101 Revision Flashcards
(161 cards)
1
Q
What three factors define health?
A
- The absence of illness
- The capacity to function
- Complete wellbeing
2
Q
What is WHO’s definition of health?
A
Health is a state of complete physical, mental and social well-being, and not merely the absence of dis-ease.
3
Q
What is a health system?
A
Any activity whose primary purpose is to promote, restore and maintain health
4
Q
What is the issue with health systems?
A
They do not involve some factors which have the biggest impact on health- like the environment. Therefore the health system plays a role in public health, but is not the sole factor determining the health of a population
5
Q
What are the factors which impact health but are not included in the health system?
A
The environment Nutrition Housing Education The social environment Sport and leisure Transport
6
Q
How do health systems improve population health? (2 expanded points)
A
- Financial protection against the cost of ill health
- Rich & Poor treated equally- now poverty not a disadvantage and wealth not an advantage - Respond to peoples’ expectations
- Implement new technology
- Have reasonable wait times
- Respect their patients
7
Q
What is amenable mortality?
A
Deaths that could have been prevented if people got the right treatment at the right time.
8
Q
How can we judge whether a health system makes a difference?
A
Look at amenable mortality rates.
9
Q
What are the three key standards of health systems?
A
Quality, Access and Efficiency
10
Q
What is quality?
A
It is defined by different people differently.
Doctors judge it by whether they have technology, drugs, whether they diagnose correctly.
Patients judge it by wait times, how comfortable they are, whether they’re cured and the convenience of it.
11
Q
What is access?
A
People being able to make use of a service if they need it. It includes transport and geography.
12
Q
What is efficiency?
A
The ratio of resource allocation to outcome- getting max output of minimum cost, and assuring the right amount of each service is provided to meet the healthcare goals.
13
Q
What happens if one of these aspects fails?
A
The health system is less likely to make a difference to the health of their population.
14
Q
What is primary care?
A
It is medical care provided by a healthcare professional, usually located in the community rather than a hospital setting. Other than in emergencies, primary care is the first point of contact between a patient and the healthcare system. (their location can be described as ‘ambulatory’ as people can just walk up)
15
Q
What is secondary care?
A
This involves more specialized medical or surgical services, and uncomplicated hospital care, for both inpatients and outpatients. Often they are accessed by referral from a primary health carer and are provided mainly in a hospital setting.
16
Q
What is tertiary care?
A
Hospital based, highly complex and expensive services
17
Q
What is public health?
A
All organized measures to prevent dis-ease, promote health and prolong life among the population as a whole. It involves providing conditions in which people can be healthy. It focusses on groups rather than individuals.
18
Q
What does public health involve?
A
Prevention (such as immunisation/screening), Health promotion and education (sex-ed), environmental health and communicable disease control (water quality, food safety etc).
19
Q
How are disability and aged care services related?
A
Both provide support, rehab and accommodation while caring for health and non-health needs.
20
Q
How are disability and aged care services different?
A
The MoH funds disability services, but only monitors aged care services.
21
Q
What are some examples of regulated professions?
A
GPs Specialists Dentists Nurses Midwives Allied Professionals
22
Q
What are some examples of non-regulated professions?
A
Care workers
Patient navigators
Community health workers
Health promoters
23
Q
How does primary health care contribute to health outcomes?
A
It prevents avoidable hospitalization, manages health issues before they become too acute, and is patient-focussed.
24
Q
How does a GP contribute to the organization of a health system?
A
They keep track of the patients’ movements and receive information from the treatment providers to keep a holistic view.
25
What is gatekeeping?
Patients can only access secondary/tertiary care through referrals from a primary care specialist. They manage the entry to more specialized services.
26
When does gatekeeping become an issue?
When different specialists can't diagnose an issue, so a patient has to travel back and forth between the primary and secondary carers all the time.
27
Which is broader: Primary care or primary health care?
Primary health care
28
What is 'user pays'?
Care is available to those willing and able to pay for it.
29
What is 'universal access'?
All citizens have healthcare regardless of whether they can pay
30
What is the paradox in payment for New Zealand?
The govt. pays almost all hospital costs, but less than half the cost of primary care. As a result, people use hospitals for primary care, or don't get primary care at all.
31
What created the system with both govt and user paying in New Zealand?
Specialists are paid by hospitals, but primary care physicians were originally small businesses- therefore, they only get part funding.
32
From a healthcare perspective, what are organisations?
