Exam 3 Flashcards
(45 cards)
current state of health care system
technology intensive, specialized, expensive, and exclusive
future goals for the state of health care system
specialized care -> primary care
technological -> humanistic
cost unaware -> cost aware
institution focused-> ambulatory focused
governed professionally -> governed managerially
acute care -> chronic care
future goals for the state of health care system PART 2
individual patient perspective -> population perspective
curative care -> preventative orientation
content mastery -> process mastery
individual provider -> team provider
competition -> cooperation
primary component of public health practice
education
provides information, empowers, and motivates
can occur in gov health agencies, voluntary health agencies, social services agencies, schools, business and industry
primary medical care
education
promotion of nutrition
safe water and sanitation
maternal and child health care
immunization
prevention and control of endemic disease
treatment
essential drugs
secondary medical care
specialized care provided by physicians, hospital or outpatient, or emergency care
tertiary medical care
highly specialized for those with unusual or complex conditions
specialized hospitals
academic health centers
Ex: Mayo Clinic for heart issues, St. Jude for childhood cancer
Long-term practice
restorative- staying somewhere for a somewhat short amount of time to heal
long-term care- living there for an extended amount of time/for the rest of your life
health services pyramid
in order of most to least use: population based public health services -> primary health care -> secondary -> tertiary
in order of most to least money spent -> tertiary -> community hospital -> ambulatory services -> community based prevention and primary care
brief history of US healthcare
before 1850- medicine at home
1850-1900- medicine in an office/hospital
1911- first health insurance policies by Montgomery ward
1929- 3.9% of GDP spent on health care
1930-50- age of medicine
1965- medicare and medicaid
1970s- cost containment, anti-fraud stuff
1980s- cost greatly increase, AIDS, new tech
1992- 14% GDP spent
2020- 20% GDP spent
Age of medicine
1930-1950
NIH established
Hill-Burton Act- money for hospital construction
Health-Manpower Act- provided money for nurse/doctor training
“Flat of the Curve” medicine
healthcare outcomes are positively correlated with health care costs
increasing the slope of the curve will represent better health care outcomes without increased costs
health care as a “market failure”
US consumers often don’t have the needed information to make appropriate choices that you do with any other good or service in the marketplace
little to no information on the price or the quality, making it difficult to make the best decision
political parties differ based on health care beliefs
DEMOCRATS- gov run system (gov foots the bill, monopsony), all have access and all must participate, strict regulatory control
REPUBLICANS- consumer driven system, controls (malpractice reform) but less strict, retain private operation, medical savings accounts
supply vs demand
every other good/service is influenced by consumer demand except health care
in medicine, demand is influenced by the provider (more doctors in an area = more surgeries)
medical malpractice
4% of hospitalized patients experience some kind of adverse outcome
28% of these cases could be traced back to negligent care
only 1-2% of these cases actually filed a malpractice suit, and most of the time it did not have anything to do with negligence
common elements of medical malpractice
a poor outcome for the patient
a substantial level of disability as a result
a poor interpersonal relationship between patient and doctor
only in rare circumstances are these cases based on actual physician negligence
Lessons from abroad- O’Rourke (first 5)
- possible to provide universal access and at least restrain cost increases
- spending more money on healthcare is neither necessary or desirable, esp bc we are not any sicker
- savings from administrative and inappropriate services are alone sufficient
- the health status of other industrialized countries compares favorably with the USA
- universal access and cost control can occur within the parameter of a mized public/private delivery system
Lessons from abroad- O’Rourke (second 5)
- public satisfaction with health care is much higher in other countries
- healthcare spending in other countries is not open ended, need limits/caps
- other countries view healthcare more as a human service rather than a market commodity
- spend money where it will do the most good to maximize the output
- improvement in health care and status requires a broader perspective than focusing on medical care
criticisms of healthcare abroad
-under provision
-waiting lists for the waiting list
-some people still have issues with affording certain kinds of care
-patients have to sign legal releases to accept that delays in treatment may negatively impact health to hold hospital blameness
public policymaking process
formation phase- identify problems and solutions to dev legislature
policy implementation phase- rulemaking and operation
policy modification phase- feedback from individuals, orgs, and interest groups can influence policy at any time in this process
where the nation’s health dollar comes from
33 cents- private health insurance
25 cents- direct patient payments
17 cents- medicare
11 cents- medicaid
14 cents- other gov programs
fee for service system
means the patient pays the physician or facility
third party system
typical set up for health insurance plans
a fee for service is paid by a 3rd party insurance agency/gov that has collected funds as insurance premiums or taxes
