HCD 303 Final Exam Study Guide
Singapore's Model:
- centralized - public and private (delivery both, insurance public), medisave, medishield, medifund, medi...
3 types of nudging & examples of each
-Environmental nudges ex: 100% smoke free workforce - this results in lower prevalence of smoking -Economic nudges ex: sin taxes, health benefit plans, social benefit plans -Educational nudges ex: educating people and children on living healthy lifestyles
US rankings in: 1. WHO report 2. Bloomberg Business report 3. Commonwealth Fund report
1. 37th 2. 54th 3. 11th
3 Public health enemies & prevalence in the US
1. tobacco use 2. obesity 3. physical inactivity
Approximately, what portion of the US population still smokes tobacco?
1/5
How much does the healthcare system actually impact the health of a population?
10%
In Germany, healthcare spending accounts for what percentage of the GDP?
11%
Where did the Commonwealth Fund rank the US healthcare system?
11th
How many distinct State Ministries of Health are there in Germany?
16
When did Singapore become an independent country?
1965
When did the government in Singapore first start to really develop the various components of its healthcare system?
1980s
If a citizen of Singapore is in the 2nd to lowest income bracket, they are expected to pay _____% of their medical bills, while the government will automatically cover ____% of their medical bills
35, 65
Where did the World Health Organization rank the US healthcare system?
37th
How many generalized models of healthcare systems are there in the world?
4
How much do individual behaviors impact the health of a population?
40%
Percentage of health determined by behaviors & examples of those behaviors
40% tobacco use exercise eating habits etc
In Singapore, healthcare spending accounts for what percentage of the GDP?
5%
What percentage of the federal budget is attributed to healthcare in Germany?
5%
According to the Kaiser Family Foundation, what estimated percentage of the population will people of color compromise in the year 2050?
54%
Where did Bloomberg Business Report rank the US healthcare system?
54th
The NHS is currently ranked ____________ among the largest employers in the world.
5th
In regards to healthcare expenditures by source of payment, how much of all expenditures are made payable through Statutory Health Insurance plans?
63%
What percentage of federal spending in Singapore is allocated towards subsidies?
64%
What percentage of our health is NOT attributed purely to genetics?
70%
How many unique care management and preventative programs were developed under the "Healthy Kenzigtal" initiative?
8
What percent of the GDP did the UK attribute towards healthcare spending in 2017?
9.7%
Match the following parts of Medicare with the associated services they cover?
A - Inpatient Services B - Physician Services C - Medicare Advantage Plan D - Prescription Drugs
Shared vision
A common goal for more than one individual
What is Project ECHO?
A continuing medical education model where teams of specialists train primary care providers to treat complex patients in need of specialty care services
Health disparities
A higher burden of illness, injury disability, or mortality experienced by one population group relative to another group
What are health disparities?
A higher burden of illness, injury, disability, or mortality experienced by one population group relative to another group
How is money accumulated within the health system in Singapore?
A mix of general taxation and payroll deduction
How are primary care physicians paid in Germany?
A mix of payment models including fee-for-service with a uniform fee schedule and bonus for chronic disease management programs
What payment model is utilized to pay specialists in Germany?
A mix of payment models including fee-for-service with a uniform fee schedule and bonus for chronic disease management programs
What is a social compact/contract?
A mutually understanding among members of society to cooperate for social benefit, which may include sacrificing individual rights for community benefit
Pay-for-performance
A payment model that reimburses healthcare organizations and physicians who achieve, improve, or exceed their performance on specified quality and cost measures, as well as other benchmarks. incentive: Measure of performance metrics, Incentives can be financial or non-financial, Adherence to process
Fee-for-service (FFS)
A payment model where all healthcare services, products, and prescription medications are unbundled and paid for separately. incentive: Overtreatment, Provide more services, testing, and treatments that are billable through an ICD-code.
What is a shared savings program?
A program where healthcare organizations and insurance companies share overall savings generated through effective implementation of high-value, patient centered care
Which of the following accurately describe aspects of the DRG payment model? Select all that apply.
A prospective payment model Follows a patient for 30-days post-discharge Covers costs from admission to discharge
Capitation
A prospective payment model where the hospital or provider is paid a contracted rate per-member-per-month, regardless of the number of services provided. Rates are typically (but not always) risk-adjusted Incentive: Keep the patient healthy and living their daily lives in their own home, keep patient out of the hospital/clinic, freedom to provide non-traditional healthcare services
Shared reality
A reality that people have agreed to share
What is a system?
A set of procedures according to which something is done; an organized scheme or method A set of connected things or parts forming a complex whole (Both)
What is a common theme we see with regards to healthcare reform efforts throughout Singapore's history?
A strong emphasis on public health and preventive health efforts
What is an integrated care system?
A type of system design where various stakeholders including providers and payers, are linked through conscious system design to work collaboratively towards improved patient care
Project ECHO
ASU ECHO Programs •Behavioral Health Integration ECHO •Mayo Clinic/ASU End-Stage Liver Disease ECHO •Veteran Community Health ECHO •Medication-Assisted Treatment ECHO •Palliative Care ECHO
What is one model of care that was originally developed in the United States that is being highly considered and adopted throughout the NHS in England?
