pay
2. Availability of services (deliver) 3. Payment (sometimes Medicaid isn't accepted) 4. Enablement Barriers (race, language, transportation) |
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National Health Insurance (NHI)
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Gov't finances HC through taxes
but rendered by private providers |
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National Health System
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financing a tax supported NHI
gov't operates medical instituations |
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Socialized Health Insurance
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financed through gov-t mandated contributions by employers/ees
gov't exercises full control |
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American Public Health Association
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Influences policies
set priorities public health forefront of many efforts to prevent disease and promote health oldest/largest organization of public health professionals in the world +50,000 members, 50+ occupations of public health |
