Health Psychology Exam 4 - McMillen MSSTATE

Five things that are unique to the health care market

1. have to interact with healthcare at some point in our lives

2. quantity focused instead of quality of care given to patients (Fee for Service Model)

3. complex federal, state, and internal regulations. 7% of costs are administration costs

4. difficult billing system to navigate for patient

5. a lot of expenditures are not disclosed upfront with patient

The amount of money the US spends on healthcare in 2020

$4.1 trillion; less $ for education, infrastructure, etc.

Healthcare expenditure trends and levels in the U.S. compared to the other nations

higher in the US compared to other nations

areas of highest cost: private health insurance, medicare, medicaid, out of pocket

reasons US is much higher: Fee for Service Model, population is becoming older and more obese, new drugs/technologies/procedures are all advancing, irrational market (unknowledgeable costs of procedures before hand)

Life expectancy on the U.S. compared to other nations

around 79 years, ranked 26th among other countries

Reasons for healthcare cost growth

-Fee for Service Model

-population is becoming older and more obese

-new drugs/technologies/procedures are all advancing -irrational market (unknowledgeable costs of procedures before hand)

The lack of rationality in the US healthcare market and why this market is unique

unknowledgeable costs of procedures beforehand

unique because we have to have procedure, basically forcing us to pay even if we don't know how much it is

Examples of the non-rational healthcare market from class

appendicitis: range for costs was around $1.5k-$138k

total hip arthroplasty: $11k-$126k

less than half of hospitals were able to give price of procedure and would tell cost after procedure was done

The differences between public and private health insurance plans

public: state taxes, includes medicaid and medicare

private: pay for yourself, includes employer-based and marketplace plans

Differences between employer-based and marketplace plans for insurance

employer-based: employer pays majority of insurance, can come out of expenses for salaries though. Deductible is how much money individual has to pay until insurance kicks in. Untaxed benefit

marketplace plans: came from Affordable Care Act (allow people insurance that didn't have employ-based insurance, such as self-employers or small firms)

geography, age, # of people in household, tobacco all USED TO determine level of premium for this plan

Differences between Medicare and Medicaid

Medicare: largest health insurance provider int he US, does not involve taxes. Qualifications are simply ages 65+. Don't negotiate drug prices

Medicaid: needs-based system. Income, household, poverty, at least one minority in house, disabled or pregnant women all are factors for Medicaid

Geographic variability in health care coverage

lower in those in Southeast region, those with lower income, lower socioeconomic status

The four factors that market place health insurance plans can use to set premiums

geography, age, # of people in household, tobacco usage

Identify disparities in health insurance coverage

access (affordability) and geography (rural living areas with less access)

The six basic methods for measuring patient adherence

1. ask healthcare provider

2. ask patient (most access to known behavior)

3. ask family member

4. monitor medication usage (bluetooth pill bottles)

5. biochemical evidence (blood or urine samples)

6. combination of all of these 5

Factors that predict adherence

-severity of disease: patient perception of severity

-treatment characteristics: cost, bad side effects, complexity of treatment

-personal characteristics: age (very young or very old are less adherent because of comprehension or willingness)

-environmental factors: economic factors

-emotional factors: social support, depression/anxiety

Most common sources of health insurance for Americans

employer-based and medicare are most common sources

Types of primary care providers

General practitioners, family physicians and pediatricians, NPs or PAs

Issues related to the shortage of primary care providers

individual burning out before retirement, fewer medical students choosing to pursue primary care, a lagging supply of medical school seats, and low supply of postgraduate training positions.

Role of nurse practitioners and physician assistants

more flexible, more availability for speciality, less expensive, provide care for patients

The four main features of primary care

primary care provider

long-term relationship with provider about health status

comprehensive care for most health needs

Behavior willingness in adherence

convince people to change behavior, willingness to adhere to advice and make changes

Implementing intentions in adherence

putting goals to action, changing behavior, making behavior change easier for patient

more specific intentions = more willingness patient will do it

using positive reinforcement, using prompts to remind patients to make healthy choices, tailoring treatment to patient (what they can do/are capable of), putting goals to action

Barriers to adherence

-ability issues: cost of medications and treatments

comprehension of treatment: patient doesn't understand

-willingness: how willing patient is to adhere (patient may view treatment as too difficult, too much effort, too time consuming)

-lifestyle changes can be difficult for people as well as behavior alterations

-patient may sugar coat severity of Dr.'s orders

-patient may discontinue treatment because symptoms went away (which would allow them to forget or just not take them anymore)

Nonadherence

diseases that cause pain, are very deadly, or run risk of disfigurement, like cancer, are more adherent for people

diseases like diabetes are not as adherent because people don't take it seriously or see it as a risk

Adherence

willingness or ability to follow medical advice.

Partial adherence is following for a little while and then stopping

Medical advice as a benefit or not

provider has to make right diagnosis and treatment

patient has to take advice and do what they say

2014: Affordable Care Act

Not directly address issues in healthcare market, really just increased the amount of people who have health insurance

it was supposed to slow down the expenditure, debatable issue. Just increased amount of people who can afford insurance

Where do most of the nation's health dollar come from?

health insurance (private health insurance, medicare are both highest in this section) and other third party payers and programs

Why is health insurance important?

-cost: less out of pocket healthcare expenses. Negotiate prices

-social justice: risk selection (not insuring people based on pre-existing conditions)

-one checkup a year is covered by insurance, includes appropriate screening and checks (secondary prevention). thought to increase quality of life

What will determine a person's ability to afford health care?

type of health insurance they have