Health Care for All - Exam 2 Chapter 12

What is the role of enabling and predisposing factors in access to care?

Access is a determinant of health status, environment, lifestyle, and heredity factors

What does access to care mean?

Access to care can be defined as the ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely manner

What are the implications of access for health and healthcare delivery? -Access Initiatives

Access to care has been incrementally addressed by the US govt through a variety of public programs including Children's Health Insurance Program (CHP) and the 2010 Patient Protection and Affordable Care Act (ACA)

Name and describe the major factors contributing to the high costs of health care. -Defensive medicine

Additional tests and medical services are used merely as a protection against lawsuits

Name and describe the major factors contributing to the high costs of health care. -Multi-payer system and administrative costs

Administrative costs in a multi-payer system are nearly double of what they would be in a single payer system

Discuss the main developments in process improvement that have occurred in recent years. -Critical Pathways

Critical pathways are outcome-based and patient-centered case management tools that are interdisciplinary and facilitate coordination of care among multiple clinical department and caregivers

What are the implications of access for health and healthcare delivery? -Critique and Prospect

It is society's duty to ensure equitable access to an adequate level of health care for all

Name and describe the major factors contributing to the high costs of health care. -Medical model of healthcare delivery

Medical interventions are costlier than prevention and health promotion

Discuss the dimensions of quality from the micro- and macro- perspectives.

Micro quality Indicators Small area variations, medical errors, patient satisfaction, quality of life, and health outcomes Macro Quality Indicators Cost, access, population health

What is a third-party payment/reimbursement?

Pays the lion's share for most of the services used; not the consumer

What are the three major cornerstones of health care delivery?

1) Cost 2) Access 3) Quality

Explain how, under imperfect market conditions, both prices and quantity of health care are higher than they would be in a highly competitive market.

Because the US health care delivery system does not consist of a national health care program, it is not as highly regulated as are single payer systems in other countries. Furthermore, healthcare delivery in the US does not constitute a highly competitive market because of various market imperfections discussed earlier in this text In an imperfect market, the use of healthcare is driven by need rather than economic demand Quantity of healthcare services produced and delivered is likely to be much higher than in a competitive market, and the prices charged for health care services are permanently higher than the true economic costs of production

Name and describe the major factors contributing to the high costs of health care. -Third party payment

Contributes to moral hazard and provider-induced demand because it insulates consumers against the cost of health care

Discuss price controls and their effectiveness in controlling health care expenditures.

Despite efforts to control healthcare spending, there are 2 major reasons why these attempts have failed Implementing system wide cost-control initiative has not been feasible in such a fragmented healthcare system Cost shifting: ability of providers to make up for lost revenues in one area by increasing utilization or charging higher prices in other areas that are free of control

What are the two main objectives of this chapter?

Discuss the major reasons for the dramatic rise in health care expenditures Discuss how cost, access, and quality contribute to the rapidly growing US health care expenditures

Name and describe the major factors contributing to the high costs of health care. -Waste and abuse

General waste as well as fraud and abuse of various programs increases costs of healthcare

Name and describe the major factors contributing to the high costs of health care. -Practice variations

Geographic variations in treatment patterns across the country indicate cost-inefficient treatment

What is meant by the term "health care costs"? Describe the three different meanings of the term 'cost.'

Health care costs: costs incurred by individuals when they receive health care services 1) price of health care services: consumers and financiers speak of the price of health care services as the cost of health care 2) national health care expenditures: refers to how much a nation spends on health care services → reflects the consumption of economic resources in the delivery of health care 3) provider perspective: notion of cost refers to staff salaries, capital costs for building and equipment, rental of space, purchase of supplies, and other costs of production

Discuss the main developments in process improvement that have occurred in recent years. -Clinical Practice Guidelines

In response to findings of small area variations, various professional groups, MCOs, and the govt have embarked on the development of standardized practice guidelines

What are the implications of access for health and healthcare delivery? -Access Disparities

In the US, both low socioeconomic status and minority group memberships are associated w/ lower overall healthcare usage and access

What are the implications of access for health and healthcare delivery? -Data on Access

Population based surveys supported by federal statistical agencies are the major data sources for conducting analyses on access to care Federal govt, state govt, associations, and research institutions regularly collect data on topics of interest to them With growth of managed care, encounter databases have become increasingly critical in recording and evaluating access

Discuss the main developments in process improvement that have occurred in recent years. -Risk Management

Proactive efforts to prevent adverse events related to clinical care and facilitates operations, and is especially focused on avoiding medical malpractice

What are some of the implications of the definition of quality proposed by the institute of Medicine? In what way is the definition incomplete?

Quality performance occurs on a continuum, theoretically ranging from unacceptable to excellent Focus is on services provided by health care delivery system as opposed to individual behaviors Quality may be evaluated from the perspective of individuals and populations or communities Emphasis is on desired health outcomes In absence of scientific evidence regarding appropriateness of care, professional consensus can be used to develop criteria for the definition and measurement of quality

Discuss the role of PROs (peer review organizations) in cost containment.

Refers to the general process of medical review of utilization and quality carried out directly by, or under the supervision of physicians

What are the two competition-based cost-containment strategies?

Refers to the rivalry among sellers for customers Providers of healthcare services try to attract patients who have the ability to choose from several different providers Demand side incentives and supply side regulation

Name and describe the major factors contributing to the high costs of health care. -Growth of technology

Research and development are costly, and are included in health care expenditures. Once developed, new technology often creates its own demand

Why should the US control the rising costs of health care?

Rising healthcare costs mean that Americans have to forgo other goods and services when more is spent on health care Economic resources should be directed to their highest-valued uses, even though consumers decide how much should be spent on purchasing a product or service based on their perception of the value they expect to receive

Name and describe the major factors contributing to the high costs of health care. -Increase in elderly population

They consume more healthcare than younger people

Name and describe the major factors contributing to the high costs of health care. -Imperfect market

Utilization of health is driven by need rather than economic demand, the quantity of healthcare services produced and delivered is likely to be much higher than in a competitive market, and the prices charged for health care services will be permanently higher than the true economic costs of production

Discuss the main developments in process improvement that have occurred in recent years. -Cost-Efficiency

When the benefit received is greater than the cost incurred in providing the service