Accountable Care Organizations (ACOs)
What service line does more than half of all NHS expenditures go towards?
Acute hospital care, including hospital-based physician services
What is universal coverage?
All citizens within a country have access to healthcare insurance, regardless of individual circumstance.
What is a system?
All of the above
Why should we study health and healthcare disparities? (Select all that apply)
Although some populations are impacted on a greater scale, the existence of disparities does impact all of us We all benefit from having a stronger social compact/contract Our population is extremely diverse, and becoming more-so with time, increasing the risk of populations being impacted greater
Which aspect of the US healthcare system is represented by the Bismarck model?
Average Worker
Which of the following populations would NOT be considered at risk for health or healthcare disparities?
Being in the top 1% of income earners in the US
According to the article, "What Can the US and England Learn from Each Other's Health Care Reforms?," which of the following are common goals for both countries?
Better integrating health services Improving population health
How does the healthcare structure in Germany systematically integrate the principle of social solidarity?
By mandating that providers and hospitals have to treat all citizens, and that sickness funds must contract with any citizen, regardless of individual circumstance
Where did the Prime Minister of Singapore attend University?
Cambridge
Which payment model provides the least financial risk for payers and the most financial risk for providers?
Capitation
Which of the following are considered to be forms of 'bundled payments'? Select all that apply.
Capitation Reference Pricing DRGs
What payment models are utilized to reimburse NHS hospitals? (Select all that apply).
Capitation Pay-for-performance DRG's
Which of the following accurately describes aspects of the Medishield program?
Catastrophic care plan Tax-exempt
Which of the following ARE key features of the INSURANCE program(s) in the National Health Insurance model?
Centralized Tax based +1?
In Singapore, healthcare delivery is....(select all that apply)
Centralized A healthy mix of public & private
What are key characteristics of the healthcare system that established in East Germany? (Select all that apply).
Centralized Mostly public healthcare services
Safety Net
Children under 18 years of age exempt from all cost-sharing Adults: Annual cap equal to 2% of household income Annual cap lowered to 1% of household income for qualifying chronically ill people Unemployed contribute to SHI in proportion to their unemployment entitlements; For long term unemployed government contributes on their behalf
Beveridge - who was he and what was his role
Civil servant, educator Worked in London's lower east side - before, during & after WWII 1942: wrote & released The Beveridge Report Official Name: Social Insurance & Allied Health Services Government report Laid out the entire plan on how to develop & implement a fully federally-run healthcare system
Who is Sir William Beveridge? (Select all that apply).
Civil-servant Radio show host Author of the Social Insurance and Allied Health Services Report
Cost Sharing
Cost Sharing (all USD): Outpatient Prescriptions: $6.40 - $12.70 Inpatient Stay: $10.00/day (first 28 days/yr) Rehabilitation Stay: $10.00/day (first 28 days/yr) Deductibles: vary by sickness fund plan Preventative services do not count towards deductible
Which list of countries has implemented the Beveridge model?
Cuba, The United Kingdom, and the Scandinavian countries
Bundled payments (DRG, EDGR, Reference Pricing)
DRG - A prospective payment model in which hospitals are reimbursed with a fixed fee regardless of the actual costs. Includes hospital expenses only. ACA required 30-day readmission penalty DRG Incentive - Reduce length of stay, Discharge appropriately, Keep costs to a minimum EDRG - An EDRG is another form of a bundled payment. The bundled payment = hospital + all physician payments + longer period of time (e.g. 6 - 12 months after hospitalization). The EDRG acts as a forcing function - encouraging physician and hospital collaboration on improving both patient outcomes and cost. Reference Pricing - Reference Price = the payment amount now going to medical centers with high quality and low cost Medical centers can charge more than reference price Patients told which medical centers charge more than reference price If patient chooses higher cost medical centers, patient pays the difference between reference price and medical center price
Which of the following are key distinctions between the DRG payment model and the EDRG payment model? Select all that apply.
DRG will only ever follow a patient for 30-days, while EDRG follows a patient for up to 5 years, DRG does not include physician services, while EDRG does include physician services in the bundled price
What are key characteristics of the healthcare system that was established in West Germany? (Select all that apply).
Decentralized Mainly private healthcare services
Which of the following ARE key features of HEALTH CARE DELIVERY in the Bismarck model?
Decentralized Mostly Private
Singapore Belief
Developed the belief that a system that took care of ALL of its citizens' needs would diminish the population's desire to succeed." "the people's desire to achieve and succeed must never be compromised by an overgenerous state" He believes that a system that takes care of all of its citizens' needs would diminish the populations desire to succeed, where the UK believes that this is a shared responsibility of which the community/government as an obligation to provide completely
What payment model is utilized to reimburse hospitals in Germany?
Diagnosis-related groups
Which payment model is utilized to reimburse hospitals in Singapore?
Diagnosis-related groups
Healthcare disparities
Differences between groups in health insurance coverage, access to and use of care, and quality of care
What are healthcare disparities?
Differences between two or more groups in health insurance coverage, access to and use of care, and quality of care received
Which dimension of population health management did Mercy Health in Ohio leverage to overcome issues with interoperability within their electronic health records?
Digital health & AI
Who is covered by Medicare? (Select all that apply).
