US Healthcare Systems Quiz 1 correctly answered

US Healthcare Systems Quiz 1 correctly answeredHealth care delivery and health services delivery refer to the: Components, processes,and provisions Objectives of health care: 1. Access: able to receive or access care when need (after hours etc) 2. Cost: treatments and care 3. Quality: needs to meet certain standards Health care in developed countries (US versus other countries) Other countries: most have a national system of healthcare where universal access comes from (but no place has truly universal healthcare) US: -does not have a national system of healthcare delivery, have several (patchwork) so can't provide continuous care -has subsystems which are developed through market sources Subsystems of US healthcare (6 things) 1. Managed care 2. Military 3. Vulnerable populations- medicaid and medicare 4. Integrated delivery- have all parts of healthcare available (cradle-grave) 5. Long-term care 6. Public health- community access clinics Major Characteristics that Differentiate US Healthcare system (10 things): 1. No central governing agency and little integration and coordination 2. Technology driven and focuses on acute care 3. High cost, unequal access, and average in outcomes 4. Imperfect market conditions 5. Government as a subsidiary to the private sector 6. Fusion of market justice versus social justice 7. Multiple players and balance of power 8. Quest for integration and accountability 9. Access to healthcare selectively based on insurance coverage 10. Legal risk influences practice behaviors 1. No central governing agency and little integration and coordination: -complex and costly system -multiple systems of payment -public funding: reimbursement through medicare and medicaid Not centrally‐controlled -Unique mechanisms for payment, insurance,and delivery. -Financed publicly and privately. 2. Technology‐Driven and Focuses on Acute Care -technology is over-utilized which has a negative impact on the insurance Demand for new services -Negative impact on insurance market 3. High in Cost, Unequal in Access, and Average in Outcome Costs: Almost 17% of GDP on healthcare (more than any other developed country in the world -Access: Ability to pay and/or availability of services -Outcome: problems with not coordinated and continuous for uninsured. Don't see good outcomes 4. Imperfect Market Conditions -quasi free market -true "free market" virtually non existent 5. Government as Subsidiary to the Private Sector Desire to limit government (plays bigger role in other countries in setting prices and treatments) 6. Fusion of Market Justice versus Social Justice Market Justice: market forces in a free economy (most of the system is governed by market justice) Social Justice: community well‐being over individual (components of this with medicare and medicaid) 7. Multiple Players and Balance of Power Physicians Administrators Insurance companies Large employers Government This is why we have problems controlling costs, have lack of accountability, and with regulation governments rule other countries 8. Quest for Integration and Accountability -Integration of primary care as the organizing hub. -Accountability of provider&patients (making sure quality of care is maintained by the provider and the patients are responsible for their self care 9. Access to healthcare based on insurance coverage Options for people without coverage is very limited 10. Legal Risk Influences Practice Behaviors Protection from legal consequences Main roles of the government: -providing medicare and medicaid -safety standards -licensing requirements for healthcare personnel Main objectives of healthcare: 1. Processes 2. Access, equality Pre-Industrial America Medical education not grounded in science •Medical practice more of a trade (apprenticeship), vs. a profession •Reactive response to acute events •Medical institutions were primitive and set up by physicians as a way to supplement but had very low standards •Few hospitals, found in largest cities •Health insurance did not exist -not regulated, more like a small business Post-Industrial America Growth of medicine -Urbanization so practices were set up in cities •Reform of medical education •Medical Schools were affiliated with universities •American Medical Association (AMA) •Flexnor Report-important because it showed that medical schools were not regulated whihc led to variability between med schools and then AMA accreditation •AMA accredited schools of medicine Post Industrial America and Development of Hospitals -Hill-Burton Act, 1946- this act brought funding (Federal grants and loans) -Institutionalization of healthcare -Physicians & hospital policy (can care for their patients but still have their autonomy preserved) -Advances in sanitation practices & nursing training (lower mortality rates) -Improved outcomes, especially for surgery Postindustrial America and the emergence of healthcare insurance Workers' compensation -1st broad coverage health insurance in the U.S. -Trial for the idea of government‐sponsored health insurance. -Rise of private health insurance -J.F. Kimball- hospital insurance for teachers -Blue Cross & Blue Shield -Employer‐based health insurance -Nontaxable benefits in 1954 Why did postindustrial america not have national health insurance? Relative political and labor stability -Decentralized American government, no social welfare -American values, & distrust of big government -Powerful interest groups opposed (AMA) -Middle class objections to higher taxes Creation of medicare and medicaid Medicare: -Coverage the elderly(65) -Non-elderly disabled on Social Security, &ESRD -Coverage Parts A, B, C, &D -Medicaid: Program for the poor, & other special needs populations. Amount of funding is highly variable Coverage parts of medicare A-hospital benefits B- outpatient benefits C- advantage-managed care (A, B, D combine) D- prescription drugs Corporate era: 1981- Some cost containment by market forces -Growth of managed care (responsible for health insurance side and the delivery side) -Integrated delivery systems (cradle to grave) -Physician‐hospital Organizations (PHOs) -Telemedicine & E‐health (fitbits, apple health) -Globalization (cross‐border activities) such as medical tourism PPACA: 2010-present -Voluminous, complex, & confusing piece of legislation -Political process -Passed by Democratic majority House -National legislation supported for the 1st time by AMA -2012 Supreme Court supported -2012 Presidential Election Major factors that continue to interact and shape U.S. healthcare -Cultural beliefs & norms: ex. that welfare is for the most needy and immigrants -Social changes -Technological advances: demands for new tech and training and facilitating environments -Economic constraints: personal income -Political opportunism: power players and foreign parties