Delivering Health care in america

3 Pieces of health reform
Access
Quality
Cost Control
Access
insurance, 50 million people had no Medicare, no access to healthcare, that’s why Obama Care was created.
since 2010 the number have gone down to 35 million
MA has about 99% coverage rate of healthcare
Quality
We are looking for the best quality. until now, healthcare has been looked as quantity (lots of different test, lab test, x-rays etc.)
healthcare was getting payed by how much healthcare they thrown at us
quantity does not equal quality (e should pay for quality not quantity)
defense mechanism
Doing a lot of test do that the hospital wont get sued
Cost control
18n cents, we are number 1 in spending on healthcare but 37th on receiving quality care
Acceptable Healthcare delivery system
1.It must enable all citizens to obtain healthcare service when service is needed
2. the service must be cost effective and meet certain established standards of quality (not everyone can afford healthcare)
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Basic components of healthcare delivery system
Healthcare delivery system incorporates 4 functional components
financing
insurance
delivery
payment
4 function overlap
the degree of overlapping varies between private and a government run system and between traditional healthcare and manage base healthcare
Financing
its necessary to obtain health insurance or to pay for healthcare service
in companies/ private insured Americans- employers finance healthcare (spouse and children would also benefit from the working spouse/parent’s health insurance receiver by their employer
insurance
protects the insured against catastrophic risk when needing expensive health care services
insurance function also determines the package of healthcare services the insured individual is entitle to receive
specifies how/where health services may be receive
delivery
refers to the provision of healthcare services by various providers
providers
refers to any entity that delivers healthcare services and can either independently bill for those services of is tax supported
EX: physicians, dentist, optometrist and therapist in private practices
most providers render services to those who have health insurance
Payment
the payment function deals with reimbursement to providers for services delivered
insurer determines how much is paid for service
in government insurance plans such as Medicare and Medicaid, tax revenues are used to pay providers
uninsured Americans
people without private or public health insurance coverage
premium cost sharing
when employees have to pay a fraction of the cost
working people with a low wage income are disenfranchised because most are not eligible for public benefit and cannot afford premium cost sharing
Medicare
the program for the elderly and certain disable individuals
100% of Medicare comes from the government.
its for 50n states, benefits do not change if you change to a different state
Medicaid
the program for the indigent and jointly administered by the federal government and state.
for low income families (safety net ) if Medicare runs out you still have Medicaid
CHIP (children’s health insurance program)
the program for children from low income families
OBGYN + Neuro
Are the ones with the higher malpractice rates
Patient Outcomes
are more important now
doctors want to be reimburse/ get paid
quality outcome
positive outcome= a lot of reimbursement
inpatient
nursing homes, inpatient revenues is going out average length for sty at a hospitals 1-2 days
pays for a lot but not everything. Skilled care (nursing care, therapy)
Morbility
injured/ sick people rate
mortality
dead people rate. requires medical intervention (does not equal pharmaceuticals)
Block grant
you can do what you want with the money (more flexibility)
direct
you have to do what the government wants. flexibility compare to Medicaid is worse because you do not have the same coverage in different states.
the program might be different so less flexibility for someone moving to a different state
systemic error
errors that happened because if poor systems
EX:” Dana farmer” best cancer facility. but before they killed people with the treatment because their dosage was way off.
because Dana farmer screwed up, other hospitals started to check their systems.
physician panels
the number of group of patients
physician Extenders
other people besides physisians
triage
placing people who have the worst injury/health problems first
1. heart attack
2.slit hand
3. common cold
ADL
activities of daily living
1. brush teeth
2. shower ect
Some people are not able to perform either of these. they need help with one or both
IADL
instrumental activities of daily living.