A social unit of people systematically structured and managed to meet a need or to pursue collective goals on a continuing basis. All organisations have a management structure that determines relationships between functions and position, and delegates roles, responsibility and authority to carry out tasks. They are open systems as they affect and are affected by the environment beyond their boundaries.
33
How do we make the distinction between public & private organisations?
Ownership and accountability
34
What are the three key questions to ask when determining public/private fp/private np?
1. Who is in charge?
2. Where does the money come from?
3. What kind of things do they do in the system?
35
What are the qualities of Publicly funded Health Care?
- Accountable to government, and therefore the electorate and voters
- Run by ministries or a board
- Funded by the government via taxes and levies
- Provides health services, such as hospitals
- Funds health service providers and activities
- Formulates health policy nationally and locally, and oversees its implementation
36
What are the pros of publicly funded health care?
- Serves the public interest
- Provides services with no easy profit (no market)
- Public controls their actions
- Equal access (universal)
- Won't go bankrupt
37
What are the cons of publicly funded healthcare?
- Often inflexible
- Inefficient
- Difficult to measure performance as no profit figures
38
What are the qualities of private for-profit care?
- Accountable to the company owner(s)
- Have boards of directors
- Income from investment and revenue
- Cannot out-spend revenue
- Some govt. contracts
- Provide insurance, drugs and aged care
- Large groups lobby govt. over policy (influence)
39
What are the pros of private for-profit care?
- Respond to market demand
- Efficient
- Flexible and innovative
- Profits are a clear measure of success
40
What are the cons of private for-profit care?
- The interests of the private company may oppose those of the public
- Cost is a barrier to access
- Prone to 'cream skimming'- only accepting the easiest, low risk patients
41
What are the qualities of private non-profit care?
- Accountable to board of organisational members
- Funded by membership fees, govt. contracts and donations
- Provide services which other systems don't/won't- ie community mental health facilities
- Primary care, hospitals and insurance can be n-p
- They represent professionals and industries (eg. doctors' interests)
- They can lobby the govt. over policy
42
What are the pros of private non-profit care?
- Respond to needs without necessitating a large amount of demand
- Responsive to local groups and communities
- Give groups a voice
- Give the govt. ideas
43
What are the cons of private non-profit care?
- Difficult to control effectively
- Dependent on voluntary commitment
- Difficult to assess performance
- Often struggle to get funding
44
What does publicly funded healthcare mean for doctors?
Wide variety of cases- chance to increase their skills
| Their work is linked to 'bigger picture' objectives
45
What does publicly funded healthcare mean for patients?
Gives them equal treatment, regardless of their ability to pay
46
What does private for profit healthcare mean for doctors?
Their work is linked to profitability
47
What does private for profit healthcare mean for patients?
Services of quality and high quantity are available if they can pay
48
What does private non profit healthcare mean for doctors?
Their work is linked to the goals of their organisation
49
What does private non profit healthcare mean for patients?
They may be provided specialist treatment as organisations choose whom they serve.
50
What are DHBs?
They are publicly funded organisations accountable to the government. The MoH receives advice from the DHBs and tells them their regional health goals.
There are 20 DHBs, each in charge of a different region. They provide hospitals, community and public health services, and assessment, treatment and rehab facilities
They have contracts with the government, private and NGO providers.
51
What are the three main functions which an organisation can perform in the health system, and what is special about the overlaps between them?
Policy, payer or provider. (NB these aren't mutually exclusive)
Overlaps provide the 'glue' holding the health system together- contracts and agreements which allow the health system to work efficiently.
52
What does the policy function involve?
- Decisions made on behalf of the taxpayer
- Setting priorities and incentives
- Advising stakeholders (including the MoH)
- Eg. ACC and PHARMAC
53
What is involved in the payer function?
- Looks after those who pay (inc. taxpayers)
- Determines what will be paid for
- Looks after interests of taxpayers and contributors
- Eg. DHBs, PHOs, PHARMAC, ACC
54
What does the provider function involve?
- Gives out services
| - Eg. Student health, hospitals
55
What organisation carries out all 3 healthcare functions?
DHBs
56
What are PHOs?
They are NGOs which liaise with GPs and DHBs. The DHB contracts a PHO to provide primary care. The PHO's group of GPs actually provides the care. They monitor and channel funding from DHBs to the GPs. They can have some policymaking function.
57
What are the three ways in which we can experience the health system?
As a taxpayer, citizen or patient
58
What do taxpayers want?
