Health Care access and disparities; comparable health systems

What about patients drives up US healthcare costs

demographics and lifestyles

medicaid

for long income and young, child, and pregnant, elderly, disables. run by states but funded by federal and state taxes

accessibility

locations of providers and patients

true or false : Community rating establishes premiums based on the medical statistics of a community

true

true or false: Socioeconomic status is a dominant influence on health care access.

true

which models does the US have for its health care system

--Beveridge model (UK/Cuba) = veterans affairs --Bismarck model (Germany) = employer sponsored insurance for working Americans --national health insurance model (Canada) = medicare and medicaid -- out of pocket: uninsured americans

service delivery building block

1) Effective, safe, quality 2) Personal and non-personal 3) Wherever and whoever needed 4) Minimum waste resources medical services and preventive care to those who need it

Burden of Mental Illness trends

1) Infrastructure insufficient for dealing with growing needs 2) Stigma and don't seek help Large prop. Countries don't have anything and those that do have issue assigning a budget

population aging trends

1) Population of elderly will double 2) Decline in prop. Of children, declines in fertility rates in the overall pop. 3) Increase in prop. Of adults 60 yrs of age and older as MR declines 4) Economic contributions and productive roles of older people greater importance

health workforce building block

1) Responsive, fair, efficient 2) Best outcomes with available resources and circumstances

About how much of every US dollar is spent purchasing healthcare?

18 cents

Americans reporting issues paying medical bills in the last year

26% of all adults have issues paying HC bills. Mostly are uninsured, have a disability, women, of low income.... basically the minorities. For low and middle income adults, 36% had a problem paying any medical bull if uninsured. And the rates for the newly and previously insured were about the same. Uninsured for each factor were statically significant then newly or previously insured

high school graduation rate

81% HSGR = national average, lower in south and few in the west, overall large variation in the country. Could mean lower literacy and health literacy

firms offering health benefits for programs by size

98% of large firms over 200 are likely to offer at least one specified wellness program compared to 73% for smaller. have or more than half of large firms offer things like class in nutrition and health living, flu shots (almost 90%), assistance programs and weight loss, etc. And for smaller firms less than have of these.

injuries

A hidden epidemic of young men 1) Affect young adults

how does employee based insurance work

Employers pay most/portion of the premium purchasing for their employees. Each premium dollar results in reduction of taxes collected, subsidizing employer sponsored health insurance by government. BrFringe and benefits for this not taxable by government. So double tax exemption by employer and employee. Brings. huge loss in tax revenue for not taxing the US. Government indirectly subsidizes employee sponsored insurance.

history of individual private insurance

European societies had voluntary benefits for industries to pay a monthly sum, then illness assistance with sickness benefits. Insurance agents visited clients to collect premiums after paying. Was never that huge of a thing because of high administrative costs

air quality trends

Harsh weather, poor ventilation, little light, constant repair

What TWO of the following factors have played a direct and significant role in the diminishing accessibility of private insurance coverage?

Health insurance premiums have risen substantially Economic transitions such as the rise of part-time and low-wage work that does not sponsor insurance.

inputs of health systems

Inputs: financial, material, human resources

describe the average annual growth rate per US health spending per capita

It is always growing, but sometimes faster. The growth rate has slowed by more recently picked up

What drives US health care costs?

Medical model, practice variation; complex system and market; patients

reading level in the US

Most American adults read 3-5 grades lower than the highest grade of schooling completed. Average reading level in US=6-8th grade

world health trends

Population Aging, The Burden of Mental Illness, Injuries --- A hidden epidemic of young men, Air quality

Bismarck model systems: financing

They have an insurance system of sickness funds by payroll reductions. All sickness plans (ex: 24) together must cover everyone, and all participate and is non-profit. Jointly financed by employers and employees. Universalistic and non-profit. Sickness funs not run by government but are highly regulated by them. Cap the fees for sickness funds and what they can change. They subsidize the non-employed

Health care spending as a percentage of Gross Domestic Product (GDP) in 2013 was highest in which country?