Elderly Disabled Patients with end-stage renal disease
What is the goal that Human and Health Services (HHS) has set out in their action plan with regards to health and healthcare disparities?
Eliminate racial and ethnic health disparities
What type of health insurance programs became popular immediately after WWII?
Employer-based insurance
Which of the following are ECHO programs currently being run by ASU or scheduled to launch in Spring 2020?
End-stage liver disease behavioral health integration medication assisted treatment veteran community care
What are 3 types of nudging that were discussed in this week's lectures?
Environmental Educational Economic
What type of nudging is evidenced in the "Healthy Kinzigtal" program?
Environmental Educational Economic
What is the primary role of the Federal Ministry of Health in Germany?
Establish health policy, rules & legislation by which the rest of the system must adhere They supervise the operations of the providers and sickness funds
Who is covered within the UK's healthcare system?
Every citizen in the UK, including visitors in cases of emergency and/or treatment of infectious disease
Health plans usually have both copayments and co-insurance.
False
In the United Kingdom, they experience health disparities because of the role social determinants play in an individual's health, but they do not experience healthcare disparities because they have universal coverage and socialized medicine.
False
The terms decentralized and private are synonyms.
False. Decentralized means system organization occurs at the state/regional level, while private means that organizations are not government-run.
How are primary care physicians reimbursed in Singapore?
Fee-for-service
Which payment model provides the least financial risk for providers and the most financial risk for payers?
Fee-for-service
60% of all primary care physicians working for the NHS are on nationally negotiated contracts. Which payment models are used within these contracts to reimburse these PCPs? (Select all that apply).
Fee-for-service Capitation Performance-based payments
Who is Otto Von Bismarck?
First Chancellor of Germany
In AMA style of writing, select all that apply:
Full citations on the reference page should be listed by order of appearance in the paper In-text citations should be listed as a superscript number
Which of the following is a measure of access within a healthcare system?
Geographical proximity to needed services Patient insurance status such as insured or uninsured Physician to patient ratios Patient insurance coverage
What is a subsidy?
Government assistance
Which of the following accurately describes aspects of the Medifund program?
Government fund that pays for portions of medical bills that cannot be covered otherwise Can ONLY be used at public hospitals
Singapore used to be a colony of which country?
Great Britain
What does GDP stand for?
Gross Domestic Product
How does Lee Kuan Yew's underlying beliefs in the governments role in healthcare differ from that of the United Kingdom?
He believes that a system that takes care of all of its citizens' needs would diminish the populations desire to succeed, where the UK believes that this is a shared responsibility of which the community/government as an obligation to provide completely
What is nudging?
Health interventions that make the healthy choice, the default choice
Which of the following are measures of cost within a healthcare system? (Select all that apply).
Healthcare spending as a % of the GDP Cost per procedure such as a knee or hip replacement
What are the 3 goals of a healthcare system?
High quality, low cost, easy access
What are some of the key aspects of the innovative care delivery design that occurred in Valencia, Spain? (Hint: visit the required readings from this week).
Implemented capitation payments throughout the entire region Payments were NOT risk-adjusted Public financing to a completely private healthcare organization
Historical Emergence: UK
In 1911, parliament passed the very 1st form of what would become the National Health System (NHS) Parliament passed a very limited National Health Insurance Act Covered workers (not dependents) for primary care, pharmaceuticals, and provided cash for short term disability or sickness Few other private organizations offered voluntary coverage Everyone else paid out of pocket, through charity, or by big public hospitals Problems at this time Poor coordination between public and private hospitals Access to specialists was uneven as many specialists gravitated towards private pay patients Feud erupted among physicians over qualifications and who could work in hospitals Throughout the 1920's and 1930's these issues sparked a heated and prolonged debate over healthcare reform This reform debate took two forms: Option #1: extend the 1911 act into comprehensive National Health Insurance Analogous to nationalizing Medicare Based upon the ideology that all individuals have the right to healthcare Option #2: expand & universalize existing locally funded & run public health services Analogous to having public health efforts/services and insurance programs the responsibility of individual municipalities and states Based upon the ideology that society has an obligation to look after the health of the people In the United Kingdom alone, during WWII: > 2 million homes were destroyed ~100,000 people were killed As a result: Emergency medical services was formed and took charge of all medical services nationwide A coordinated hospital service forms National and regional services for lab work and blood transfusions was formed National service for surgery, neurology, psychiatry, and rehabilitation Every citizen of the U.K. was granted access to these services Beveridge and Bevan
nudging
Interventions that rely less on conscious choice by individuals and more on influencing behaviors through environment/societal norms are more likely to succeed
What did policymakers implement in Germany to shift the focus away from cost containment and towards enhancing efficiency in the early 2000's?
Introduced diagnosis-related groups as the primary basis by which sickness funds would reimburse hospitals
In Germany, which of the following properly describes aspects of Statutory Health Insurance?
Is a marketplace where private sickness funds market plans to citizens and/or business, much like the insurance marketplace in the United States established by the Affordable Care Act Every German citizen qualifies Covers approximately 86% of the population Is premium is set by your income level and is paid through payroll deduction
Orlando Health faced a barrier to effectively monitor and track the health of the population as a result of a fragmented, outdated patient health information system. As a result, they utilized AI to automate and digitize records, while simultaneously aggregating data. Why is aggregated data so important when managing population health? (select all that apply).
