quiz 3 Flashcards
(41 cards)
united states health care system
In terms of ACCESS & OUTCOMES, US Health Care is Less than Effective!
Obamacare = Affordable Care Act (ACA), same thing, interchangeable
The US spends MORE THAN ANY OTHER COUNTRY
yet had > 47 million people without Health Insurance
and since A.C.A. / Obamacare
still has 26 million people without Health Insurance `
who covers health care costs?
*Employers *Individuals/Families *Government
The Federal government is the #1 Payer w/ Medicare & Medicaid
Yet, Third Party payers (insurance companies) still cover the most…
medicare
a federal insurance program that helps pay for medical care for people 65 y.o. >+ (and older), permanently disabled workers, their dependents, and people with end-stage renal disease.
Recipients must qualify according to INCOME; – means-tested
No deductibles / co-pays;
↓ Expenditures in past 20+ years
PART D – G. W. Bush (2003) Bush/Con
medicaid
a jointly-funded federal-state-local program designed to make healthcare more available to the POOR.
Eligibility requirements and program benefits vary from state-to-state;
Majority of funds provide service for the elderly, blind, and disabled;
2/3 of Medicaid recipients are members of an AFDC (welfare) family.
↑ HEALTH CARE COSTS ESCALATING FOR DECADES
Why?
New medical technologies
People living longer & needing more care for chronic & acute illnesses
Largest growing age population, 100yo+
Medical wastes
Enormous corporate Profits*
Exorbitant salaries & compensation packages
High administrative costs
Medical fraud
Even as a % of GDP (Gross Domestic Product,): the US has much higher costs than ANY OTHER country.
In 2008, Hospital Care accounted for most increases in Health Care costs.
Over the past 3 decades, the funding for Health Care in the US … has gone from a reliance on Private sources, to increased dependence on Public sources, and with ↓ declining “out-of-pocket” expenditures.
Though typically not mentioned in the news, many companies WANT some degree of public health care (to reduce production costs).
private businesses
health care expenditures…
primarily spent on health insurance;
increasingly accompanied by higher employee contributions
Interestingly, MAJORITY of Americans without Insurance is in families with an employed worker.
The uninsured (before A.C.A.) in the US ≈ 40 – 60 million people.
In any 2-year period before A.C.A., 80 million Americans are without insurance for at least part of the year.
managed care programs
have attempted to cut costs while securing “lower provider reimbursements” and “regulating patient care.”
This means ↓ Payment of Services & ↓ Doctors’ Autonomy
Several Types of Managed Care:
Health Maintenance Organizations (HMOs) – prepaid health care plans offering a range of services for a FIXED FEE.
Preferred Provider Organizations (PPOs) – networks of physicians & hospitals that agree to give price discounts to groups who enroll in their program, use their services, and agree to follow specified regulations.
hybrid managed care programs
research find that:
MD-owned facilities tend toward more procedures w/higher fees;
MDs refer to places where they have ($) interests.
1997 Children’s Health Insurance Program (CHIP) – Beyond Medicare/Medicaid, CHIP’s AIM: to ↓ #Children w/out health insurance.
FINALLY – and INTERESTINGLY – MEDICAL REFORM, HASN’T ADDRESSED MALPRACTICE
ethics
a field of study that helps “define what is good for the individual and for society and establishes the nature of duties that people owe themselves and one another.”
medical ethics
most informative when collaborative, drawing from Sociology, History, Anthropology, Theology, Philosophy and the clinical studies
truth-telling
as far back as the Hippocratic Oath, but once again at the forefront of medical ethics; has long been a complex decision for doctors.
Proponents – [it] demonstrates respect for the patient and lying would undermine trust and rapport.
Opponents – argue that patients really “don’t want to know,” especially about serious illness; thus they are against [it] because they believe it’s in the patients’ interest.
Patients: doctors telling you the truth
Doctors: should patients hear the whole truth and nothing but the truth
justifying lying to/ deceiving patients
on the grounds of:
Discretion – Doctors shouldn’t be forced to “just report the facts.”
Lying – may benefit the patient.
Patients can’t always fully understand the truth.
truth supporters argue
Patients know themselves better than their doctors, and truth helps in planning.
Truth-telling enhances the doctor-patient relationship.
