HSM 606 FINAL - Health Care
Organization and the Patient Experience
of Care with Complete Solutions
IHI Triple Aim - ANSWER-Access - Population
Quality - Experience of Care
Cost - Per Capita Cost
Characterize the U.S. healthcare system - ANSWER-- Cultural beliefs and values
- Social Factors
- Science and Technology
- Economic Forces
- Political Factors
Characteristics of U.S. Health Care System (10) - ANSWER-- No central governing
agency; little integration and coordination
- Technology-driven and focuses on acute care
- High on cost, unequal in access, and average in outcomes
- Imperfect market conditions
- Government as subsidiary to the private sector
- Market justice vs. social justice
- Multiple players and balance of power
- Quest for integration and accountability
- Access to health care selectively based on insurance
- Legal risk influences practice behavior.
How the marketplace will keep prices low: - ANSWER-- Increased competition amongst
private insurance plans through greater comparative shopping and more informed
consumers.
- Providing small businesses the same purchasing power in Exchanges as large
businesses.
- The ability to pool risk
ACA - Individual Mandate - ANSWER-Under the ACA, most individuals who can afford it
will be required to obtain basic health insurance coverage or pay a tax penalty
If affordable coverage is not available to an individual, he or she will be eligible for an
exemption or subsidy
,The tax penalty began in 2014 at $95 annually or 1% of income for individuals,
whichever is higher
History of Evolution of U.S. Healthcare system (Eras) - ANSWER-- Pre Industrial Era
(1700s - 1800s)
- Post Industrial Era (Late 1800s - Mid 1900s)
- Corporate Era (Late 1900s - early 21st century)
- Health care reform (present day)
Pre Industrial Era (Pre 1900) - ANSWER-- Epidemics, Acute Infections
- Patients seen at home or voluntary hospitals, in "alms" houses (poor), or in "pest"
facilities (mentally ill)
- Anyone can practice medicine
- Medical education not grounded in science
- No pooled or structured financing for individuals (i.e. No Health Insurance)
Post Industrial Era (Late 1800s - Mid 1900s) - ANSWER-1900 -1970
- Development and growth of the medical profession and hospitals
- Emergence of private health insurance
- Creation of Public Health Insurance Programs
Acute events, trauma, acute infectious diseases, surgical procedures
- 1901: American Medical Association becomes a national organization with a
membership of 8,000
- 1910: Flexner Report sets the model for medical education; AMA membership grows
to 70,000
- Period of "organized medicine"
- 1930: Emergence of employer-based health insurance
- 1935: Social Security Act (SSA) provides retirement and death benefits, an
unemployment compensation system, and federal grants to states to develop public
health programs
- 1930: Creation of Blue Cross (hospitals) and Blue Shield (physicians) as structured
pooled financial mechanism
, - 1942: National War Labor Board freezes wages
- 1943: IRS exempts employer-purchased group health insurance from taxable gross
income
- 1947: Hill-Burton Act provided federal grants to states for the construction of new
community hospital beds. Target goal: 4.5 beds/1000 people.
- 1940: President Truman proposes a single national health program plan - denounced
by AMA
- 1950: More medications and vaccines available
- 1950: First successful organ transplant
-1950: Economic interests of physicians and hospitals are aligned -> increase utilization
= increased revenue. Physicians become the hospital's primary customer.
- 1960: Emergence of chronic diseases
- 1963: Health Professionals Educational Assistance Act provided first federal subsidy
of health professionals education
- 1965: Congress enacts Medicare and Medicaid programs
- 1960: Technology race between hospitals
- 1960: Hospitals held liable for negligence of core hospital employee practitioners and
when hospital does not have a reasonable credentialing program
-1
Corporate Era (1980 - Early 21st Century) - ANSWER-- Corporatization: Medical care
has become the domain of large corporations
- Information Revolution: Telemedicine, E-Health
- Globalization: Various cross-border activities (information exchange, goods and
services, interdependence of economies)
- 1980: Chronic disease definition broadened (mental illness, genetic conditions) and
infectious diseases reemerge
- 1983: Social Security Amendments outline a prospective payment system (PPS) for
hospital inpatient reimbursement based on diagnosis-related groups (DRGs).