It allows providers to access a much larger patient base when researching effective treatments, especially for rare diseases It allows the health system to better identify high cost patients known as super-utilizers It allows health systems to develop programs and direct resources towards segments of the population that are most in need
Which of the following statements is true?
It doesn't seem to matter which measures are used within international health systems rankings, the US healthcare system performs poorly amongst other developed nations
What impact did the invasion of the Nazi Germans have on the development of the UK's healthcare system?
It forced healthcare delivery services to organize into a centralized healthcare system
What is agency & why is it important when combating health disparities?
It is the capacity of individuals to act independently and have a voice in aspects impacting their lives. It is important in combating health disparities as it empowers citizens that have been traditionally marginalized.
The Glasgow Effect
It is the concept that neighborhood plays a very important role in our health and can change drastically, even within a small geographic area
What is the Glasgow effect?
It is the concept that neighborhood plays a very important role in our health and can change drastically, even within a small geographic area
What is healthcare financing?
It is the function of a system concerned with the mobilization, accumulation, and allocation of money to cover the health needs of the people, individually and collectively, in the health system
What does the term prospective mean?
It is when the reimbursement amount for a service or group of services are set in advance
What approach is key to understanding the needs of individuals and cohorts of people in order for population health management to be successful?
It must be data-driven to accurately reflect the immediate needs of the population
What is a uniform-fee schedule?
It refers to the amount of services that each provider can administer within each quarter
What is the systematic purpose of copayments and co-insurance?
It's a forcing function to incentivize patients to seek the appropriate level of care
What is a gatekeeper?
It's when a health plan dictates that a patient must get referred by their PCP to see a specialist
Which list of countries has implemented the Bismarck model?
Japan, Germany, and Switzerland
Lee Kwan Yew - who was he and what was his role
Lee Kuan Yew, Prime Minister of Singapore (1959-1990) Had a unique opportunity to learn from Western healthcare systems such as the U.K. and the U.S. 1940's: young student in Cambridge Lee Kuan Yew, Prime Minister of Singapore (1959-1990) 1965: Singapore was a new nation but poor and impoverished Since his college days in the '40s he was able to witness the strain these Western nations were beginning to show due to the high healthcare costs associated with their healthcare systems Lee knew it was necessary that for his country to realize his vision, its entire population would need to be motivated and working hard Early years of Singapore's independence (1960's): Lee introduced a 5-year plan calling for: urban renewal and construction of new public housing, greater rights for women, educational reform, and industrialization. High-quality healthcare was not a high priority, however some steps were taken to improve the health of Singaporeans. Brought primary care services closer to people (built a network of satellite outpatient dispensaries and maternal and child health clinics) which became a one-stop shop for: Immunization, Health promotion, Health screenings, Well-women programs, Family planning services, Nutritional advice, Psychiatric counselling, Dental care, Pharmacy, Laboratory services, Home nursing and rehabilitative services Took huge pressure off the hospitals to provide such care
How do you measure the various goals?
Life expectancy quality of care patient outcomes patient safety patient satisfaction cost of care access to care
When was the Affordable Care Act signed into law?
March 23, 2010
Which aspect of the US healthcare system is represented by the National Health Insurance model?
Medicare
What population did CareMore enroll into its innovative, capitation-based, care delivery programs? (Hint: visit the required readings from this week).
Medicare Advantage patients
This health insurance program in Singapore is specifically designed to help citizens in the lowest income bracket pay for their medical bills.
Medifund
This health insurance program in Singapore is designed as a health savings account for each individual citizen to contribute earnings for medical expenses.
Medisave
This health insurance program in Singapore is designed as a low-premium, high-deductible plan to protect citizens from extremely high healthcare bills.
Medishield
Who was Aneurin Bevan? (Select all that apply).
Minister of Health Elected official
Bevan - who was he and what was his role
Minister of Health (1945 - 1951) Shared in Beveridge's vision Official founder of the NHS when it was passed into law in July, 1948 Had to make many compromises, especially w/ specialists
What is ONE lesson that the US can learn from recent reforms within the NHS?
Mixing financial incentives should be avoided and should stretch beyond just clinical care outcomes
Under which branch of the federal government is healthcare financing regulated in Singapore?
Monetary Authority
What are the two main branches of the federal government that oversee the healthcare system in Singapore?
Monetary Authority The Ministry of Health
In the early 2000's the Surgeon General release two reports that ultimately led to the creation of which organization?
National Center for Minority Health and Healthcare Disparities
What healthcare model is represented in Singapore?
National Health Insurance model
What is the NHS?
National Health Service
In our country, that is currently experiencing strong political divides, what is an aspect of Singapore's healthcare model that might be appealing to those on the 'right' or more conservative in their political views?
One of the countries five main objectives is built in personal accountability and avoiding the over-reliance of a welfare state
In our country, that is currently experiencing strong political divides, what is an aspect of Singapore's healthcare model that might be appealing to those on the 'left' or more democratic political views?
One of the countries five objectives is universal coverage and there are systems in place to protect consumers from high costs when the system fails
Which of the following properly describes aspects of Private Health Insurance?
