Module 5 lecture, part 2

Question 1

How does the US have an imperfect market?

Answer 1

It’s a quasi-market where HC is partially managed by free markets
It deviates from free market principles

Question 2

Who is the 1st party?

Answer 2

Pt

Question 3

Who is the 2nd party?

Answer 3

The provider

Question 4

Who is the intermediary third party?

Answer 4

Often, the insurance

Question 5

What problems can arise with having an insurer as a third party?

Answer 5

A wall of separation between financing and delivery
Quality of care and price is a secondary concern

Question 6

What occurs in a free market HC system?

Answer 6

Multiple pts and providers act independently, and pts can choose to receive services from any provider.
The price of services is determined by the forces of supply and demand
Pts should have info about the appropriateness of various services
Pts directly bear the cost of services received

Question 7

How does the US HC system deviate from free market principles in terms of healthcare plans?

Answer 7

Consolidation of pts into health plans has the effect of shifting the power from the pts to the administrator of the plans.
The health plans are the real buyers in the market, and pts have a limited choice of providers.

Question 8

Describe the concept of moral hazard

Answer 8

Once enrollees have purchased health insurance, they will use HC services to a greater extent than if they were to pay for the services out-of-pocket

Question 9

How does the US HC system deviate from free-market principles in terms of prices?

Answer 9

Prices are determined by the payers, such as MCOs, Medicare, and Medicaid, not by the forces of supply and demand.

Question 10

How does the US HC system deviate from free-market principles in terms of providers?

Answer 10

Providers have formed alliances and integrated delivery systems on the supply side as well.

Question 11

How does the US HC system deviate from free-market principles in terms of information and decision-making?

Answer 11

It is very difficult for pts to obtain info and understand the appropriateness of various medical services.
Decisions by HC use are often determined by the need or the amt of medical care that medical experts believe a person should have to remain or become healthy, rather than by price-based demand

Question 12

From where can artificial demand be created?

Answer 12

Pts’ self-assessed need, moral hazard, and practitioners’ financial interests (aka provider-induced demand)

Question 13

When there are multiple payers and different plans for companies, what is the result?

Answer 13

A billing and collection nightmare
System becomes more cumbersome

Question 14

What is a single-payer system?

Answer 14

A national HC system where usually the primary payer is the gov’t

Question 15

What are the multiple players in the system, and what is the result of that?

Answer 15

Big business
Gov’t
Labor
Insurance companies
Physicians
Hospitals
Fragmented self-interests at odds

Question 16

In what admin costs does the US spend far more on?

Answer 16

Billing
Rebilling
Collections
Bad debts
Maintaining medical records

Question 17

Expand on the litigation risks of the US HC system?

Answer 17

The US is a litigious society
This results in expensive malpractice insurance and practitioners engaging in defensive medicine
-Prescribe diagnostic tests, return checkups, documentation
These practices are costly and inefficient

Question 18

Describe the aspects of high tech in a HC system

Answer 18

Creates demand for new services despite high costs
Competition on the basis of having high tech
With capital investments, must have utilization

Question 19

What are the three broad categories of medical services?

Answer 19

Curative
Restorative
Preventative

Question 20

The continuum of services is not confined to ____

Answer 20

Hospital and physician’s office

Question 21

How is there a lopsided health care continuum?

Answer 21

Heavier emphasis on specialized services

Question 22

What is involved in the quest for quality?

Answer 22

Higher expectations
Quality standards with compliance
Continuous quality improvement

Question 23

Characteristics of the National Health Insurance (NHI), Canada

Answer 23

Gov’t finances HC through taxes
Care provided by private providers
Gov’t consolidation of financial, insurance, and payment

Question 24

Characteristics of National Health System (NHS), Great Britain

Answer 24

Financing: a tax-supported NHI
Gov’t manages the infrastructure for delivery
Gov’t operates medical institutions
Providers: gov’t employees or tightly organized

Question 25

Characteristics of Socialized Health Insurance (SHI), Germany, Israel, Japan

Answer 25

Financed through gov’t-mandated contributions by employers and employees
Sickness funds collect contributions and pay providers
HC delivered by private providers
Gov’t exercises overall control

Question 26

How many countries by 2012 had some form of universal coverage?

Answer 26

25 of the wealthiest, except the US

Question 27

What are the 3 basic models of universal coverage?

Answer 27

National Health insurance
National Health System
Socialized Health Insurance

Question 28

What are the components of the systems framework?

Answer 28

System foundation, system resources, system processes, system outcomes, and system outlook

Question 29

Definition of system foundation

Answer 29

Historical, cultural, social, and economic factors that explain the current structure

Question 30

What are two types of system resources?

Answer 30

Human
Non-human

Question 31

Definition of system processes

Answer 31

What the HC system does or what happens in the system

Question 32

Definition of system outcomes

Answer 32

The critical issue and concerns surrounding what the health services system accomplishes or not accomplishes

Question 33

What are the main outcome criteria?

Answer 33

Access
Cost
Quality

Question 34

Definition of system outlook

Answer 34

Future projections of desired system outcomes