Organization and the Patient Experience
of Care with Complete Solutions
IHI Triple Aim - ANSWER-Access - Population
Quality - Experience of Care
Cost - Per Capita Cost
Characterize the U.S. healthcare system - ANSWER-- Cultural beliefs and values
- Social Factors
- Science and Technology
- Economic Forces
- Political Factors
Characteristics of U.S. Health Care System (10) - ANSWER-- No central governing
agency; little integration and coordination
- Technology-driven and focuses on acute care
- High on cost, unequal in access, and average in outcomes
- Imperfect market conditions
- Government as subsidiary to the private sector
- Market justice vs. social justice
- Multiple players and balance of power
- Quest for integration and accountability
- Access to health care selectively based on insurance
- Legal risk influences practice behavior.
How the marketplace will keep prices low: - ANSWER-- Increased competition amongst
private insurance plans through greater comparative shopping and more informed
consumers.
- Providing small businesses the same purchasing power in Exchanges as large
businesses.
- The ability to pool risk
ACA - Individual Mandate - ANSWER-Under the ACA, most individuals who can afford it
will be required to obtain basic health insurance coverage or pay a tax penalty
If affordable coverage is not available to an individual, he or she will be eligible for an
exemption or subsidy
,The tax penalty began in 2014 at $95 annually or 1% of income for individuals,
whichever is higher
History of Evolution of U.S. Healthcare system (Eras) - ANSWER-- Pre Industrial Era
(1700s - 1800s)
- Post Industrial Era (Late 1800s - Mid 1900s)
- Corporate Era (Late 1900s - early 21st century)
- Health care reform (present day)
Pre Industrial Era (Pre 1900) - ANSWER-- Epidemics, Acute Infections
- Patients seen at home or voluntary hospitals, in "alms" houses (poor), or in "pest"
facilities (mentally ill)
- Anyone can practice medicine
- Medical education not grounded in science
- No pooled or structured financing for individuals (i.e. No Health Insurance)
Post Industrial Era (Late 1800s - Mid 1900s) - ANSWER-1900 -1970
- Development and growth of the medical profession and hospitals
- Emergence of private health insurance
- Creation of Public Health Insurance Programs
Acute events, trauma, acute infectious diseases, surgical procedures
- 1901: American Medical Association becomes a national organization with a
membership of 8,000
- 1910: Flexner Report sets the model for medical education; AMA membership grows
to 70,000
- Period of "organized medicine"
- 1930: Emergence of employer-based health insurance
- 1935: Social Security Act (SSA) provides retirement and death benefits, an
unemployment compensation system, and federal grants to states to develop public
health programs
- 1930: Creation of Blue Cross (hospitals) and Blue Shield (physicians) as structured
pooled financial mechanism
, - 1942: National War Labor Board freezes wages
- 1943: IRS exempts employer-purchased group health insurance from taxable gross
income
- 1947: Hill-Burton Act provided federal grants to states for the construction of new
community hospital beds. Target goal: 4.5 beds/1000 people.
- 1940: President Truman proposes a single national health program plan - denounced
by AMA
- 1950: More medications and vaccines available
- 1950: First successful organ transplant
-1950: Economic interests of physicians and hospitals are aligned -> increase utilization
= increased revenue. Physicians become the hospital's primary customer.
- 1960: Emergence of chronic diseases
- 1963: Health Professionals Educational Assistance Act provided first federal subsidy
of health professionals education
- 1965: Congress enacts Medicare and Medicaid programs
- 1960: Technology race between hospitals
- 1960: Hospitals held liable for negligence of core hospital employee practitioners and
when hospital does not have a reasonable credentialing program
-1
Corporate Era (1980 - Early 21st Century) - ANSWER-- Corporatization: Medical care
has become the domain of large corporations
- Information Revolution: Telemedicine, E-Health
- Globalization: Various cross-border activities (information exchange, goods and
services, interdependence of economies)
- 1980: Chronic disease definition broadened (mental illness, genetic conditions) and
infectious diseases reemerge
- 1983: Social Security Amendments outline a prospective payment system (PPS) for
hospital inpatient reimbursement based on diagnosis-related groups (DRGs).
