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Flashcards in Final Deck (21):
0

Drivers of healthcare costs

Third party payers
Technology
Market imperfections
Aging population
Medical model
Admin expenses
Defensive medicine
Waste and abuse
Practice variation

1

Cost containment strategies

Combination of govt regulation and market-based approaches

Supply side controls (ex certificate of need - doesn't work)
Price controls
Utilization controls

Supply side regulation
Demand side incentives
Payer driven competition
Utilization controls

2

Certificate of need

Method to contain costs

Need prior approval for expansion or equipment purchases based on demonstrated need

Did not work

3

6 areas of waste in US health care

Failure of care delivery
Failure of care coordination
Over treatment
Administrative complexity
Pricing failures
Fraud and abuse

4

Bending the cost curve

30% of spending could be eliminated without consequence

Areas of savings
Bundled payments
Unnecessary treatments
Medical errors
Care coordination
Pay for performance

5

Care transition

Movement of patient thru healthcare system as there condition and thus needs change

Transitional care - coordination and continuity

6

Re hospitalization rates

Around 20% in first 30 days

Means systems not well coordinated

7

ACA and care transition

Reduces Medicare payment if readmission within 30 days

Tests models in place

8

Key implications of healthcare access

Determinants of health
Benchmarking
Assessing effectiveness
Measure of equality
Quality and efficiency of medical services

9

Determinants of healthcare access

Insurance
Availability of care
Coordination of care
Effluence
Equity (predisposing vs enabling conditions)

10

3 things that affect healthcare access

Predisposing conditions
Enabling conditions
Characteristics of policy and system

11

When enabling conditions create difference in medical care utilization

The delivery of Medical care is considered inequitable

12

Define quality in healthcare

Application of medicine to maximize its benefits without increasing its risks

13

Two components of quality

Technical standards and patient expectations

14

Dimensions of quality

Technical performance
access to services
effectiveness of care
efficiency of service delivery
interpersonal relations
continuity of services
safety
physical infrastructure choice

Both objective and subjective

15

Macro versus micro view of healthcare quality

Macro view includes
life expectancy
mortality rates
Epidemiologic measures
population
policy

MicroView includes
clinical care
patient centeredness
quality-of-life
care delivery system

16

Three studies by the Institute of medicine

1996 IOM round table
1999 to err is human
2001 crossing the quality Chasm

17

Safety in medicine

50000-100000 people die in hospitals each year due to preventable medical error

Medical errors 5th leading cause of death

Result of system failures not health care workers

18

Medication errors

One of the most common medical errors
1.5 million preventable injuries
Cost $3.5 billion
Misuse abuse and underuse

19

Six aims for healthcare improvement

Safe
timely
effective
efficient
equitable
patient centered

20

Imperatives for health care redesign

Reengineer care process
Information technology
Knowledge and skills management
Effective teams
Care coordination

System failures