Term
| How much of healthcare is funded by the government? |
|
Definition
+50
tax expenditures
(employers deduct-employees don't include) |
|
|
Term
Medicare Eligibility
and Funding |
|
Definition
Age 65
2.9% on wages on all salary |
|
|
Term
| Medicare Disability Eligibility |
|
Definition
1972-expanded to people under 65 years with permanent disabilities,renal disease, Lou Gehrig's disease
People under 65 receive Social Security Disability Insurance (SSDI)
become eligible after 2 years of waiting period |
|
|
Term
| Unfunded Liability of Medicare Part D |
|
Definition
|
|
Term
| Retirement Savings for copays |
|
Definition
|
|
Term
Medicaid define
how is it financed? |
|
Definition
nation's public health insurance program for low income Americans
financed by the Federal and State governments |
|
|
Term
| Medicaid Outlines to quality |
|
Definition
program finances health long-term care services for children and adults in low income working families and for the
elderly and disabled
Individuals must meet both financial and categorical criteria to qualify and be either a U.S. citizen or have five
years of legal residency. |
|
|
Term
| 4 major actors in health care |
|
Definition
• Purchasers
• Insurers
• Providers
• Suppliers |
|
|
Term
|
Definition
18% of GDP 2011
20% by 2020 |
|
|
Term
| Health Care Spending 1960 and Today |
|
Definition
1960 6% of funding
2012 17.8% of GDP |
|
|
Term
| Amount of money spent on health care in 2013 |
|
Definition
$2.8 trillion
3 times larger than French economy |
|
|
Term
| Law of Diminishing Returns |
|
Definition
| productive processes, adding more of one factor of production, while holding all others constant will at some point yield lower per-unit returns |
|
|
Term
| breakdown of health care dollar |
|
Definition
Buying healthcare with $.17
83% cost is paid for by a third party payer |
|
|
Term
Misaligned incentives
Patients |
|
Definition
| Patients: little incentive to be prudent in their use of services or to pay the costs of their own unhealthy lifestyle |
|
|
Term
| Misaligned Incentives Hospitals & Doctors |
|
Definition
Under the fee for- service model, doctors and hospitals get
paid more the more they do
Fear of lawsuits causes them to practice "defensive medicine" |
|
|
Term
| Misaligned Incentives: Insurance |
|
Definition
| make more money by denying claims |
|
|
Term
|
Definition
| involve more oversight of reimbursement rates and closer monitoring of specific medical procedures and therapies to disallow those deemed ineffective |
|
|
Term
|
Definition
| try to create “market incentives” that would supposedly suppress wasteful care, with insurance companies, doctors and hospitals receiving enormous latitude as to how. |
|
|
Term
| Why is there a lack of access to health care |
|
Definition
| US shifts to a service economy, jobs often offer no benefits |
|
|
Term
| What fraction of uninsured adults are employed? |
|
Definition
| ¾ of uninsured adults are employed. |
|
|
Term
| How much does lack of health insurance increase the risk of dying |
|
Definition
|
|
Term
|
Definition
looks at the history of health care use in family- history of health care use
less re-distributive than community Healthy groups do not subsidize high risk groups rating |
|
|
Term
|
Definition
Have the poor paying relatively aren’t near as wealthy as others
People who become ill receive benefits in excess of the funds they pay. People who use less health care than their premiums are worth help pay for those who use more health care than their premiums can buy, |
|
|
Term
|
Definition
For each according to her ability to each according to her need
Canadian system |
|
|
Term
|
Definition
| Few individuals can afford the cost of modern medicine without risk sharing. |
|
|
Term
| Intergenerational Injustice |
|
Definition
Transfer an average of $30,000 per senior- average s.s. benefit is $14,184
Costs American workers $10,673 per household |
|
|
Term
| What kind of payer system is Medicare? |
|
Definition
single payer system for health care for the elderly
Socialized insurance |
|
|
Term
| Social Determinants of Health |
|
Definition
| The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. Income, Race, Gender |
|
|
Term
| Health is a combination of factors |
|
Definition
10% medical care
20% health standards
30% individual |
|
|
Term
|
Definition
| Men in the lowest grade had a mortality rate three times higher than that of men in the highest grade |
|
|
Term
| How many deaths have mosquitoes been responsible for? |
|
Definition
|
|
Term
| Why did life expectancy increase 30 years |
|
Definition
Due to public health measures
ONLY 5 years HAD ANYTHING TO DO WITH ALLOPATHIC MEDICINE |
|
|
Term
| What are examples of other services that could be provided to the elderly |
|
Definition
●Meals on Wheels
● Health Education
● Information and Referral
● Aging Resource Centers
● Phone Reassurance
● Personal Emergency Response Systems
● Homemaker Services
● Transportation
●Wellness Programs |
|
|
Term
| What do we have to convince conservatives of? |