- Best value for money
- Pay as little as possible
- Increases in costs and copayments minimized
59
What do citizens want?
- Health services provided in accordance with rights
- Access guaranteed
- Make sure that those who aren't supposed to access these rights (eg. health tourists) don't get access
60
What do patients want?
- High quality treatment
- Short wait times
- Safe treatment
61
What are some organisations which act in the interests of taxpayers?
```
PHARMAC
ACC
MoH
Treasury
Souther Cross
```
62
What are some organisations which act in the interests of citizens?
MoH
DHBs
Commissioners (childrens, health and disability)
Researched medicines industry
63
What are some key issues for users?
- How to get access to health services
- How to get specialist attention or into hospital
- Availability of services
- Cost
- Results and outcomes
64
How did NZ come to have a dual system?
Originally GPs were run by private owners and individuals. The govt. wanted to introduce free health to all, so tried to buy all care facilities- but got strong opposition from the GPs. Now, most are paid for by the govt, but there is capitation in GPs- govt. pays for some, the GPs charge extra directly.
65
What was the primary health care strategy (2001)?
It increased the funding for primary healthcare, so GPs could charge less
It changed how GPs were paid
New PHOs addressed population health needs in their zones.
66
What was the effect of free care for U6 and U13s?
Many patients paid lower fees, but many still don't.
67
What is an example of a publicly owned, publicly funded ogranization?
Hospitals
68
What is an example of a publicly owned, private for profit funded ogranization?
Doesn't happen
69
What is an example of a publicly owned, personally funded ogranization?
Rare
70
What is an example of a private for-profit owned, publicly funded ogranization?
Primary healthcare, physio
71
What is an example of a private non profit owned, publicly funded ogranization?
Community based services (eg. plunket)
72
What is an example of a private for profit owned, private for profit funded ogranization?
Private hospitals
73
What is an example of a private for profit owned, personally funded ogranization?
GPs, dentists, optometrists
74
What is an example of a private non profit owned, private for profit funded ogranization?
Doesn't happen
75
What is an example of a private non profit owned, personally funded ogranization?
Rare
76
Why were maori health providers created?
Give culturally appropriate care, incorporating maori beliefs and traditions. This makes the families comfortable and understood within the health sector.
77
What do maori health providers do?
- Provide primary healthcare services to enrolled patients- can be through a hapu or iwi, or other maori communities
- Operate within and funded by PHOs (maori or otherwise)
- Operate in a maori cultural context, making sense to patients and whanau
- Integrated services with other aspects of maori development, like maraes and schools
78
How are maori health providers funded?
By PHOs. They don't receive extra funding for being maori, but if they're low decile they may receive a top-up
79
What are the differences between maori health providers and others?
The maori ones might provide extra services- like dentists, addiction support, gym membership
They operate in Te Ao Maori, so can also provide maori massage, traditional medicine and marae based services
80
How do MHPs contribute to a better health outcome?
They are very focussed on self-determination- allowing maori to exercise control over all aspects of their care.
In addition, they take some responsibility for seeking healthcare away from the patient- they will do house calls etc
81
Why are MHPs important?
Maori have significant health disparities
MHPs provide an alternative pathyway for primary care which may be more effective
They contribute to maori development
82
What is kaupapa maori and how do MHPs implement it?
The maori norm
MHPs have extra training in maori cultural practices
Individual needs are considered in the context of the wider whanau
83
What is a regulated workforce?
Access to and exercise of work are subject to the possession of a specific professional qualification
84
What must those in a regulated workforce do to maintain their qualification?
They must demonstrate competence annually to a regulatory board.
85
What are the functions of a regulatory board?
- Maintain a register
- Maintain standards of the profession
- Provides structures for the discipline of individuals
- Approves educational & training programmes
86
When does a group become a 'regulated profession'?
- There is a body of knowledge unique to the profession
- There is a long formal education
- The group has control over their area of expertise
- A body regulates membership for those who meet the standards.
87
How many NZers work in health?
10%
88
What are some regulated professions?
There are 16 of them, including medicine, pharmacology, optometry, dentistry, dietetics, psychology and nursing
89
What are unregulated professions and some examples?
They do not have a regulatory body. They include health promoters, caregivers, hospital clerical staff and health educators.
90
How do unregulated health professionals benefit the health system?
They can make the health system more efficient, as they can give advice and information without needing a lengthy qualification.
91
What are the 6 roles of a health system's workforce?