Landmark California Case: The Tarasoff Case
…ruled that doctors have a duty to break confidentiality in order to protect innocent third parties.
(Confidentiality is a critical issue, especially w/electronic records and hacking.)
Patients count on their physicians to not share their personal / private information with others.
Personal Information should go no further.
But, it’s NOT ABSOLUTE.
And – again – Confidentiality dates back to Hippocrates.
Man tells therapist he wants to kill tatiana tarasoff, therapist tells police, police saw him of sane mind and released him, he ended up killing her weeks later – parents found out this information and took it to supreme court
benefits of protecting confidentially
People needing treatment will seek it (not be deterred);
People will provide maximum information;
Trust with physicians is enhanced.
Physicians have a DUTY to care for people, even if they have contagious diseases.
Recently, there has been a push by some to refuse to treat … on the basis of:
*Excessive Risk *Questionable Benefits
*Obligations to other patients / self / family
Proponents of Treating Regardless of Risks argue that …
It’s inherent part of being a doctor – their profession;
It’s part of the social contract between society – medical institution, and
Patients are dependent on their doctors.
AMA Policy … has changed over time; now it
Expresses both Duty to Treat, and Easy Exemptions.
Five (5) Important Components of US Health Care Delivery System
Hospitals
Freestanding Ambulatory Sites
Surgical Care Sites
Nursing Homes
Hospice Care Facilities
health care system development history
1700s – 1800s – Most general hospitals were charitable care for people without family / money, staffed by volunteers. Much of this care was “hospice-like.” (similar to end-of-care, make it comfortable)
~1900 – begin to admit mostly sick people (but curable), w/other care for elderly and the homeless.
By 1920 – Hospitals became primary centers for acute care treatment, including surgery, skilled nursing, etc.
With ↑ Hospital size →↑ Administrators to coordinate complex bureaucracies.
Later, BILLIONS of government $$ dollars for Community hospitals after WWII.
Hospital used to be funded by religious institutions.
hospitals as primary source of us health care
~5,700 hospitals with > 6 million workers, but ↓ # Hospital beds for several decades. [Voluntary Hospitals most common.]
In US, in 2014, ~18% of hospitals are for profit, And they have been replacing public hospitals.
For-Profit Hospitals are also consolidating through mega-mergers.
For-Profit Hospitals are accused of / criticized for:
Profit Maximizing
Catering to rich clients / patients
Providing little / no care for those who cannot afford to pay.
uncompensated hospital care in us
annually $25-30 billion.
↑ Ambulatory Care: care provided to an individual who is not an inpatient in a healthcare facility. [Save $, not health; e.g. ↑ outpatient surgeries.]
Urgent Care, Med Express, etc., as alternatives to doctor’s offices, family doctors, used by poorer people and for acute events.
Also includes retail store clinics (e.g. Walgreens), ambulatory surgical centers, and public health centers.
Majority of US physicians practice in Offices/Groups.
“Patient-dumping” illegal, but often occurs.
↑ Home health services – to ↓ Costs; Serving increasingly elderly population, the disabled and veterans.
Hospices – provide services, care, comfort and palliative care for terminally ill patients. Relief to patients and family at life’s end. ↑ concern for profit is increasingly playing a role.
nursing homes
are long-term residential facilities that provide nursing and other therapeutic and rehabilitation services. They mainly serve incapacitated elderly residents, but also some younger adults with significant physical and/or mental health problems.
Nursing Homes were in the epicenter of the Covid Pandemic with deadly consequences stemming from political intervention in uncertain times. Many legal battles are underway in this arena.
Primary Concerns about Nursing Homes include:
Neglect
Abuse
Accidents
The High Price of Care
Staffing Shortages
Rapid ↑ Technological Innovation with equipment and technicians/operators.
Benefits (Clear):
More accurate diagnoses
Quicker diagnoses
↑ Effective treatments
↑ Life Expectancies
Negatives:
↑ Costs
≠ Access
Technological advances that FAIL.
Ethical Issues
Dependence on technology; loss of “eye skills”
SOCIAL CONSEQUENCES OF NEW HEALTH CARE TECHNOLOGIES
New options for people
Can alter human relationships
Can affect entire health care system
↑ reflection on value questioned
↑ social policy questions