|
Definition
| STAKE IN THE UNINSURED & costs can be controlled |
|
|
Term
| What do we have to convince liberals of? |
|
Definition
| LIMITS MUST BE SET and cannot do everything medical science has invented for everyone |
|
|
Term
| What is the difference between doctors and public policy |
|
Definition
Doc: Is it good medicine
Public Policy: Is it a good system
(1) TECHNOLOGY & TRAINING
(2) OUTCOMES
(3) ACCESS |
|
|
Term
| Non-financial barriers to health care |
|
Definition
Inability to access
language
literacy and cultural
differences between patients and health caregivers
gender and race. |
|
|
Term
| How many American's did not have health insurance prior to the Affordable Care Act? |
|
Definition
|
|
Term
| How many unnecessary deaths due to lack of health coverage? |
|
Definition
|
|
Term
| What % of bankruptcy filing is due to health care costs? |
|
Definition
50%
75% of those bankruptcy cases had health insurance |
|
|
Term
| What are the 4 basic modes of paying for health care? |
|
Definition
• Out of pocket payment
• Individual private insurance
• Employment-based group insurance
• Government financing |
|
|
Term
| Possible components to get Universal coverage |
|
Definition
a. Subsidies
b. Mandates (no free riders)
c. Set limits
d. Two level of health care |
|
|
Term
| What percent of premature deaths could have been prevented? |
|
Definition
| If you control for less than 10 risk factors-between 40-70% |
|
|
Term
| What percentage of health care costs are attributed to chronic disease? |
|
Definition
75%
significant % brought on by obesity and smoking |
|
|
Term
| Breakdown of health care costs by % of population |
|
Definition
1% of the population uses 27% of the health care
5% of the population uses 55% of the health care.
bottom 50% accounts for 3% of spending |
|
|
Term
| Problem with the current system |
|
Definition
OUR CURRENT SYSTEM
MAXIMIZES DEMAND FOR
MEDICAL SERVICES PAID
FOR WITH POOLED
RESOURCES WITHIN A
SYSTEM THAT INSULATES
PEOPLE FROM THE COST |
|
|
Term
| Angioplastics have increased of declined? |
|
Definition
angioplasties, for example, increased by 326 percent between 1987 and 2004.
But rates of heart disease have declined |
|
|
Term
| What % of heart surgery were performed on patients where risks outweighed benefits |
|
Definition
|
|
Term
| Concentration of expenditures to elderly |
|
Definition
|
|
Term
|
Definition
| less than 3% of people leave the hospital |
|
|
Term
| What is the role of government % |
|
Definition
|
|
Term
| Continuous Quality Improvement CQI |
|
Definition
| is a process to ensure programs are systematically and intentionally improving services and increasing positive outcomes |
|
|
Term
| During Terri Schiavo # of floridians without health insurnace |
|
Definition
|
|
Term
| 4 principles of medical ethics |
|
Definition
•Beneficence
•Nonmaleficence
•Autonomy
•Justice |
|
|
Term
| California- voted to pay for transplants but |
|
Definition
terminated
270,000 medically indigent
adults from Medi-Cal |
|
|
Term
|
Definition
National Health Service
Government owns hospitals, labs
Government employs specialists
GP’s are private, but bill the government
No premium; no copay; no doctor bill
National health service
Dedicated to the proposition that no one should ever have to pay a medical bill. |
|
|
Term
|
Definition
a. Private doctors
b. Private hospitals
c. Private insurance |
|
|
Term
|
Definition
a. Private doctors
b. Private/charity hospitals
c. Public payment
d. Socialized insurance |
|
|
Term
| How many out of pocket models |
|
Definition
| About 150 of the world’s 200 countries |
|
|
Term
|
Definition
|
|
Term
| How much are those with insurance subsidizing those without |
|
Definition
|
|
Term
| How much higher are insurance premiums to make up unpaid bills of uninsured |
|
Definition
|
|
Term
Oregon Health
Priorities System |
|
Definition
|
|
Term
| Public Resources: (Tax Monies) |
|
Definition
| Must maximize the health of the public |
|
|
Term
|
Definition
| Must maximize the health of the group |
|
|
Term
|
Definition
Have the right to spend their own
money, however, they (legally) choose. |
|
|
Term
|
Definition
Access for all to a base level of health care
A means of limiting the use of
procedures that are ineffective or
marginally effective. and limiting
some procedures that are effective,
but too expensive
Some consensus on health care
priorities, both social and individual
4. Limitations on malpractice suits;
5.Control of bureaucracy; and
6. Some limitation on the supply side of
health care - other competition or
regulation must reduce the excess of
medical technology, hospital beds,
doctors, specialists, etc. |
|
|
Term
| What %of adults could not get needed care because they could not afford to pay the bills In 2007? |
|
Definition
|
|
Term
| What % of patients continue to receive care that is not appropriate? |
|
Definition
|
|
Term
| What % services do elderly found that elderly patients in some areas receive than similar patients in other areas with the SAME mortality rates, quality of care, access to care, and patient satisfaction |
