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This is a basic table defining some of the major terms and issues in healthcare today. Great for someone who wants some basic definitions and a quick reference guide.
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Critical Issues Final Review Sheet Topic Details Medicare -‐ Federal health insurance, 65 and over, eligible
for ss disability payment and indiv who need kidney transplants or dialysis -‐Part A – (hospital insurance)-‐> inpatient care, skilled nursing facility, hospice, home health care, no premium required -‐Part B-‐ (medical insurance)-‐> covers medically-‐necessary services like doctors’ services and outpatient care/preventive services -‐Part C-‐ (Medicare Advantage Plans) – combines A, B and D -‐> managed by priv ins companies approved by Medicare -‐Part D-‐ (Medicare Prescription Drug Coverage) helps cover prescription drugs
Medicaid -‐ Federally aided, state-‐operated and administered program -‐> low-‐income families with children, elderly, disabled, blind individuals who are covered by SSI, pregnant women whose family income under 133% of poverty level
Two Models of Government Health Plans
Social Insurance = Medicare (only those who have paid are eligible) Public Assistance = Medicaid (criteria based on income and/or medical condition) -‐> those who contribute may not be eligible
SCHIP -‐ Cover uninsured children up to age 19 from families who made too much $ to qualify for Medicaid
Socioeconomic Status -‐ Social standing or class of an individual or group -‐ Measured as a combination of education, income, occupation -‐ Often reveal inequities in access to resources, plus issues related to privilege, power, and control
Gradient/Gap -‐ gradient isn’t just about “poor” -‐ every rung up SE ladder people w/in society tend to be healthier and live longer the higher up you go -‐person-‐level unit of analysis – rigorous evidence of a strong and positive association between absolute SES and health -‐ health is affected by social position and scale of soc/econ diff among the population -‐ in terms of income, relationship is with relative rather than absolute income levels
Epidemiologic Transition -‐ poor places suffer with poorer health and lower life expectancy -‐ economic improvement leads to improvements in health and life expectancy, but only to a point
Gini Index -‐ “measurement of the income distribution of a country’s residents. Number ranges from 0 to 1 and is based on residents’ net inome, helps define the gap between the rich and the poor, with 0 representing perfect equality and 1 representing perfect inequality.
Pathways for SES Relationship to Health
Social Mobility-‐ people in poor social/econ condition because of poor health -‐> has impact on social mobility but too small to account for health diff Behav/Cultural-‐ Lack of self-‐regulation, poorly developed coping skills, external locus of control, discount rates, collection of learned behaviors w/in a community Materialistic-‐ Higher income affords better shelter, food, clothing, more education -‐> safer, less phys demanding jobs, wealthier places have better schools, hospitals, transportation Pyschosocial Mechanisms-‐ Stress of trying to keep up, humans well designed to deal w/ immediate, short-‐term, actionable stress
Policies to Decrease SES Health Inequalities
-‐ Income redistribution -‐ Education Promotion -‐ Social Cohesion
PPACA ****Refer to the document Gardent posted that describes all the different features in detail
1. Providing Health Care to All Americans 2. Role of Public Programs 3. Improving quality and efficiency of health
care 4. Prevention of chronic disease & public
health 5. Health care workforce 6. Transparency & program integrity 7. Improving access to innovative therapies 8. Community living assistance services &
supports 9. Revenue provisions
Individual Mandate Employer Requirements Health Insurance Exchanges
Changes to Private Insurance Paying for PPACA
Societal Approaches to Changing Behavior
Individual (medical model) -‐ Convince individuals not to smoke, drink, eat, ect -‐ Counseling -‐ Education Population (public health model) -‐ Broad public health efforts might be a better use of funds -‐ Change social structure
• Education Campaign (knowledge) • Marketing/Advertising (Fear/Promote) • Social Change (make it socially negative) • Ban/Restrict (limit access) • Tax (make it more costly)
Pauly Article – Disruptive Innovation
-‐Using cheaper, simpler, more convenient products or services that meet needs of less demanding customers -‐ dominant players focused on improving products/services miss more convenient and less costly offerings -‐ A little less quality for a lot less money -‐ (think of the flat curve of spending Hansen referred to in his lecture)
Role of Pricing in HC Costs -‐ is supply inducing demand or is demand inducing supply?