1.housework
2.making breakfast
3. driving a car
Some people are not able to perform either of these. they need help with one or both
acute disease
can get treatment
EX: cold
Chronic disease
cant get treatment. it has a time frame
EX: asthma, cancer, aids
epidemic
spread of disease in a controlled area
pandemic
spread of disease worldwide
quality of life
-something that helps you enjoy life- being hooked to
Functional status
when patients are returned back to a level of functional status
almshouse
was a precursor of hospitals, but it was not a hospital.
also called a poorhouse because they serve primarily the poor, existed in all cities of all sizes and were run by the government.
were unspecialized institutions that admitted the poor and needy people of all kinds, provide food and shelter
pest house
was operated by local governments to quarantine people who had contracted a contagious disease, such as cholera, small-pox, typhoid or yellow fever
function= to insolate people with contagious diseases so disease would not spread among the inhabitants of a city
free for service
the practice of billing separately for each individual type of service performed
cultural authority
refers to the general acceptance of and reliance of the judgment of the profession because of their superior knowledge and expertise
legitimizes a profession in the eyes of the people.
organized medicine
the concerted activities if physicians through the AMA are collectively referred as OM to distinguished them from uncoordinated actions of individual physicians competing in the market
voluntary health insurance
was refer as the private health insurance. in contrast to the proposals for an argument-sponsored compulsory health insurance system
role= income protection during sickness and temporarily disability
prepaid plan
contractual arrangement under winch a provider most provide all needed services to a group of members in exchange for a fixed monthly free paid in an advance
P.A
Practitioner assistant
M.D
Medical Doctor.
medical care. Ex: illness, staring to get into family plans.
were on time constrains, that is why they did not ask about family history.
perform for practice + insurance companies.
O.D
Doctor of osteopathic
holistic background of the patient, their past and family history.
became accepted because they were demanded as a group.
they are more thorough than MD’s in a lot of ways.
R.D
registered dietician
N.P
Nurse practitioner
hospitalist
person that cares for the people in the hospital.
usually a fall time employee ( 24 hour accessibility)
3 12 hour shifts.
make less money than doctors
can predict what their life style would be like. have a better schedule.
don’t have to worry about any of the headache that come with being a doctor. EX: malpractice insurance, have benefits.
Benefits of having a hospitalist
Continuity of care, consistently working with the same patients. also delivery costumer satisfaction.
Denise
Speech pathologist. speech therapist would usually work with children.
in hospitals speech therapist work with stroke patients. has become more prolific in hospitals as well as skilled facilities.
NPP
No physician practitioners= NP (nurse practitioner), RN,PA, pharmacist
.
mini clinic
Clinic that takes less time than a doctor does. which means more competition for the MD.
Allopathic
MD. takes 1 exam. cant do any osteopathic techniques
osteopathic
OD. takes two exams. practices osteopathic procedures as well as allopathic
health informatics
application of information science to improve efficiency, accuracy, and reliability of health care services.
taking information to apply to something useful
-requires the use of IT but goes beyond IT by emphasizing the improvement of healthcare delivery
Electronic health records
are IT application that enable the processing of any electronically stored information per training to individual patients for the purpose of delivering healthcare services
-replaces the traditional paper medicine books which includes all of the patient information
E-health
refers to all forms of electronics healthcare delivery over the internet raging from informational, educational and commercial products to direct services offered by professionals and non professionals business and consumers themselves
virtual physician visits
online clinical encounters between a patient and physician
telemedicine
distant medicine employs the use of telecommunications technology for medical diagnosis and patient care when the provider and the client are separated by distance
-help take care of people through the use of internet connection
-practice med like Skype of phone, can perform surgery
Telehealth
encompasses telemedicine as traditionally known and educational research and administrative use, as well as clinical applications that involve a variety of such as physicians, nurses, psychologist and pharmacist.
-taking healthcare information from the web
da Vinci Robot
can eliminate human error because they are programed, its precise, stable hands and size. micro surgeries = no invasive procedures, reduces risk of infection
Clinical trials
have to prove that it works in order to test it on human beings
cost efficiency
step beyond determination of efficiency
DME
durable medicine equipment= hand-bars at bathrooms of showers, walkers, wheel chairs
-if hospitals do not update their M.E they will loose business
need and demand
doctors who demand something, whether they need it or not.
-if they have the best of the best equipment, it may help you look like the best doctor
Technological imperative
having medical equipment that’s not really needed