Only those who make over ~$70,000/year qualify The premium is set by your performance on an individual health assessment
Organizational Culture vs. Societal Culture
Organizational Culture is the unique personality of an organization that influences the behavior of the members in that organization. Societal culture is the culture that a particular society follows to interact in such a way to share a common interest
Centralized
Organized at the federal level
What does the term centralized mean?
Organized at the federal level
Decentralized
Organized at the regional or state level
What does the term decentralized mean?
Organized at the regional or state level
Bismarck - who was he and what was his role
Otto von Bismarck: Germany's 1st Chancellor (1871) Hundreds of "sickness funds" already in operation throughout Germany Bismarck saw working class movement at that time as a threat (labor unions were gaining strength) In attempt to quell social unrest among workers and to control growing strength of labor unions Bismarck proposed a national social insurance system 1883: Sickness Insurance Act Passed 1st social insurance program organized at a national level Organization & operation the sickness funds remained at the union level Remained primary structure of the system until WWII.
Historical Emergence: Germany
Otto von Bismarck: Germany's 1st Chancellor (1871) Hundreds of "sickness funds" already in operation throughout Germany Bismarck saw working class movement at that time as a threat (labor unions were gaining strength) In attempt to quell social unrest among workers and to control growing strength of labor unions Bismarck proposed a national social insurance system 1883: Sickness Insurance Act Passed 1st social insurance program organized at a national level Organization & operation the sickness funds remained at the union level Remained primary structure of the system until WWII. Adolf Hitler and the National Socialists did not share Bismarck's vision of health insurance as a way to promote political stability Health insurance was a means to achieve the Third Reich's goal of a healthy, productive, fit and racially pure German state. Centralized the power of the sickness funds After WWII, Germany is divided into two separate entities The Democratic Republic of Germany (East Germany) Under the influence of the former Soviet Union Saw this as an opportunity to show that socialist healthcare was superior than the capitalist models Within months: established Central Health Administration 1947: eliminated private practice Maintained Bismarckian insurance model 89%: covered by employee based "sickness funds" 11%: covered by the government The Federal Republic of Germany (West Germany) Maintained its connections with the west Reestablished pre-war healthcare model Highly de-centralized model: 90%: covered through approximately 1,300 autonomous statutory sickness funds Funds divided into primary funds and substitute funds Patients can choose primary care physician and given one treatment voucher per quarter PCP act as gatekeepers
What is the complete and official name of the ACA?
Patient Protection and Affordable Care Act
Which of the following are measures of quality within a healthcare system?
Patient satisfaction Patient safety Patient outcomes
Select the response below that BEST illustrates a healthcare disparity:
Patients with disabilities experience cost as a barrier at a rate of 78% higher than their able-bodied counterparts
What payment model was dubbed pay-for-process by physicians and played a significant role in what would ultimately become the opioid epidemic?
Pay-for-performance
What are the 4 components of a healthcare system?
People, parts, interrelationships, and culture
Which payment model reimburses organizations and/or providers based upon the number of days treatment was given?
Per diem
Salary
Physicians are paid a predetermined salary based upon their level of expertise and experience. incentive: No incentive for overtreatment, Provide the best treatment, regardless of ICD-code to the patient, There is also no direct incentive to work hard.
Who is covered by Medicaid? (Select all that apply).
Pregnant women Low-income Disabled
Who is Lee Kuan Yew?
Prime Minister
In Germany, healthcare delivery is....(select all that apply)
Private Decentralized
In Germany, sickness funds are....(select all that apply)
Private Decentralized
Which of the following ARE key features of the INSURANCE program(s) in the Bismarck model?
Private Employer-Based Decentralized
What are safety nets?
Programs put in place to protect vulnerable populations from cost-sharing
Which of the following is NOT the goal of a healthcare system?
Provide care to only those who can afford it
In Singapore, the mandatory healthcare insurance coverage program is....(select all that apply)
Public Centralized
Match the department within the NHS to its primary role within the system:
Public Health England - improve overall well being and reduce health inequalities NHS Business Services Authority - issues health insurance cards to citizens Care Quality Commission - regulation Monitor - ensures systematic performance is meeting standards
According to the article, "Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition," what is the primary focus of healthcare reform in Germany today?
Quality improvement
Which of the following statements are TRUE when comparing the key distinctions between the DRG payment model and reference pricing? Select all that apply.
Reference pricing may provide greater price transparency to patients, but can also provide greater financial risk to patients Reference pricing allows hospital's to charge as much as they would like, while DRG's does not
At what level are reimbursement payment amounts set in Germany?
Regional because the system in Germany is decentralized
What 3 key aspects are needed to accurately define a health or healthcare disparity?
Risk factor, comparison population, and a health or healthcare outcome
What regions/countries had the most significant influence over East Germany? (Select all that apply).
Russia
What payment model is utilized to pay specialists in the NHS?
Salary only
What is ONE underlying systematic design employed by ACO's aimed to improve quality and reduce healthcare costs?