Economics of Employer Mandate -‐ Making employers provide costly insurance reduces the demand for labor -‐ If insurance is part of the package-‐ the supply of labor also increases
Consumer Choice and Moral Hazard
-‐How much healthcare will people demand with marginal price close to zero -‐ How does that compare to what we would demand in a world with “perfect insurance”
Hospital Consolidation -‐ Increases in hospital market concentration lead to increases in price of hospital care -‐ Hospital mergers in concentrated markets lead to significant price increases -‐ for some procedures -‐> hospital concentration reduces quality -‐ Hospital competition improves quality under an administered pricing system -‐ Competition improves quality where prices are
market determined, although the evidence is mixed Healthcare Ethics – General Principles
-‐ Health care ethics relates to national policy/reform: -‐ access, quality, safety, effective, and value -‐ Ethics is a driver for health care change
Healthcare Ethics-‐ Healthcare Organizations
-‐ Ethics defines what and who organization is at its core -‐ Serves as how organization will fulfill that foundation in practice/culture and how it will address ethical conflicts
Common Morality Respect for patients (autonomy) – Promoting self-‐determination through shared decision-‐making, confidentiality, truthful communication, promise-‐keeping Promote patients’ best interests (beneficience, nonmaleficence)-‐ promoting beneficial, evidence-‐based care w/in rel and avoiding actions that cause harm Distributive & Social Justice – Allocating resources failry and providing value for services rendered
Ethical Conflicts in Medicine -‐ Occurs w/ uncertainty/conflict/question regarding competing ethical principles, values, or professional/organizational ethical standards of practice -‐ When one considers violating an ethical principal, personal value, or organizational standard of practice = an ethical conflict -‐ clinical ethics = application of ethical framework to individual patient care issues
Research Ethics -‐ Application of an ethical framework to the design, sponsorship, review, conduct, and dissemination of research -‐ Voluntary consent of human subject = essential for research -‐ Research Ethics Framework = social/sci value, scientifically valid design, fair subject selection, favorable risk-‐benefit ratio, independent review, informed consent, respect for enrolled subjects
Quality Improvement Ethics -‐application of an ethical framework to the design, review, conduct, and dissemination of QI
Organizational Impact of Ethics Conflicts
-‐ Organizational ethics = application of ethical framework to system of care, including its missions, values, structure, culture, and practices -‐ Ethics conflicts have impact on health care org
-‐ Ethical conflicts have sig cost implications -‐ Theoretical correlation between ethical conflicts and organizational costs -‐> impact org performance, including wages, efficiency, and price
IOM Six Aims for Improvement 1. Safe 2. Effective 3. Patient-‐centered 4. Timely 5. Efficient 6. Equitable
Health Workforce Planning -‐ Do we have shortage of clinicians? How does regional supply of clinicians affect population utilization and outcomes? How should hc org rethink clinician workforce? -‐ “easier to add capacity than take capacity away” -‐ “healthcare economics = imperfect market -‐> shapes pattern of care”
Physician Shortage Concerns Concerns 1. Growing population (elderly) 2. Increase in age-‐specific utilization rates 3. Econ expansion -‐> “GDP is destiny” 4. “demand” increasing rapidly -‐> failing to anticipate “demand” w/ more phys = shortage 5. Assumes demand = patient needs & preferences
Desirable Population Outcomes-‐ Investing in Medical Workforce
Access – to care when it is wanted/needed Quality – care that is technically excellent and matches patients’ preferences Outcomes – care that improves health and well being of patients and populations Costs – care that is affordable to the patient and to society
ð if these outcomes are agreed upon, what are effective/efficient ways to achieve these ends?
ð Evidence that acces/quality/outcomes are sensitive to physician supply?
ð Understand why technical quality/patient satisfaction is not necessarily better with more physicians
-‐ With similar outcomes, must be noted that many health care systems deliver care w/ far fewer physicians (think about WHY this is, what FACTORS affect this, and how to INCREASE efficiency) -‐ “good care trumps care & clinician quantity”
Clinician Workforce Planning w/in Health Care Organizations
-‐ Improve patients health & wellbeing -‐ Optimize organizational by strengthening: 1. Secure valuable referrals (PCP networks) 2. Build capacity in high margin specialties 3. Assume fee-‐for-‐service revenues will flow unimpeded -‐ Current: Add clinician capacity to organizations
does not reliably lead to better outcomes -‐ Future: fee-‐for-‐service will be supplanted by capitated payments
Scenarios in Organizational Workforce Planning
1. Regional Per Capita Supply of Physicians vs Proportion employed by a health system -‐ Evaluate proportion of highly effective care High Regional per capita supply + high health syst proportion of regional supply = near regional monopoly within possible over capacity region, high organizational gain – high risk, questionable patient benefit High Regional per capita supply + low health system proportion of regional supply Modest surgeon share w/in possible over capacity region, high organizational gain – moderate risk, uncertain patient benefit
Direction of Workforce capacity w/in organization
Depends on: 1. Regional workforce environment 2. Proportion of workforce environment that is “owned” by the organization 3. Proportion of current care that is highly effective in relation to patient needs and preferences
Economics of the Employer Mandate **Make sure to review the graphs in Hansen’s lecture and understand them
-‐ Making employers provide costly insurance reduces the demand for labor but if insurance is part of the package, the supply of labor also increases -‐ With marginal price close to zero -‐ Flat of the curve spending – if we are near flat of the curve and we increase co-‐pays, what should happen to the health of the insured population?? NO CHANGE -‐ Expenditure = price x quantity -‐ Understand the role of prices and choice in competition (think of chemotherapy example, Alaska colonoscopy example, medical tourism industry and how that affects competition, insurance companies encouraging patients to seek cheaper care) -‐ lack of competition (market power) can be destructive -‐ consolidation and creation of market power is happening (new york hospitals combining and forming giant hospitals) -‐ Insurers are able to create demand elasticity => Demand elasticity measures the rate of response of quantity demanded due to a price change, used to
see how sensitive the demand for a good is to a price change (higher price elasticity, more sensitive consumers are to price changes)