|
Definition
|
|
Term
| 2009 what % of health care dollars are wasted? |
|
Definition
|
|
Term
| What % Americans reported not seeing a doctor or not filling a prescription due to costs |
|
Definition
|
|
Term
|
Definition
Direct purchase by the consumer of goods and services
12% of national health expenditures in 2009 |
|
|
Term
| Individual Private Insurance |
|
Definition
individual policies provided health insurance for only 5% of the US population
A third party is added to the health care transaction. A private insurance requires 2 transactions: a premium payment from the individual to the insurance plan and a reimbursement from the insurance plan to the provider. |
|
|
Term
| Employment based private insurance |
|
Definition
employers usually pay most of the premium that purchases health insurance for their employees
Tax deductible business expense and not taxable income for the employee
Employer subsidies ESTIMATED $260 BILLION PER YEAR |
|
|
Term
| Medicare Advantage Program |
|
Definition
| – expansion of the role of private health plans (2003). 2/3 of them are HMOa |
|
|
Term
|
Definition
82% of part d was fianced through tax revenues
establishment of prescription drug coverage- Federal taxes and monthly premiums |
|
|
Term
|
Definition
|
|
Term
| Why do doctor's not like medicaid |
|
Definition
| • Medicaid pays physicians an average of 72% Medicare fees and therefore many doctors limit the number of Medicaid patients |
|
|
Term
| State Children’s Health Insurance Program (SCHIP) |
|
Definition
1997
• Covers children and families with incomes at or below 200% of the federal poverty level, but above the Medicaid income eligibility level
States receive matching funds |
|
|
Term
|
Definition
| Take a rising % of income as income increases. THE PROGRESSIVE INCOME TAX IS MOSTLY USED FOR GOVERNMENT FINANCED HEALTH CARE. |
|
|
Term
|
Definition
| Take a falling % as income increases DOES NOT MAKE SENSE FOR A HEALTH CARE SYSTEM BECAUSE PAYMENTS WORSEN HEALTH. Out of pocket payment is an example. Also experience rated. |
|
|
Term
|
Definition
| if the ratio of payment is the same from all income classes |
|
|
Term
What % health expenditures were financed through out of pocket payments in 2009
What % funded by government revenues |
|
Definition
|
|
Term
| What % poorest quintile of households spent on health care compared to the highest quintile |
|
Definition
|
|
Term
| Problems created by private insurance |
|
Definition
1.The opportunity for health care providers to increase fees to insurers caused health services to become increasingly unaffordable
2.Employment based nature of group insurance placed people who were unemployed, retired, or working part time at a disadvantage
3.Competition gave rise to experience rating, which made premiums unaffordable for elderly and other medically needy groups |
|
|
Term
| What is the single most important factor in explaining the growing number of uninsured |
|
Definition
| is a 25 year trend of decreasing private insurance coverage in the United States |
|
|
Term
| How much did the cost of health insurance increase from 2000-2010 |
|
Definition
employer sponsored insurance premiums rose by 114%.
On average, employee contributions represent 19% of premiums for individuals and 30% for family coverage |
|
|
Term
| Why do people lack insurance |
|
Definition
1.Rising cost of health insurance
2.The change in the economy toward low wage, part time, non-unionized, service based.
3.Unstable nature of employment. A total of 87 million people, 29% of the entire US population, went without health insurance for all or part of the 2-year period between 2007-2008 |
|
|
Term
| Uninsured demographics in 2009 (race) |
|
Definition
12% of nonhispanic whites were uninsured
21% of African Americans
17% of Asians
32% of Latinos |
|
|
Term
| Uninsured demographics in 2009 (income) |
|
Definition
27% of individuals with annual household incomes less than $25,000
9% of those with annual household incomes greater than $75,000 |
|
|
Term
|
Definition
Too many medical schools and too many doctors
closure or consolidation of university training, a reversion of American universities to male-only admittance programs to accommodate a smaller admission pool |
|
|
Term
| How much more expensive are prescription drugs in the United States? |
|
Definition
|
|
Term
| For every dollar how much goes to administrative waste? |
|
Definition
|
|
Term
| What are two strategies that are a form of cost control? |
|
Definition
regulatory strategies:Govt regulation of taxes serves as a control over public expenditures for health care
Competitive Strategies:Attempts to control the financing flow through a competitive strategy rather than through regulation |
|
|
Term
|
Definition
• Medicare, Medicaid and many private insurance plans have implemented physician payment with predetermined prices for particular services- piecemealing - use cost shifting from one provider to another