Shifting the payment model away from fee-for-service to link savings to care outcomes
Medicaid (who does it cover, when was it established, changes through the ACA)
Signed into law by President Lyndon Johnson on June 30th, 1965 All states provide Medicaid coverage to: - Low-income (below 100% Federal Poverty Line) - Pregnant women - Families w/ children, depending on income - Disabled
Medicare (4 parts, who it covers, when it was established)
Signed into law by President Lyndon Johnson on June 30th, 1965 Provides health insurance coverage to 3 groups: - Elderly 65 years and older - Disabled - End stage renal disease Part A (Part of the Original Medicare Bill) Inpatient Hospital Care Inpatient stays at skilled nursing facilities Hospice & home health services Part B (Part of the Original Medicare Bill) Doctor & clinical lab services Outpatient and preventative care Screenings, surgical fees, & supplies Physical & occupational therapy Part C (Introduced in 1997 by the Balanced Budget Act) Also known as Medicare Advantage Different way of getting part A & B coverage Combines parts A & B into one plan and offered as: HMO, PPO, PFFS, SNP Part D (Introduced in 2006, by the Medicare Prescription Drug, Improvement, & Modernization Act of 2003) Prescription drug coverage
What is the primary means by which money is accumulated within the healthcare system in Germany?
Since the system in Germany is highly privatized money is accumulated by the sickness funds through payroll deduction
Historical Emergence: Singapore
Singapore gained independence from Britain in 1965 At the time, it was a tiny, impoverished country with few assets and no natural resources Lee Kuan Yew, Prime Minister of Singapore (1959-1990) Had a unique opportunity to learn from Western healthcare systems such as the U.K. and the U.S. 1940's: young student in Cambridge Lee Kuan Yew, Prime Minister of Singapore (1959-1990) 1965: Singapore was a new nation but poor and impoverished Developed the belief that a system that took care of ALL of its citizens' needs would diminish the population's desire to succeed." "the people's desire to achieve and succeed must never be compromised by an overgenerous state" Early years of Singapore's independence (1960's): Lee introduced a 5-year plan calling for: urban renewal and construction of new public housing, greater rights for women, educational reform, and industrialization. High-quality healthcare was not a high priority, however some steps were taken to improve the health of Singaporeans. Brought primary care services closer to people (built a network of satellite outpatient dispensaries and maternal and child health clinics) which became a one-stop shop for: Immunization, Health promotion, Health screenings, Well-women programs, Family planning services, Nutritional advice, Psychiatric counselling, Dental care, Pharmacy, Laboratory services, Home nursing and rehabilitative services Early years of Singapore's independence (1960's) con't: Introduction of Fees at Outpatient Clinics: At first, all services were free- Lee's government imposed a fee of 50 cents per visit, doubled during public holidays Set the tone early on, that healthcare is not free and that citizens would have to take personal responsibility for their care Public Health Efforts Prior to independence: most Singaporeans live in unhygienic slums and crowded settlements, only 9% of the population lived in government flats 1960: set up Housing Development Board (HDB) began investing in good, clean, affordable housing 1965: 55,000 flats were built 1970: housing problems were solved Today: almost 85% of Singaporeans live in HDB flats Sweeping reform in the 1980's: 1st Comprehensive National Health Plan introduced The plan aimed to: Keep healthcare affordable, Meet the demands of a growing population (in both numbers and affluence), keep empowering citizens to lead healthy lifestyles, Improve costs and efficiency of its healthcare system Forecasted growing demands based upon an aging population Mentioned the need to restructure the delivery system to cope with the changing trends of disease This was a shift most other countries started around 2010. Sweeping reform in the 1980's: 1st Comprehensive National Health Plan introduced, con't Restructuring of the hospital system Government gave public hospitals more autonomy Some incorporated in 1980s, most in the '90s Goal was to create competition between the hospitals 1984: Medisave 1990: Medishield 1993: Medifund 1993: Released White Paper titled "Affordable Health Care" Became blueprint for developing and refining Singapore's healthcare system: Become a healthy nation by promoting good health Promote individual responsibility for one's own health and avoid overreliance on state welfare or third-party medical insurance Ensure good and affordable basic medical services for all Singaporean's Engage competition and market forces to improve service and raise efficiency; and Intervene directly in the healthcare sector when necessary, where the market fails to keep healthcare costs down
Which list of countries has implemented the National Health Insurance model?
South Korea, Canada, and Taiwan
Which of the following is NOT a dimension of population health management
THESE ARE ALL DIMENSIONS OF POPULATION HEALTH MANAGEMENT: Prevention & public health Healthcare delivery Big data & population analysis Patient engagement & empowerment Case management & self care Digital health & AI
Which of the following ARE key features of the INSURANCE program(s) in the Beveridge model?
Tax based public centralized
Which of the following accurately describes aspects of the Medisave program?
Tax-exempt Premium is set by individual income and is shared between employee and employer Health savings account Required enrollment by all citizens in Singapore
What are sin taxes?
Taxes that are placed on products that are known to be harmful to your health
What does the term universal access mean?
That everyone within a country has access to some form of health insurance
What happens in Germany in 1990?
The Berlin wall is torn down, signifying the reunification of East and West Germany
Which of the following are healthcare models we see emulated in various countries throughout the world?
The Bismarck Model The Beveridge Model The National Health Insurance Model The out-of-pocket model
Why would the NHS, a government-based system, utilize the fee-for-service payment model when it is well documented that the FFS model incentivized quality over quantity of care (ie. over-treatment)?