US

how much does US health care cost

US spends more of its GDP on HC than other industrialized countries (17%) and the prices are slowly increasing but increasing faster in the US. the next highest spending per gdp behind US is 11.6% and all other countries seem to be more clumped together

example countries of the beveridge model

United Kingdom, Spain, Scandinavia, New Zealand, Hong Kong, cuba

country with highest total spending per person per year

United States : $6,103

Life expectancy at birth for americans

Worst health outcomes at birth in the United States (78.6 yrs), while the comparable country average is around 82 years.

state childrens health insurance program

a companion program to medicaid. SCHIP covers children in families with incomes at or below the 200% of the federal poverty level, but above the income eligibility level.

Within the United States, which of the following groups has the worst infant mortality rate?

african americans

health financing building block

as fair to everyone as possible, shouldn't be impoverished. Raise adequate funds for health, Use needed services, Protected from financial catastrophe/impoverishment, Incentives for providers and users

5 dimensions of access to health care

availability, accessibility, affordability, accommodation, acceptability

how much does medicaid pay phys

avg of 72% of medicare fees

progressive

based on income tax. take a rising percentage of income as income increases

four basic health care system models

beveridge model; Bismarck model; national health insurance model; out of pocket model

experience ratings

brought a change in dynamic with insurance. based upon experience of each group using health services. Premium by individual characteristics, like how health you are, and perceptions based on groups, age, medical conditions with some spending more than others.

community ratings

cannot judge on individual characteristics. But drives health people away from paying higher premiums.

Which of the following is not a main mode of financing health care? Out-of-pocket payments Individual private insurance Co-insurance Employment-based private insurance Government financing

coinsurance

blue cross and premium structure

community rating by treating all groups the same and giving the same premium. they redistribute funds from healthy to sick. And subsidy to pay costs to those unable to. Within each group, those ill receive benefits in excess premiums they pay, and healthy pay premiums with new or no health benefits. among groups, bakers use less health care then the premiums worth for minors in using more health care but cannot Pay premiums because too big.

acceptability

compatibility between patients attitudes and providers personal and practice characteristics; and providers attitudes toward patients personal characteristics and values

common challenges of health services

cost containment (some systems more wasteful, but some better at containing cost without hurting health outcomes), access to care, impact of new technologies (need to balance expensive costs and what you have in your budget and cheaper alt for most people), quality of care (complex issues hard to evaluate, continuous monitoring of care), measuring health outcomes

factors to assess health systems

cost, quality, access.... there are tradeoffs. improvement in one area may also harm another

medical technology

cost-effective, new machine/interventions of surgery and drugs. Equitable access, Medical products, drugs, vaccines, tech: Of assured quality, safety, efficacy, cost-effectiveness

what would happen if providers charged insurers instead

costs would only increase with private experience rated and employment based people with low incomes would be more difficult to afford insurance

establishing part d medicare

covers for prescription drugs. funded by tax revenues. criticized for major gaps in coverage, and coverage farmed out to private insurance companies rather than administered by fed medicare program and gov cannot negotiate for lower drug prices

why did health insurance come along

direct purchase of health services increasing and difficult for consumers to keep up with hospital and physicians needs to be paid reliably. Private insurance brought an increase in effectiveness and increase in health care costs

medicaid changes

eliminate the categorical eligibility and offered to all with family income <133% FPL. need to control because expenditures increasing so fed gov gave control to states for medicaid programs through waivers that allowed them to reduce number of this eligible, change scope of services, and recipients need to pay part of costs, obligated recipients to enroll in managed care plans

the flow for employee based private insurance

employee/employer to premium (financing) to health plan to reimbursement to provider

True or False? Across the four study drugs, the average drug prices were highest in the highest-income ZIP codes, indicating no evidence of an affordability issue for lower-income ZIP code residents.

