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34 Cards in this Set
- Front
- Back
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Longer health expectancy =
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Smaller families
More education More females working More investment in retirement Less risky behavior |
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What stem cells can cure
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Spinal injuries
Alzheimer's Parkinson's Birth Defects Cancer |
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How US health market differs from Europe
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US concerned about dangers of monopoly
No institution to negotiate prices Want decentralization and social experimentation |
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Two types of Europe health care
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National - Denmark, Sweden, UK
Funded by tax, universal, government owned, guaranteed by public organizations Problems: waiting lists, inefficient management Social Insurance - France, Germany Funded by payroll contributions, physicians paid per service, private facilities, segmented coverage, guaranteed by sickness funds Problems: oversupply and overconsumption, question of equity |
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Health ranks
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1. France
37. US |
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Australia health care
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Public hospitals are better
$1944 per capita Fee per service Universal care 42% doctors are general practice High rate of admission Low rate of stay Physician paid 2x instead of 5x in US |
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Problems of one child family
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High suicide of women
Aging population Not enough support Rural disobeys b/c they need help |
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Demographic entrapment
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Exceeded/projected to exceed:
1. Carrying capacity of ecosystem 2. Ability to obtain the products and food produced by other 3. Ability to migrate to other ecosystems to preserve standard of living |
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Why managed care orgs are going to South America
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Physicians have lower wages
Decreased profits in the US Large pension funds in South America |
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Health care in Rwanda
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women life expectancy: 43 years
11% have HIV malaria malnutrition cholera |
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Concepts of Belmont Report
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Utilitarian basis of research
Investigator's relationship should be like doctor's Informed consent Must benefit all |
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Dilemmas of 3rd world research
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Does it only benefit us?
Do they understand informed consent? Same standards? |
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Bezwoda
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High dose trials of chemo falsely reported better results
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Patient Self-Determine
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Health care facilities mandated to question all patients regarding their ethics in health care matters
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Advanced Directive
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Document enables a competent individual to specify the form of care they want if unable
1. Living will 2. Health care power of attorney |
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Cost of end of life care
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27% of Medicare costs at end of life
Expenditures don't help much |
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Attitude changes needed at end of life
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Limit amount of needless money
Population-based Accept old age/death Settle for 80 years |
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Death isn't the enemy, what is?
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Premature death
Disease Disability Pain Suffering |
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Palliative care
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Study and management of patients with chronic or terminal diseases for whom the prognosis is limited and the focus of care is quality of life
Issues: rule of double effect, autonomy and consent, accountability, avoid ideology |
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What patients want at end of life
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Pain meds
No prolongation of dying Sense of control Relieve burden of loved ones Strengthen relationships |
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Rule of double effect
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It is morally wrong if death is caused intentionally but permissible if foreseen but unintended
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Physician assisted suicide in Oregon
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Only in Oregon/Washington
Only terminally ill 6 months life expectancy 2 oral, 1 written request 15 day between requests Physician's choice |
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research vs. clinical imperatives
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Research - eliminate death
Clinical - accept death as unavoidable |
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Community vs. experience health care
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Experience - sicker/older pay higher premium
Community - everyone pays the same |
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Reasons for growth of private health insurance
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Depression
WW2/wage freezing Push for national health insurance |
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Two methods of rationing health care
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Europe - medical necessity
US - ration by price/ability to pay |
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Two things Gov. Egdar discussed
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He had a surplus when he was governor
Medicaid is the biggest problem |
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Health transitions
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Health:
Era of persistence and famine -life expectancy <30 years -Men live longer than women Era of receding pandemics -Life expectancy 50 years -1918 influenza pandemic Era of non-communicable diseases -Life expectancy increased from 55-80 years -Women live longer than men |
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Demographic transitions
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Initial stage
-High death rate, high birth rate -Culture supports high fertility Transition stage -Lower death rate, high birth rate -Population explosion Modern stage -Low death rate, low birth rate -At or below replacement rate |
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War and health
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1. Altruism--impulse to care about others
2. Science--Value accorded to actions that produce verifiable results 3. Legitimacy--health care workers accorded high legitimacy by society Lots of death from Infectious disease, malnutrition, transmission (1.5mil/1.7mil deaths in Congo) |
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7 elements of informed consent
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Authorization
Competence Understanding Decision Disclosure Voluntariness Recommendation |
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Canada vs. US health care
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Funding: 70%/50% gov't
Coverage: Public/Private Benefits: Everything/limited Medi Together/Fragmented Both: state vs. federal US has better technology US has lower life expectancy, higher infant mortality Per capita: 3k/6k #30/#37 All insured/~50mil uninsured |
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Medicare
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65+
A: free, hospitalization, skilled nursing, facility, hospice B: $44/month, outpateint, physician, therapy, equipment D: Rx NO eyes/teeth/ears |
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Medicaid
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Low income women/children
Federal mandated, state administrated Not all providers accept |