The NHS is aware of this, and therefore only reimburses providers through FFS for procedures and/or treatments that are well documented to be under-serviced
What happened on July 5th, 1948 in the UK?
The NHS was passed into law
What is a premium?
The amount paid monthly for a health insurance plan
Deductible
The amount that must be paid out-of-pocket annually, before insurance coverage kicks in
What is a deductible?
The amount that must be paid out-of-pocket annually, before insurance coverage kicks in
What are the implications to the healthcare system in Germany when the Berlin wall is torn down?
The country adopts the health system of West Germany which is highly decentralized
What does mortality amenable to healthcare measure?
The deaths preventable within a healthcare system with timely and appropriate medical care
What is population health the study of?
The health outcomes of a group of individuals, including the distribution of such outcomes within the group They study of how diseases impact populations which can be defined by many parameters including geographically
The Commonwealth Fund and the World Health Organization reports both used health equity as a measure in their rankings. What is health equity?
The inclusion of fairness in a system for providing health services and insurance coverage taking into consideration an persons individual circumstances
Health Spending as % of GDP
The percent of money spent on healthcare every year, in relation to the total amount spent throughout all industries in the same year
When analyzing healthcare systems, spending as a percent of the GDP is often considered. What does this measure tell us?
The percent of money spent on healthcare every year, in relation to the total amount spent throughout all industries in the same year
What is the proper meaning of generalized reciprocity?
The principle belief in giving to something knowing that you may not get an immediate returned benefit
What is the proper meaning of subsidiarity?
The principle belief that matter of government responsibility should be handled at the lowest level of government that makes operational sense
What is social solidarity?
The principle that governments have an obligation to ensure that every citizen has access to all social services, including healthcare
What is the proper meaning of social solidarity?
The principle that the government has a responsibility to ensure all citizens have access to essential social services including healthcare
What does the Ministry of Health Holdings protect?
The public hospitals from detrimental financial burden
Copayment
The set dollar amount that you must pay at the point of service
What is a copayment?
The set dollar amount that you must pay at the point of service
Coinsurance
The set percentage of the bill that must be paid at the point of service
What is co-insurance?
The set percentage of the bill that must be paid at the point of service
What are social determinants of health?
They are extenuating circumstances, outside the control of individuals, that have substantial impacts on health
Which of the following are responsibilities of the State Ministries of Health in Germany?
They are responsible for maintaining the healthcare infrastructure of public hospitals throughout their region Public health efforts They supervise the operations of the providers and sickness funds
What did Lee Kuan Yew believe had to occur if Singapore was going to survive as an independent nation?
They had to turn themselves into a first world oasis in a third world region
What is one of the key leverage points that exists within healthcare financing that can be used to improve healthcare delivery?
To align incentives between patients and providers
What was the initial focus of Singapore's healthcare system once they gain their independence?
To focus on public health services such as adequate housing and basic primary care services
Why should we study healthcare systems around the world?
To gain an understanding of what types of system models are being used and how those models perform Learn about innovations in care delivery and their impacts on population health Learn how other systems are structured, financed, and what barriers they are facing Determine what we can learn from other healthcare systems to improve our system here in the US. Get a gauge of where the US system performs overall, comparatively speaking (ALL OF THE ABOVE)
What leads to more preventable deaths in the US than any other factor?
Tobacco
What are the 3 largest threats to public health in the US today?
Tobacco Physical inactivity Obesity
Which aspect of the US healthcare system is represented by the Out-of-pocket model?
Uninsured population
Which country spends the highest percent of their GDP on healthcare?
United States
The Beveridge, Bismarck, and National Health Insurance models are all systematically very different. However, which of the following are commonalities that we see among all 3 models, that we also fail to have within the US healthcare system?
Universal coverage The government maintains oversight of the system, allowing it to intervene when the system fails
Which aspect of the US healthcare system is represented by the Beveridge model?
VA/Tricare
What regions/countries had the most significant influence over West Germany? (Select all that apply).
Western Europe United States
Does Germany have safety net programs?
Yes, children are exempt from all cost-sharing and adults have a spending cap equal to 2% of their household income
Can healthcare disparities be compounded? In other words, does your risk increase if you qualify for more than one risk factor?
Yes, patient's who qualify for more than one risk factor would be at an exponentially greater risk for health and/or healthcare disparities.
Access
a person's ability to get care or coverage
System
a set of connected things or parts forming a complex whole
Universal Coverage
all residents have coverage
4 models of healthcare o Clearly define each o Be able to list a country where each model is represented o Where in the US are each of the models represented
beveridge- socialized medicine - Medical and hospital services that are provided by a government and paid for by taxes Europe: United Kingdom Spain Scandinavia Asia: Hong Kong Oceania: New Zealand Latin America: Cuba bismark- Medical and hospital services are provided through both private and public services and paid for through sickness funds Europe: Germany Belgium Switzerland France Asia: Japan Latin America: Primarily everywhere except for Cuba national health insurance- national health insurance model - Medical and healthcare services are provided through both public and private entities and paid for by a single government insurance plan North America: Canada Asia: Taiwan South Korea out of pocket- medical and healthcare services are provided through both public and private entities and paid for by the individual receiving services Rural Regions: South America Africa China India In the United States: We have elements of all 4 models working in our healthcare system Beveridge model- Veterans Affairs/Tricare National health insurance model- medicare Bismarck model- Average worker Out-of-pocket model- ~10% with no access to health insurance
Which of the following ARE key features of HEALTH CARE DELIVERY in the National Health Insurance model?