1. Protecting a population from becoming 'at risk'
2. Developing interventions targeting those 'at risk'
3. Reducing negative impacts of early stage symptoms
4. Managing the condition to prevent development of other conditions
5. Intensive and acute care
6. Palliative care
92
When in a person's life do they receive the most health care?
80% of a person's health care is received in the last 8 weeks of life. This is because the professionals are trying to prevent the inevitable
93
`What is the issue with specialization?
As more and more professionals become specialized, GPs get neglected in favour of these less necessary, more expensive procedures.
94
What are the 10 factors affecting healthforce makeup?
1. Population characteristics
2. Time
3. Workload faced
4. Money
5. Technology
6. New clinical approaches
7. Rise of chronic conditions
8. Govt. Strategy
9. Individuals
10. Socio-political environment.
95
How do population characteristics affect healthforce makeup?
The numbers, migration, ageing profile of the population affects the kind of conditions, treatments and therefore professionals required.
96
How does time affect healthforce makeup?
The time taken to attract and train new professionals affects how many of each type are needed.
97
How does workload faced affect healthforce makeup?
The greater pressure and workload, the more burnouts, absenteeism and staff turnover
98
How does money affect healthforce makeup?
How much the government pays for new workers affects how many new workers can be trained. How much professionals are paid affects how many apply
99
How does technology affect healthforce makeup?
Technology can create roles and specialization, but it may also make roles redundant
100
How do new clinical approaches affect healthforce makeup?
It can lead to specialization, creating new services and roles
101
How does the rise of chronic conditions affect healthforce makeup?
It creates roles focussing on chronic disease (eg. diabetes nurses). This makes healthcare as a whole more expensive as we can't build hospitals or train professionals fast enough to meet the rising rates of chronic disease.
102
How does government strategy affect healthforce makeup?
Whether the govt puts more focus on disease prevention or treatment affects what professions are more important
103
How do individuals affect healthforce makeup?
How individuals prioritize their own health needs impacts what services are in demand
104
How does the socio-political environment affect healthforce makeup?
Poverty, housing, employment etc. all affect what diseases are prevalent, affecting what professionals/specialists are needed.
105
Within a health system, which 3 groups have clashing interests?
Payers
Providers
Patients
106
What are the 4 main groups in a health system workforce?
Doctors
Nurses
Managers
Boards/Directors
107
What are doctors interested in and what do they view as important?
```
Interested in cure
- Independence in decision making
- Following their profession's direction (not the employer)
- Supporting patients' interests
- Care & management of disease
as important
```
108
What are nurses interested in and what do they view as important?
```
Interested in care
- Working collectively
- Direction their organisation is going
- Providing patient care
- Their patients- support received, how treatment impacts them, if they know about or are educated on their disease
as important
```
109
What are managers interested in and what do they view as important?
```
Interested in control
- Collective decision making
-Efficiency
- Quality improvement
- Budget
- Advancing their organisation
- Treatment vs opportunity cost
- Cultural competence
- Sufficient centers for treatment
as important
```
110
What are boards/directors interested in and what do they view as important?
```
Interested in community
- Most effective use of resources
- What is best for the population
- Advancing interest of advocacy groups
- Decreasing discrepancies
- Education
as important
```
111
What do the 4 groups have to do with healthcare improvement?
It is by working together that healthcare will improve- all 4 must integrate. At present, teams are the exception, not the norm.
112
What can the relationships between the 4 main groups be termed as and why?
- Political
- Heirarchial
- Limited collaboration
- At conflict
due to conflicting inerests
113
Which of the 4 groups have the most communication with others?
Nurses and allied health workers
| However, doctors and managers have a good amount of discourse, too.
114
What are the 3 different barriers to relationships between the 4 main groups?
1. Organisational barriers
2. Team level barriers
3. Individual barriers
115
What are organisational barriers related to?
- Lack of knowledge or appreciation of other health professionals
- Financial/regulatory constraints
- Legal issues- scope of practice and liability
- Different professionals have different reimbursement structure, including who gets reimbursement- can lead to resentment.
- Hierarchal admin/education structures which discourage interprofessional collaboration
116
What is needed to overcome organisational barriers?
- Argue for team building to senior decision makers
| - More research on how collaboration benefits health outcomes.
117
What are team level barriers related to?
