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Ambulatory Care
Outpatient care that does not require an overnight hospital stay
Economics
The study of choices people make to attain goals given limited resources
3 goals of healthcare policy
Cost of care
Quality of care
Access to care
Determinants of Health
Income, education, gender, physical environment, personal behavior
Primary care
Basic health care problems, preventive care
Secondary care
Requires more clinical expertise, often by specialists
Tertiary care
Highly specialized, complex treatments, often requires advanced equipment
Regionalized Health Care Model
Example—United Kingdom’s National Institute of Health
Highly structured system: the government owns hospitals and employs most doctors
Dispersed Health Care Model
Example—United States Health Care System
Less structured: more patient choice, no requirements for referrals, patients can see specialists directly
Insurance (in simple terms)
Protection against financial burden in case of an emergency. Works on the principle of risk pooling
Multi-speciality Group Practice (MGPs)
Example—The Mayo Clinic
Physicians from different specialities work together for better coordination
Community Health Centers (CHC)
Focus on primary and preventive care, service to high need communities, governed by community boards, fees based on ability to pay
Prepaid Group Service (PGS)
Individuals pay in advance for a set list of services
First Generation HMOs—Vertical
Physicians are salaried, hospitals operate under global budgets, encourages care coordination and efficiency
Second Generation HMOs—Virtual
Contract based instead of ownership based
Independent Practice Associations (IPAs)
Groups of physicians working with multiple HMOs
Accountable Care Organizations (ACOs)
Provider-led organizations responsible for managing the full continuum of care (primary care +)
Patient Centered Medical Home (PCMH)
Larger group working together for your (the patient’s) benefit
Asymmetric information
One group might know more than the other
Problem exists when providers work in their own interest, instead of the patient’s
Fee-for-Service
Fee for every service the provider provides
Every service has a price tag
RISK!!! Providing extra services that aren’t necessary—encourages quantity over quality
Diagnosis Related Group (DRG)
Earning $$ based on patient’s diagnosis
Revenue is locked in place
Discourages providers from being inefficient
Contradicts the fee-for-service risk