false

True or False? Age, race, and gender are examples of enabling characteristics that can put a person at higher-risk for poor health.

false

true or false: Community rating is always more fair than experience rating.

false

true or false: Health care is a luxury product that is not marketed toward everyone.

false

true or false: In a Beveridge Model health care system, a large proportion of the population usually participates in the private system that operates alongside the government-run system.

false

comparative health systems

field of study to understand how national health systems can be compared; comparing health systems and considering what they can learn from eachither

accommodation

fit between how resources are organized and the persons ability to use the arrangement

medicare : A/b/d

for older than 65. a is hospital insurance for the elderly financed by social security taxes. b ensures elderly for physician services paid by federal taxes and monthly beneficiary premiums. part d is a prescription drug coverage and paid for federal taxes and monthly premium beneficiaries

What about the complex system and market drives up US healthcare costs

fragmentation, administrative expenses (because of different programs) and an imperfect market (monopolies, fewer providers increasing costs). If there are fewer providers in the market it is easier for them to charge higher fees.

example countries of Bismarck model systems

germany, france, Belgium, netherlands, japan, Switzerland, Latin America

health information building block

getting data on how it is running. Production, analysis, dissemination, use of reliably, timely info On health determinants, system performance, health status

public and private mix

government run health service; government financed and administered insurance; government mandated insurance financing; private, voluntary health insurance

beveridge model systems: financing, providers, cost containment

healthcare is provided and financed by the government through tax payments; most hospitals and clinics are owned by the government and most doctors are government employees; cost containment= government as sole payer... must fight to contain cost for taxes because tax is still needed to go to other things. There is no concept insurance system except those that purchase it voluntarily

What about the medical model and practice variation drives up US healthcare costs

high costs, new technology, end of life care

blue cross

hospital insurance plans

Bismarck model systems providers and cost containment

hospitals tend to be privately owned, doctors are usually private employees, and tight government regulation for cost containment

who may be affected by accommodation dimensions

hourly workers, people with chronic and or acute conditions, people with limited literacy or language skills

comparison of coverage intentions between Europe and us

in Europe, it was consumer driven development of health insurance and coverage of US by health care providers seeking steady income source. guarantee reimbursement be generous

issue with affordability and medicaid

income would need to be pretty low for it to be completely covered

best predictor of health

income; GDP highly coorelated with countries health status

predisposing characteristics

individual characteristics putting a person at a higher risk of poor health; no control over family characteristics, social structures, health beliefs i. Demographics (age, gender, marital status, vet status) ii. health beliefs (values, attitudes, knowledge about disease and health services iii. social stucture (ethnicity, edu, social networks, occupation, fam size, religion)

the flow for out of pocket

individual directly to provider

political values that shape health care systems

individual responsibility; social solidarity; free choice; compulsion: having to carry HI vs free too; universality: priority to cover everyone; equality: everyone receives the same benefits to HC and equity: anyone should get as much as they need to achieve health; health care as a commodity vs right

the flow for individual private insurance

individual to premium financing to health plan to reimbursement to provider

Baylor hospital

initiated the start of employment based private insurance. They agreed to give up to 21 days to teachers in a hospital if the paid $6 per person per year. After Great Depression, increase in hospital insurance plans (hmos) to restrict care to particular hospital. Then with the AHA, gave blue cross hospital insurance plans (prepayment movement) with 6 million enrolling, choice to hospital. the blue shield plan covered physician services since it was hard to pay with out of pocket

Which of the following has been added to the "health system diamond" in response to rapid globalization and change?

innovation

what is vulnerability

intersection of risks from predisposing, enabling, and need characteristics

how prevalent is individual private insurance

it covers less than 5% of non-elderly Americans. you are able to get It from the act exchange market through subsidies, contribute portion of income to Pay premiums which pools money and when someone is sick pay providers.

experience rating overtake

it helped commercial insurers overtake the blues in private health insurance market. Offered lower premium to a low risk group. the blue cross eventually dropseed community ratings because high risk only left with them and a low premium with healthy people opting out. they wanted to then seek healthy groups and offer low premium. but the old and sick is less able to afford health insurance

When it comes to pay for certain common procedures, how does the United States compare?

larger for C sections, normal childbirth. and signficantly larger for angioplasty and coronary bypass surgery, nearly twice the rate for these two heart procedures compared to other countries. We have significantly more expensive technologies, and rank high when it comes to MRIs, Its, tonsillectomy #1, coronary bypass, knee replacements.