- Lack of stated, shared and measurable purpose
- Lack of interprofessional collaboration training
- Role/leadership ambiguity
- Teams are too large or small, or aren't comprised of appropriate professionals
- Lack of a mechanism for information to be exchanged
- Lack of framework for problem discovery & resolution
- Difference in authority, power, expertise and income
- Difficult to engage the community
- Traditions and professional culture (hierarchy)
- Lack of commitment
- Individuals have different goals- conflict in patient/professional relationships
- Inadequate decision making
118
What can overcome team level barriers?
- New member orientation
| - Educating collaboration from the start of professional life.
119
What is related to individual barriers?
- Split loyalties (team vs. 'tribe')
- Multiple responsibilities
- Competition and naïveté.
- Prejudice
- Defensiveness
- Reluctance to accept other professions' suggestions as 'valid'
- Lack of trust
120
How can we improve all 3 barriers in general?
- Agree on a philosophy incorporating both the patient and community
- Commit to a common goal
- Learn about other professions and to respect their skills/knowledge
- Have positive attitudes about their own profession
- Develop trust
- Share responsibility of care
- Have a mechanism for goal negotiation and re-negotiation, and one of conflict resolution
- Identify communication hubs and use them
- Understand complexity but communicate simply
- Seek resources to implement integration
- Good decision making and action pace
- Understand others' motivations.
121
How is the healthcare setting changing?
- At home care is increasing
- Primary or community setting care is increasing, and expanding into domains previously occupied by hospitals
- Secondary and tertiary care is decreasing as specialized care gets downgraded, localized, or only available overseas.
122
How will changes in the healthcare setting affect the workforce?
- Where, what, and how people do things will change.
- They will move out of hospitals and into the community
- There will be a shift in focus towards health prevention and promotion
- Team based, patient centred care will increase.
123
What is the current trend in doctor numbers in NZ? What does this mean for the future?
They are decreasing, due to an ageing workforce and movement overseas.
- The govt. finds ways to retain staff and examine new roles. It may use bonding schemes and workforce review
- New roles emerge (eg. physician's assistant)
- These are reactionary strategies and are difficult to implement. Other systems compete, and the staff feel less valued
124
What must NZ's healthcare system do in future?
- Teamwork based workforce
- Ensure staff work at a level suited to them
- Opportunity to upskill, by recognizing prior learning and modifying this to meet future need
125
What is scarcity?
Health services have unlimited things which they want to provide, but a finite amount of resources to use
126
What must we decide because of scarcity?
- To spend money on Health services or other parts of govt
- Which and how much of each service to provide
- How and where to provide health services
- Who gets access and how much
- How will health services be distributed
- How much should be charged
127
What is opportunity cost?
The value of foregone benefits because a resource is not available for its best alternative use
128
What is the economic problem?
Due to scarcity, choices must be made, which imply opportunity cost. This means that each time we choose to do something, we choose not to do something else
129
How is health a part of the economic problem?
There is an opportunity cost to health.
- Money and time
- Health status affects other wants
- Implied opportunity cost
- Resources used to improve health can't be spent elsewhere
- Health affects the economy's productivity
130
What are free markets vs. govt control?
- Free markets mean that individuals have personal responsibility for paying for their health services and choosing who will provide them. It has less govt intervention, and more personal responsibility
- Govt control means that everyone shares their resources and aren't responsible for their care: there is collective provision, so everyone is provided for
131
What do consumers ask?
- What do I want
- What type do I want
- How much do I want
- What is the price/quality
- Am I willing and able to pay?
132
What do producers ask, as they respond to consumer demand?
- What do consumers want?
- What will it cost to produce
- How much can I sell it for
- What profit can I make
133
What is an ideal market?
The right number and types of goods are produced, determined by a price consumers are willing/able to pay and consumers are willing to sell for.
134
What happens if too many goods are produced?
There is a surplus, and supply exceeds demand. This causes the price to be reduced, to increase demand
135
What happens if too few goods are produced?
- There is scarcity, so demand exceeds supply. Producers increase the price until demand lessens
136
What is the invisible hand?
It acts on the market to ensure products are produced for the lowest possible price, as those spending and charging too much will be undercut and go out of business, whereas those charging too little will not make money
137
What is market equilibrium?
Occurs at the price where supply and demand are equal- a reasonable price.
138
What are the six features of a perfect market?
1. many buyers and sellers
2. free entry/exit into the market (important for setting price signals and allowing equilibrium to develop)
3. All goods/services produced are the same
4. Good consumer information is available- allows buyers to know values of and set price signals for products
5. No externalities (use of product doesn't affect others)
6. Consumers are the best judge of their own needs
139
What are the advantages of free markets?