centralized and mostly public was wrong
population health management
combination of information gathered to define problems and build awareness and the strategies to address needs
Cost
cost
UK Model:
decentralized
German Model:
delivery and sickness funds are - decentralized - private
What type of nudging did Safeway leverage within their employee health benefits program?
economic
Building walking paths, smoke free workplaces, and employee wellness programs are examples of ___________________ nudges.
environmental
Who holds responsibility for reducing health and healthcare disparities?
everyone
Medifund and subsidies are synonyms and can be used interchangeably.
false
Since the healthcare system in the UK provides universal coverage and is paid for through taxes, there is no cost-sharing.
false
The National Health Service and the National Health Insurance model are the same thing and those two terms can be used as synonyms.
false
The US has universal coverage.
false
Attitudes/beliefs
focus on the ways that people evaluate and think about issues
Subsidy
government assistance
Goals of a healthcare system (3)
high quality low cost easy access
According to the Kaiser Family Foundation, what race/ethnic group is at the highest risk of being uninsured?
hispanic
Quality
how good or bad something is
Health Financing
it is the function of a system concerned with the mobilization, accumulation, and allocation of money to cover the health needs of the people, individually and collectively, in the health system
Marginalized/Underserved Community
minority populations
In properly defining health financing, there are 3 matters that must be included. Select all three below:
mobilization accumulation allocation
Which of the following ARE key features of HEALTH CARE DELIVERY in the Beveridge model?
mostly public centralized
How does the US perform on life expectancy?
not great, US lags behind other OECD countries (ex. japan, germany, UK, etc): 80.0 years
Opt-in vs. Opt-out programs
optout - patients may be automatically enrolled in the HIE but are given the opportunity to opt out of having their information stored and/or disclosed by the HIE; opt-in - patient consent is required in order for patient health information to be stored and/or disclosed by the HIE
Per Diem
payment model that reimburses organizations and/or providers based upon the number of days treatment was given
Uninsured/Underinsured
people either have no insurance or are underinsured/ populations are underinsured
Components of a healthcare system
people, parts, inter-relationships, and culture
quaternary prevention
prevention efforts designed to ensure patients are not exposed to additional harm when seeking medical care
secondary prevention
prevention efforts designed to keep individuals and populations from becoming at higher risk for illness/injury
primary prevention
prevention efforts designed to keep individuals and populations from becoming at risk for illness/injury
tertiary prevention
prevention efforts designed to keep individuals and populations from having acute episodes related to the poor management of...
4 types of prevention, examples of each, and their overarching role in healthcare delivery
primary - annual physicals - cost money secondary - mammograms - cost money tertiary - Monitoring medication adherence for a patient with diabetes - save money quaternary - Avoiding hospital-acquired infections for a patient undergoing heart surgery - save money
Private Health Services/Insurance
private, privately run Only those who make over ~$70,000/year qualify The premium is set by your performance on an individual health assessment
What are social programs & what is their role in health and healthcare?
programs such as SNAP - these help provide food/nutrients these programs help keep people healthy, reducing numbers of doctor visits which help to serve as preventative care
Public Health Services/Insurance
public, government run
Which payment model is utilized to reimburse specialists in Singapore?
salary
Germany Belief
social solidarity "This principle is a firmly held belief that government is obligated to ensure a wide range of social benefits are available to all citizens including medical care, old age pensions, unemployment insurance, disability payments, maternity benefits, and other forms of social welfare"1
General Reciprocity
the principle belief in giving to something knowing that you may not get an immediate returned benefititifif
Subsidiarity
the principle belief that matter of government responsibility should be handled at the lowest level of government that makes operational sense
Social Solidarity
the principle that governments have an obligation to ensure that every citizen has access to all social services including healthcare
There is high variability in cost, quality, and access throughout the US healthcare system.
true
How does the US perform on quality, access, and cost?
varies throughout country, overall rankings are relatively poor though
"When it comes to health, your _________ _________ matters more than your genetic code."
zip code
Sickness Funds
~130 sickness funds today (although this number is continually dropping) Covers ~ 86% of the country's population Membership is mandatory Must pay a legally mandated premium of 14.6% of their income (through payroll deduction) Split between employer and employee Percent of premium is determined by income ~11% of the population opts out of the SHI and opts for Private Health Insurance (PHI) Percent of premium is determined by health assessment and is risk-adjusted
Risk factors for health disparities
•Disability •Race •Socio-Economic Status (SES) •Age •Gender •Geographic Location Education Level
Gesundes Kinzingtal Program
•Established in 2006 •Joint venture between the physicians network and two sickness funds •Members of these sickness funds were given the opportunity to join for free •How it works: •A pre-determined amount of money is allotted for the care of these patients. •Providers are reimbursed for any care that they provide •At the end of the term, any money left in the allotted population budget is split and shared among the providers and the sickness funds