An argument in support of the ACA might cite access-to-care-related evidence that those who lack health insurance receive ___________ medical care and have _____________ health outcomes.

less; worse

which of the following is a financial barrier to health care access? Limited insurance coverage Lack of prompt appointment to a doctor Gender Minority group membership

limited insurance coverage

who may be affected by accessibility dimension issue

low-income people, disabled/elderly, people w/ no or less desirable insurance.

preventable hospitalizations by income

lowest income had the highest number of preventable hospitalizations, even though what was expected was the same across income

role of government --- health services continuum

market minimized ----------------market maximized UK --- germany--- canada ----------------- US

expansion part c

medicare advantage program to elect to enroll in private insurance plan contracting with medicare. medicare subsides the premium for the private plan rather than paying hospitals, physicians, and other providers directly as under med a and b. However, sacrifice some freedom of choice of physician and hospital in return for lower out of pocket payments and are only allowed to receive care from health care providers connected with that plan

percentages of firms offering health benefits to at least some of their workers by firm size

more workers, more likely to have health benefits, (if over 50). 1/2 do it it even under 50 workers. The average annual premiums for single and family coverage keep increasing, so make it more likely for companies to just pay the fee in not supplying insurance

percent of population covered by health insurance (2013)

most countries have 100% to 98% average for all industrialized nations. but we have 86% average

which two plans are highly government oriented

national health insurance model systems and beveridge

challenges related to out of pocket payments

need vs luxury; unpredictability of need and cost; asymmetry of information (patients looked at as lacking medical knowledge of what they need)

how do we compare health care systems

on how they were formed, if they are organized, if they are funded, the values they express, the types of issues they deal with the best and the worst, and the health outcomes that they product

4 odes of financing health care in the US

out of pocket payments, individual private insurance, employee based private insurance, government financing

4 modes of financing health care

out of pocket payments; individual private insurance; employee based private insurance; government financing

historically how was health care mostly financed

out of pocket. sickness was unpredictable and so is the cost of that care. then difficult to plan expenses. Also little information about what care someone was buying at the time.

out of pocket model systems: financing, providers, cost containment

patient payments are the financing; providers are of private sector for the wealthy and community healers for the poor. Cost containment b based on ability to pay

affordability

patients ability to pay

rates of new patient availability for private and medicaid insurance scenarios

people who have private insurance have a better availability to PC access, and greater source for new patients. significant geographic variation between stats

need characteristics

perceived or identified physical and/or mental health needs; illness and response to illness

blue shield

physician payment for services

leadership and governance building block

policy planning, regulations, oversight, accountability. Strategic policy frameworks, Effective oversight, coalition building, regulation, System design, accountability

classifying national health care systems

political values concerning health care; role of government; public and private mix in delivery

transactions for individual private insurance

premium to insurance plan and reimbursement payment from insurance plan to provider.

what financial schemes pays for society health care

progressive financing schemes (the wealthier you are, you spend much higher in income on health care), regressive financing schemes (income increases, paying lower %, so a greater percent of income to health care costs), proportional financing schemes (everyone pays the same percent of income)

who may be affected by acceptability dimesnions

racial and ethnic minorities; other marginalized groups

proportional

ratio of payment in come the same for all classes.

