Study guide for the final, part 10

Question 1

What is defensive medicine?

Answer 1

Unjustified medical tests and txs done for self-protection against the possibility of litigation
Along with malpractice insurance, this is costly and inefficient

Question 2

How do practice variations contribute to cost escalation?

Answer 2

Geographic variations in tx patterns and utilization
Signal gross inefficiencies in the system and unfairness
Compromise both cost and quality

Question 3

What are the two main approaches to cost-containment?

Answer 3

Regulatory approaches
Competitive approaches

Question 4

Where does restriction occur in supply-side controls?

Answer 4

Restriction on capital expenditures
-Certificate of need (CON) statutes by state legislation
Restriction on supply of physicians
-Entry barriers for foreign medical graduates

Question 5

Definition of access to care

Answer 5

The ability to obtain needed, affordable, convenient, acceptable, and effective personal health svcs in a timely manner
Whether an individual has a usual source of care
The ability to use HC svcs
The acceptability of particular svcs

Question 6

Factors affecting HC utilization according to the access framework by Anderson (1968) and Aday et al (1980)

Answer 6

Health need
Predisposing conditions: socio-demographic characteristics
Enabling conditions: individual’s means to use medical care
Health policy characteristics
Health care delivery system’s characteristics

Question 7

Equitable/inequitable access

Answer 7

Equitable access: svcs distributed according to a pt’s perceived need or evaluated need determined by a health professional
Inequitable access: svcs distributed according to enabling characteristics

Question 8

Quality assessment

Answer 8

Measurement of quality against an established standard
Define how quality is determined, identify specific variables or indicators, collect data, statistical analysis, interpretation
Subjective measures must be quanified
Measurement scales with validity and reliability

Question 9

Quality assurance

Answer 9

The process of institutionalizing quality through ongoing assessment and using the assessment results for continuous quality improvement (CQI)
Based on the principles of total quality management (TQM)
A step beyond quality assessment
Cannot occur without quality assessment

Question 10

Structure in the Donabedian model

Answer 10

Facilities and equipment
Staffing levels and staff qualifications
Delivery system: distribution of hospital beds and physicians

Question 11

Facilities and the Donabedian model

Answer 11

Licensing
Accreditation

Question 12

Staff qualifications and the Donabedian model

Answer 12

Licensure and accreditation
Training

Question 13

Delivery system and the Donabedian model

Answer 13

Distribution of hospital beds and physicians

Question 14

Process and the Donabedian model

Answer 14

Technical aspects of care
Interpersonal aspects of care

Question 15

Technical aspects of care and the Donabedian model

Answer 15

Dx
Tx procedures
Correct prescriptions
Accurate drug administration
Pharmaceutical care
Waiting time
Cost

Question 16

Interpersonal care and the Donabedian model

Answer 16

Communication
Dignity and respect
Compassion and concern

Question 17

Outcome and the Donabedian model

Answer 17

Measured and compared against pre-established benchmarks

Question 18

Final results in the Donabedian model

Answer 18

Pt satisfaction
Health status
Recovery
Improvement
Nosocomial infections
Iatrogenic illnesses
Rehospitalization
Mortality
Incidence and prevalence of dz

Question 19

Cost efficiency

Answer 19

Cost efficient when the benefit is greater than the cost
Underutilization and overutilization

Question 20

ACA and access

Answer 20

Promises to increase access to affordable insurance coverage, and supports improvements in primary care and wellness

Question 21

Uses of policy

Answer 21

Regulatory tools
Allocative tools

Question 22

Principle features of US health policy

Answer 22

Gov’t as the subsidiary to the private sector
Fragmented
Incremental and piecemeal policies
Pluralistic politics associated with demanders and suppliers of policy
The decentralized role of states
The impact of presidential leadership

Question 23

Legislative branch and US health policy

Answer 23

The most active in policy making
In the form of statutes or laws

Question 24

Executive branches and US health policy

Answer 24

Presidents, governors, and other PH officials propose policies
Intermediary suppliers of policies
Executives and administrators make policies in the form of rules and regs used to implement statutes and programs

Question 25

Judicial branches and US health policy

Answer 25

Uphold, strike down, or modify existing laws by:
-Interpreting an ambiguous statute
Establishing judicial precedents
Interpreting the Constitution

Question 26

States and US health policy

Answer 26

Decentralized role
Incremental policy actions by states
-State-initiated programs for vulnerable pops
-Policy initiatives to expand health insurance coverage

Question 27

Impact of presidential leadership in US health policy

Answer 27

Harry Truman’s Hill-Burton Hospital Construction Act of 1946
LBJ’s Medicare and Medicaid of 1965
Nixon’s HMO Act of 1973 and the National Health Planning and Resources Development Act of 1974 (CON legislation)
Raegan’s authorization of the PPS method of payment in 1983
Bill Clinton’s CHIP and HIPAA of 1996
W. Bush’s Medicare part D in 2003
Obama’s ACA in 2010

Question 28

Parts of the policy cycle

Answer 28

Issue raising
Policy design
Public support building
Legislative decision making and policy support building
Legislative decision making and policy implementation