2. The quantity of services provided often surges when prices are strictly controlled.
a. Providers respond to fee controls by inducing higher use of services in order to maintain earnings |
|
|
Term
| What % of metropolitan markets only have 1-2 large commercial insurance companies |
|
Definition
| 94% of metropolitan markets are controlled by one or two large commercial insurance companies |
|
|
Term
| How can you avoid cost shifting |
|
Definition
| when a uniform fee schedule is used by all payers or by a single payer |
|
|
Term
| %of health care expenditures are incurred % of the population |
|
Definition
| 70% of health care expenditures are incurred 10% of the population |
|
|
Term
|
Definition
| form of cost control when used in modest amounts, not applied to low-income patients and designed to encourage patients to use lower cost alternative sources of care rather than to discourage use of services all together |
|
|
Term
| Health care secure of nation's economy is ___$ |
|
Definition
| $2.5 trillion dollar plus system that finances, organizes and provides health care services for Americans |
|
|
Term
|
Definition
| Supplies the funds- individual health care consumers and businesses |
|
|
Term
|
Definition
Receive money from the purchaser and reimburse the providers -take money form the purchasers
assume the risk, and pay provider when policy holders require medical care |
|
|
Term
|
Definition
| Includes hospitals, physicians, nurses |
|
|
Term
|
Definition
| Are pharmaceutical, medical supply and computer industries that manufacture equipment, supplies and medications used by providers to treat patients |
|
|
Term
| 1945-1970: The Provider-Insurer Pact |
|
Definition
By the 1960s, the power of the provider-insurer pact was so great that hospitals and Blue Cross wrote the reimbursement provisions of Medicare and Medicaid to ensure that physician payment was as bountiful as it was for private patients
o With open-ended reimbursement policies, the costs of health care inflated at a rapid pace |
|
|
Term
| Disinterest of the purchaser stemmed from two sources |
|
Definition
Healthy economy U.S. business controlled domestic and foreign markets with little competition
o Tax subsidy for health insurance the cost of health insurance from employees was a tiny fraction of total business expenses
Payments by businesses for employee health insurance was considered tax-deductible. |
|
|
Term
| The 1990s: The Breakup of the Provider-Insurer Pact |
|
Definition
| Selective contracting tended to disorganize rather than organize medical care patterns-purchaser domination |
|
|
Term
| In 2007, only % of medial school graduates planned careers in primary care |
|
Definition
In 2007, only 7% of medial school graduates planned careers in primary care
ii. A shortage of 40,000 primary care physicians is expected by 2020 |
|
|
Term
| Beginning of the 21st century- what % of adults do not receive recommended care |
|
Definition
| 45% OF ADULTS DO NOT RECEIVE RECOMMENDED CHRONIC AND PREVENTATIVE CARE |
|
|
Term
| % of patients in a hospital are there because of a medical injury |
|
Definition
|
|
Term
| % of deaths related to coronary artery bypass graft surgery at low-volume hospitals could have been prevented by referral of those patients to hospitals performing a higher volume of those surgeries. |
|
Definition
|
|
Term
| What are the 6 Dimensions to Quality of Care |
|
Definition
1. SAFE
2. EFFECTIVE
3. PATIENT-CENTERED
4. TIMELY
5. EFFICIENT
6. EQUITABLE |
|
|
Term
| % of physicians recently surveyed had NEVER disclosed a serious error to a patient |
|
Definition
|
|
Term
|
Definition
| 2% OF PATIENTS WHO SUFFER ADVERSE EFFECTS CAUSED BY MEDICAL NEGLIGENCE FILE MALPRACTICE CLAIMS. 40% OF MALPRACTICE CLAIMS DO NOT INVOLVE TRUE MEDICAL ERRORS. ¼ of the inappropriate claims receive compensation |
|
|
Term
| In 2009, the US spent $2.5 trillion on healthcare. Only % of this was spent on prevention |
|
Definition
|
|
Term
|
Definition
Primary prevention seeks to advert the occurrence of a disease or injury (eg. Immunization)
Secondary prevention refers to the early detection of a disease (eg. Pap smears) |
|
|
Term
| 3 strategies for the prevention of illness |
|
Definition
address social determinants of health
2.Public health interventions to reduce the incidents of illness to a population as a whole
3.Individual health care providers performing preventative interventions for individual patients |
|
|
Term
% of Medicare funds is spent in the last year of life
% is spent during the final 60 days |
|
Definition
27% of Medicare funds is spent in the last year of life
13% is spent during the final 60 days |
|
|