Which of the following methods of financing health care is the least advantageous for low-income families? Progressive Regressive Proportional Community Rating

regressive

objectives of health care systems

responsiveness, health, fair financial distribution

necessary building blocks for health systems (6)

service delivery, health financing, health workforce, medical technology, health information, leadership/governance

enabling characteristics

situational factors that put a person at higher risk of poorer health; situational and can be changed; family and community resources i. Income, reg source care, insurance, social support ii. Residence, region

tax payer in health care financing

social insurance model: ss tax eligible through part A, monthly premium for part B; taxpayer may not be eligible for benefits redistribute funds from health to sick but also rich to poor

For what categories of care is US health spending greater?

spending is larger for ambulatory care and administrative costs and larger for all other categories.

functions of health care systems

stewardship (looking for opportunities to improve health, expand HCS without hurting), resource generation, financing, service provision

community rating cannot survive to _______

subsidize sicker in market driven private insurance system

healthy systems

sum of all orgs, institutions, resources whose primary purpose is to improve health

regressive

take a falling percent of income as income increases. unhealthy. increase in illness with decrease in come. experience rated as example

Which model of health care system is closest to the one the U.S. health care system has?

the U.S. system includes aspects of all these models

availability

the fit between service capacity and individual requirements. How much service we can fulfill based on what people need

who is considered a third party

the health plan or insurer

obesity by sex, race/ethnicity/ education

the higher the education, the Lower the obesity prevalence. female blacks have a greater prevalence than males. college education doesn't matter as much for blacks when it comes to obesity differences

National health care systems are classified according to...

the political and cultural values they express; the role of government in financing health care for their populations; the mix of private and public health care delivery structures.

two groups that don't benefit from employment based program

the poor who are unemployed or have jobs w/o fringe benefit of health insurance, or those unable to afford private HI also, the elderly whose premiums are subsidized by community ratings took a hard hit after the switch with less than 15% having health insurance

health system

the sum total of all the organizations, institutions, and resources whose primary purpose is to improve health.... pretty much all things combining to improve health and deliver hc to when it is needed. Needs staff, funds, info, supplies, transport, communications, guidance and direction. Services that are responsive and financially fair. cooperative efforts to work as a system... therefore needs organization to provide health with complete physical, mental and social well being

breast cancer diagnosis distribution

there is a big difference across the board on blacks vs whites and when breast cancer is diagnosed. It is higher for blacks. There are red spots on maps indicating more than 60 minute travel times to get to the closest mammogram center.

national health insurance model systems: financing, providers, cost containment

there is a government run insurance program (non-profit, and one), so no competition between insurance with government as the administer. Providers are of the private sector. Government insurance plan may negotiate with providers. Cost containment is single payer. They can limit the type, and number of services paid for.

irony of mean price for drugs in Florida pharmacies by zip code income

those with a smaller income ended up paying more for drugs

who may be affected by availability dimensions

those with limited English proficiency, low income individuals, people with conditions having acute flareups

US stroke survivors who didn't get needed prescription drugs because of costs

trend fluctuates, but individuals 45-64 were less able to get prescription drugs because of cause, then did not adhere to regims

True or False? Most countries in the world do not have established health systems. Their systems are financed by the Out-of-Pocket Model.

true

true or false: Cost, quality, and access depend on each other (and there are usually trade-offs between cost-, quality-, and access-related goals).

true

true or false: for community rating premiums, factors such as age, gender and specific claims experience aren't considered.

true

true or false: in regards to community rating premiums, Those who are healthy may pay more than they would on an experience-rated system.

true

individual private insurance parties

two parties of patient and provider and third of insurer

who may be affected in dimensions of affordability

uninsured, underinsured, those with high copays an deductibles, those who need uncovered services

inpatient procedures b/w rural and urban hospitals

urban patients have more inpatient procedures; rural has less procedures. As number of procedures increase the number of differences present decrease. rural patients have less procedures.

health services was driven by who

was involuntary and driven mostly by physicians by bias

group health insurance plans

with world war 2, couldn't increase wages but fringe benefits and worker competition