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50 Cards in this Set
- Front
- Back
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Characteristics of the us health care system
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- no central governing agency, little integration & coordination -technology driven delivery system focus on acute care -high cost, unequal access &avg outcome -delivery of healthcare under imperfect market conditions -fusion of market justices and social justices - us health care system is seconds largest workforce with 12m |
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what is the implications of moving from health policy to heath in all policies
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--health is all policies is an approach to public policies across sectors - transportation, agriculture, land use, housing, pub safety, education |
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Explain the iron triangle of health care
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Shows relationship between, cost, access, and quality -you can not gain more of one portion without taking from an other. - all parts of the triangle are interconnected |
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What are the 3 board performance categories used to compare international health system?
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-access -cost -quality |
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How are the performances categories measured? |
1) Quality -health services for individuals and population increase the likelihood of desired outcomes 2) Gross domestic product- aggregated measure of total economic production for a country 3) Per capita - what we would spend per person if we divided out spending equally
4) access - ability to obtain needed health service |
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3 dimensions of quality
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Structure Process Outcome |
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what are the implications of moving from health policy to health in all policy with respect to health care spending?
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-when you combine the amount spent on health care with the amount spent on social welfare programs, the us doesn't spend more that its peer nation.
-combined spending on social welfare and healthcare places us in the middle. US doesn't spend to much on keeping us healthy just too much on medical care when were sick |
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what is public policy? |
-Authoritative decision made in the legislative, executive, or judicial branches of gov't that are intended to direct actions, behaviors, or decisions of others - public policies are authorities, formulated by specific political process. adapted., implemented, and enforced by public agents |
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while Americans prefer private market solution for the distribution of social goods, public policy is necessary sometimes because of what? |
- there's still needs to be regulated of the private markets |
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what are the roles of the 3 branches of gov't with respect to public policy? |
legislative- formulates executive- adopts judicial - implements and enforces |
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what do regulatory policy tools attempt to do? |
they call upon government to prescribe behaviors of group by monitoring them and imposing sanctions if needed |
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what do allocative policy tools do? |
- they are direct provisions of income, services or goods to individuals or groups -distributive (spread throughout society) -re-distributive (take one group and give another) |
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who are the major stakeholders/ interest groups for health policy ( and what is their main interest)? |
- employers - provide health insurance benefits to employees and their dependent and their retirees - consumer groups- -health providers |
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what are the 3 values underling policy conflict |
-individualism - equality -justice |
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what are some differences b/w market justice and social justice? |
-market justice- importance of market forces in a free economy that cane best achieve a fair distribution of healthcare -social justice- equal distribution of healthcare as a societal responsibly that is often best achieved through central agency |
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what are 2 tentions between public interest and private interests? |
- private interest result in public cost -public interests result in private cost |
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pre modern ways people believed to get sick |
-miasmas- foul air -bad spirits -imbalance of internal bodily fluids |
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what has been the influence of medical model of health on health policy in US |
it promoted improvements in medical science and technology that corresponded with our increased ability to diagnose and treat disease |
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what are the 4 main categories of determinants in the health field concept? |
-environment -behavior and lifestyle -heredity -health care organization |
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which category among the 4 main categories of health determinants in the health field concept has the least influence on health |
health care organization (10%) |
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what is the casual web of health |
diseases never depends on single isolated cause rather it develops from a chain of causation in which each link itself together is a result of complex interaction of preceding events |
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what are distal factors of health |
indirectly associated with health outcomes |
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what are the proximate factors of health |
direct or more proximal to health outcomes ( smoking -> lung cancer) |
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what is a health vulnerability? |
susceptibility to negative health outcomes |
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What three factors constitute the framework of vulnerability? |
-predisposing -enabling -need |
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What are examples of predisposing factors
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- racial/ethnic characteristics -gender and age -geographic location |
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What are examples of enabling factors |
-insurance status -homelessness |
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What are examples of need factors |
-mental health -chronic illness/disability -HIV/AIDS |
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What are the main features of health care delivery/medical education in preindustrial America? |
-Training/ education not scientific -Anyone could call themselves a “physician” -Reliance on domestic remedies |
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What three trends promoted the transition from Almshouses to Hospitals? |
-Asylums -Dispensaries -Pesthouses |
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What major report shaped the medical education in the United States? 9-18 lecture |
Flexner Report 1910 - helped reform medical schools by providing recommendations/guidelines |
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How did policies in the 1940s shape the growth of hospital-based care? 9-18 lecture |
More hospitals were built in areas that needed them and hospitals that were under supplied were given funds to increase their inventory |
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What was the purpose of the Hospital Survey and Construction Act (Hill-Burton Act) of 1946? |
To plan and estimate the needs of hospitals and to build community based hospitals |
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The majority of today’s hospitals are public or private? |
4464 private (78%) |
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Why might hospitals seek either federal certification or JCAHO accreditation? |
-Federal Certification -Joint Commission or the American Osteopathic Association |
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What percentage of a hospital’s revenue comes from Medicare? |
43% |
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Which characteristic of the United States health care system is reflected in the Kaiser hospital of the 1950s? |
Kaiser hospital is best reflected by the U.S. healthcare characteristic of technology-driven delivery system focusing on acute care. |
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Risk spreading, |
the extent to which an insurance company can predict their average losses across a group of people |
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premiums |
The monthly amount paid or to be paid by the individual for insurance coverage |
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deductibles, |
The amount you owe for covered health care services before your health insurance or plan begins to pay. |
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community rating |
common premium to all group members within a geographic area regardless of their age, gender, health status or other potential factors that may elevate their potential for increased health care use in the coming year. |
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experience rating |
differential premiums to different groups by predicting the group’s future medical costs based on its past experience. |
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The first broad-coverage health insurance in the United States was targeted to provide compensation to which population? |
Workers compensation |
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Discuss the tensions between social and market justice approaches to distributing health insurance in the United States from 1912 through 1940s. |
This is reflected by the failed efforts to realize a public insurance program (1912 and later 1935) due to resistance by private sector (AMA and AHA). |
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What three populations are covered by Medicare? |
-Persons 65 years and older -Disabled individuals of any age who are entitled to Social Security Benefits - People of any age who have permanent kidney failure (end-stage renal disease) |
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Define basic insurance concepts: Coinsurance and Copayment |
Coinsurance- an amount you may be required to pay as your share of the cost for services after you pay any deductibles. (usually a percentage) -Copayment - the amount that the insured has to pay out of pocket each time health services are received after the deductible amount has been paid. |
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.Discuss the limitations of Medicare coverage and why most elders have “Medigap” insurance. |
-Does not cover all medical benefits -Has relatively high cost-sharing requirements -Medigap: private insurance policy → fills in the “gaps” in original medicare plan |
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Discuss the five roles the Medicaid Program |
- Health Insurance Coverage -Assistance to Medicare Beneficiaries -Long-Term Care Assistance -Support for Health Care System and Safety-net -State Capacity for Health Coverage |
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What is the enrollment difference between Medicaid and Chip? |
Enrollment Caps: Medicaid → Not permitted CHIP → permitted |
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What is the financing arrangement difference between Medicaid and CHIP? |
-Medicaid → Guaranteed federal match (regular match rate) -CHIP → Capped Financing (enhanced match rate) |
