Week 6 Bioethics (DLA25, L50, L51, L52)

Question 1

define primary care

Answer 1

• 80-90% of all health care visits
• common health problems, minor interventions, preventative measures
• via general practitioner or other caregiver

Question 2

define secondary care

Answer 2

• issues requiring more specialized care / clinical expertise
• -usually hospital setting, specialties like general surgery

Question 3

define tertiary care

Answer 3

• complex / rare disorders requiring extensive clinical expertise and hospital care
• sub-specialties like cardiac surgeons, immunologists, hematologists

Question 4

what is the term to describe the US health care model (explain)

Answer 4

Dispersed Model:

• multiple access points
• fluid roles for providers
• less distinction in hospital care
• higher value on tertiary care

Question 5

list the positive and negative impacts of health dispersion

Answer 5

Pos: flexibility, convenience, direct access to tertiary care, autonomy in selecting services

Neg: higher costs, lacks organizational coherence, difficult to integrate care and maintain continuity, unnecessary procedures/risks of medical error

Question 6

describe 1st generation HMOs

Answer 6

• ‘vertical integration’, ex Kaiser
• health plan includes hospitals, physicians, pharmacies, home health organizations

-choose PCP in network, PCP must refer to specialities

Question 7

describe 2nd generation HMOs

Answer 7

• ‘virtual integration’, group model
• health plan has contracts with IPAs (independent practice associations), hospitals, pharmacies, home health agencies
• must work in network

-choose PCP in network, PCP must refer to specialities

Question 8

define IPAs

Answer 8

Independent Practice Associations

• loose collection of private doctors who work in their own practices
• contracts with HMOs: capitation payments or fee-for-service or combination with bonuses

Question 9

describe PPOs

Answer 9

-Preferred Provider Organizations
-Pts select approved/preferred providers and hospitals
-providers discount their fees
(no PCP referrals necessary)

Question 10

describe ACOs

Answer 10

Accountable Care Organizations
-doctors, hospitals, and other health care providers come together voluntarily to give coordinated high quality care to the Medicare patients they serve

Question 11

what % of physicians will have some level of substance related impairment during their careers

Answer 11

10%

Question 12

how prevalent is physician burn out and what are the 3 symptoms

Answer 12

• 51%
• emotional exhaustion
• depersonalization
• reduced personal accomplishment

Question 13

list the modes of paying for health care

Answer 13

• out of pocket payments
• individual private insurance
• employment base private insurance
• government financing
• social health insurance

Question 14

define fee-for-service

Answer 14

unit of payment = visit / procedure

-possibly incentives medical inflation

Question 15

define payment per episode of illness

Answer 15

unit of payment = global surgical and other fees for an illness/episode

• single/bundled payment for multiple services, ex. surgery, birth
• more financial risk to provider than payer

Question 16

define capitation payments

Answer 16

unit of payment = sum of patient’s Tx (per mo/yr)
-monthly payments to physician for each patient signed up to receive care - generally for PCPs (fixed sum per Pt regardless of number of services)

Question 17

define payment per time

Answer 17

unit of payment = salary of physician

Question 18

list the 4 types of hospital payments

Answer 18

• per procedure (FFS)
• per diem/day (hotel approach)
• per episode of hospitalization (payment depends on Dx)
• per institution = global budget

Question 19

describe the 3 cost-control mechanisms in health care

Answer 19

• financing: limit flow of money from individuals/employers to health care plan
• reimbursement: limit flow of money from insurance plans to drs/hospitals
• utilization: make Pts pay part of the fees to reduce abuse

Question 20

list the types of financing controls

Answer 20

• regulation: government regulates premium payments (difficult in US)
• competition between insurance plans

Question 21

list the types of reimbursement controls

Answer 21

price control: some plans (ex. medicare, medicaid) bargain for reductions in physician/hospital fees

Question 22

list the types of utilization controls

Answer 22

• Pt cost sharing: deductibles, co-payments, non-coverage

- Reducing ‘supplier induced demand’