- The invisible hand is at work. This means price acts as a market signal, so consumers buy as much as they want (subject to means) and producers produce as much as they can, subject to cost
- Incentives exist for consumers to reveal preferences and producers to produce at low cost
- Low transaction fees imposed as little government control
- Therefore free markets are automatically efficient (lowest cost of production)
140
What are the disadvantages of free market?
- The conditions needed for a perfect market rarely hold
- They usually require some form of intervention
- Distribution of goods and services is not equitable- those with the most means can buy more.
141
What services operate like normal market in NZ?
Relatively few:
- Dental for over 18s
- Private, unsibsidized A&Es
- Cosmetic medicine, optometry services and over-counter medicine
142
What determines whether an NZ market is normal or not in health?
Whether the govt funds the service, although insurance has a role in this too.
143
Why do almost all health systems operate with some government intervention?
- The only services operating normally are private ones, and there are often comparatively few of these
- If no intervention, the market would fail due to issues in provision and funding of services, as the perfect market conditions can't be met
144
What can cause market failure in provision?
- Monopolies
| - Supplier induced demand
145
How do monopolies cause market failure?
- There are only a handful of providers, and consumers have little information about their quality. This leads to unequal information and for the few buyers needing care.
146
What causes monopolies?
- Long training time
- Need for and cost of licensure (entry to market isn't free)
- Demand is limited and low incidence, not many suppliers are needed to meet demand. Few products are available
147
What is the result of monopolies?
- Suppliers may increase the cost and decrease the quality of their service, and increase their profits, as the customers have little other option.
148
How does supplier-induced demand cause market failure?
As there is asymmetrical information available to suppliers vs consumers, the suppliers are in a position of power, and are able to dictate to consumers what they should buy. This causes a failure in 'information' and 'consumer sovereignty'
149
What causes supplier-induced demand?
Consumer information is limited, and so they don't know what they need. If suppliers are greedy or scared of being sued, they may over-prescribe, over-treat or give defensive medicine.
150
What are the results of supplier-induced demand?
- Higher cost medical care, especially fee-for-service
| - Over-treatment, over-institutionalization and defensive medicine
151
What are the 6 market conditions in reality?
1. There are not many professionals due to different specialties and rare conditions. The greater specialization, the more failure
2. Entry is not free due to training and licensure
3. The same product is not produced by everyone- different doctors may have different healthcare strategies or ideas. Also me-too drugs, novel medicines and different specialties
4. There is asymmetrical information between doctors and consumers (esp. if unconscious, mentally ill)
5. Your health is able to affect others around you, both physically and emotionally (benevolence)
6. Consumers aren't the best judge of their own needs due to the specialized knowledge of health required.
152
Which is more crucial to market failure- funding or provision?
Funding
153
What are the ways in which funding can fail in a health market?
- Adverse selection
| - Cream skimming
154
What is adverse selection?
When buyers and sellers have asymmetrical information, 'bad' products or services are the ones more likely to be selected
155
How does adverse selection cause market failure?
High risk people are the ones most likely to get insurance, as they will need it. However, insurers will go out of business if they have too many high cost subscribers, so they use community ratings to set premiums as they can't determine individual risk. Low risk people might not want to pay so much for insurance, so leave, causing higher risk people to remain and a premium increase. This continues until only the highest risk people are left. If the high risk people are also low earners, they will not be able to afford insurance and the market fails as now only few people can pay their medical bills, and there is incomplete medical coverage
156
How do insurers avoid adverse selection?
Cream skimming: Providing the product only to the high value, low cost consumers of the product or service, leaving the high cost consumers without the service
157
How do insurers go about cream skimming?
- Shaping insurance plans around healthy people
- Giving discounted premiums to those who are low risk
- Not covering pre existing conditions
- Having max payout values
- Denying claims
- Giving insurance to groups of employees as they are likely to be healthy and younger
158
What is moral hazard?
Consumer-induced demand
159
Why does moral hazard occur?
When people have no worries/little worry about their ability to pay for medical care:
- No incentive to keep service use down
- No incentive to find the most efficient provider
- No incentive to look after own health
- No incentive to reduce number of claims
When their clients have coverage, producers have no incentives to keep costs down- in fact, they may charge covered clients extra!
160
What is the result of moral hazard?
- Overuse and overprovision of services
- Use of more costly services
- Less healthy people
161
How do insurers counteract moral hazard?
- Co-payment
- Deductibles
- Excluding high-risk people
- No-claims bonuses
