Exam 1 USHC

multiple goals of health systems:

wellness

illness treatment

health

longevity

indiepdnent living

basic functioning

happiness

cost 2024:

• estimated that we spent $5.3 trillion dollars

• public insurance spending continues to rise, less Medicard enrollment

• health spending projected to reach $9 trillion/year by 2035

quality:

US contiues to rank at/near bottom of peer high-income countries for many indicators of quality care (like life expencatncy, prenatal care, converage, etc.)

we spend the most & get the least

fragmented system:

• best health care tech in world

• mpst expesive health care in world

• most uninsured people of any country

• private & public components

gov pays for ___% of healthcare, but most financing/delivery/insurance/payment functions are private

due to US _____-based economy

48%

due to US market-based economy

British has ____, Canada has ____

British have national health system (gov owns)

Canada has national insurance system (gov - insurance, delivery - private)

quad model of health

insurance

payment

delivery

financing

insurance —> access —> delivery

financing:

how we pay for insurance/service

for most americans - obtained through employer as a benefit

insurance cos provide this coverage to employers as a group, mostly through Managed Cara products, but Health maintenance organizations are a part of this as well

insurance:

private/public

protects you against the risk (cost) of some expensive health event

sold as a policy

insurance co usually provides provider of service their fee

GO BACK

getting insurance: sold as a policy

taxes

premiums:

co-payments

deductibles

types of insurance:

no insurance - seek free care/pay yourself

private insurance - employer based usually (CIgna, United health, Blue Cross, etc)

gov - medicare (65+), medicaid (income-requirement)

most of these have cost sharing - coinsurance/deductibles/copayments

delivery:

provider - anyone/anyplace that delivers some form of care

most providers are paid through insurance/provide services to people with insurance

payment:

• usually service first, payment later

• sometimes payment due upfront - usually for people without insurance

co-payment:

small part of payment due at time of service from patient

NOT WHAT VISIT COSTS

these fxns make up core of US health system:

financing, insurance, delivery, payment (each depends on & interacts with the other)

americans most ____ to accessing and affording health care

barriers

what is public health

• monitor community health status

• diagnose/investigate health probs/hazards

• inform/educate/empower people ab health probs/hazards

• mobilize community to identify/solve health probs

• develop policies to support indiv/community health efforts

insurance: self insuring cos

• can opt to cover own employees/take risk themselves

• gov cant regulate them

• Employee Retirement Income Security Act (ERISA): passed to protect pensions/says gov cant legislate priv co benefits including health insurance

deductible:

• plan covers x/y/z & ___% of it, you pay the other part

• anything other than primary care, you’re responsible for $__?_ start of cost (not what service costs)

QQ: country w a Nat’l Health System:

GB

QQ: entities in US that employ lobbyists:

• hospitals

• physicians

• large employers

• insurance cos

• nurses

QQ: health outcomes in US:

• worse than other nations

• good when in system

• vary by access/ability to pay

QQ: % of ppl in Canada w public health insurance

100%

US HC System Characteristics

• huge

• workforce employs 19-20mil ppl

• fragmented

• public/private components

• quad:financing/insurance/delivery/payment make up the system

*basic* characteristic of US system:

• no central agency

• access based on ability to pay

• healthcare delivered under “imperfect” market conditions

• multiple payers make system complex

• no dominant entity - balance of power

• legal risks influence practice (malpractice)

• goal of quality is hard to define

• services/settings evolve

major issue facing the system:

• public health: pandemic/etc

• public programs (ex:medicaid/care)

• patient’s rights

• info/tech

markets:

• should HC be sold in free market?

• economy: market influences HC system

• markets have goal of perfect competition

• markets want to be efficient/an exchange cant be equal and also efficient

definition of health from WHO

“health is a state of complete physical, mental, and social well-being and not merely the absences of disease or infirmity”

illness v disease

illness: person’s perception/evaluation of how she/he feels, you are ill bc you say you are ill

disease: based on prof evaluation, you have disease bc social authority says you have one

healing v curing

healing: illness

curing: disease

disease states:

acute: severe/treatable/may req hospitalization

subacute: less severe/may req inpatient care at a nursing home

chronic: persists over time, not reversible

measuring disability: ADLSs

• activities of daily living - capability to carry out personal care

• 7 basic fxns

• eating

• bathing

• dressing

• using toilet

• transferring from bed to chair

• grooming

• walking distance of 8 feet

IADLS - instrumental activities of daily living

• capabilities necessary for a person to live independently

• measure higher level of functioning than ADLS

• ex: using phone/shopping/money managemnt/housework/driving

disability diagnosis from ADLS/IADLS can entitle person to social benefits like

medicare

social security

employment accommodations

preferential hiring

health behaviors/risk factors

• axns indiv take that negatively impact their health status

• ex: smoking, substance abuse, lack of phys excercise, non-nutrient/unbalanced diets, improper use of motor vehicles, etc.

social determinants of health:

• education access & quality

• economic stability

• health care access & quality

• neighborhood & built environemnt

• social & comunity context

locus of control

external: indiv believes his/her behavior is guided by fate/luck/other ext circumstances (society)

internal: indiv. believes his/her behavior is guided by his/her personal decisions & efforts (individual)

veil of ignorance:

• u choose dynamic of society u were born into/not who u are born to

• options: avg income high, but variation btwm v poor and v wealthy OR avg income is low, little variation btwn very poor-v wealthy

theories of justice characteristic

market justice: health care as an economic good, asssumes free-market conditions, production/distribution based on market demand, medical care based on ability to pay, access to care is econ. reward for personal effort/achievement

social justice: health care as a social resource, requires gov involvement, medical allocation determined by social planning, ability to pay doesnt affect receiving medical service, equal access to care is viewed as a basic right

theories of justice implications

market justice: indiv responsib. for health, benefits based on individual purchasing power, limited obligation to the collective good, emphasis on indiv. well-being, priv. solutions to social problems, rationing based on ability to pay

social justice: collective responsibility for health, everyone entitled to basic package of benefits, strong obligation to collective good, community well-being supersedes indiv, public solutions to social problems, planned rationing of health care

limits of justice

• is being rich bad?

• Rawls: top doesnt matter, need to care about bottom

public health roles:

• prevention

• health promotion

• health protection

• focus on populations

• prevent disease

• provide education to pass laws

therapeutic preventions

primary: decrease/restrain problem

secondary: early detection & treatment

tertiary: rehabilitation

Comm. health assessment

assessment of popltn at local/state level in collab w public health agencies, hospitals, pther providers

eval. of health status

indicator of health and well-being interpreted through morbidity (disease/disability) or mortality (death rate)

mortality - longevity, life expectancy, life expec. at birth

morbidity - at risk popltn, incidence(# of new cases), prevalence(total # of cases at specific point in time), epidemic (lg # of people who acquire specific disease from a common source

wealth is ultimate social determinant of:

health

pre-industrial health era

• anyone could be a doctor

• almshouses/pesthouses

• mental asylums

• low demand

• some med schools starting

• medicine - not science

• MIASMA theory - “bad air”

• GW sore throat - bleed 4x

• traditional healers

• surgery - no anesthesia

post-industrial health era

• scientific method

• urbanization

• hospitals

• specialization

• private insurance

• failure of national insurance

• germ theory!!

• AMA

• growth of tech

• mental health

corporatization health era

• corporate dominance

• powerful payers

• managed care

• medical tourism

• prospective payment

reform health era

• gov intervention

• Affordable care act

• expansions in public insurance/coverage

• dependent coverage until age 26