Econ exam 2

•Any good or service designed to influence health status or outcomes

•E.g., physician visits, diagnostic tests, treatments

medical health input

•Personal behaviors that can affect health

•E.g., diet, exercise, smoking, drinking habits

lifestyle health input

•Natural or anthropogenic (resulting from human activity) 

•E.g., soil, air, water, pollution

environment health input

•Sex

•Age

•Genetic predisposition

biological makeup

• Access to insurance & health services

income

• Preventive health measures

education health input

•Crowding

•Structural conditions

•Location/neighborhood

•Affordability 

housing

•Insurance

•Others

“gov programs” health input

which factors have the greatest influence on producing good health?

lifestyle

housing

income

educati

•Can be adjusted for age, sex, race

•Highly accurate, especially in developed countries

•Not suitable for analyzing individual health

•Do not capture quality of life or the duration, severity, & consequences of disease 

population health measures

•Used at the population level to identify health outcomes that can be generated at lowest cost

•Combines effects of treatment on both life expectancy & quality of life in 1 measure

•Presumes that disability reduces quality of life 

•Potentially devalues treatment for people with disabilities 

Quality-adjusted life year

•Can be used at individual & population levels

•Depend on respondents’ interpretation of survey questions/self-assessments 

subjective health measures

What are the characteristics of high quality care?

Safe

Effective

patient-centered

timely

efficient

equitable

•Are the right things done?

•Avoid overuse, underuse, and misuse

effectiveness

•Are things done right?

•Avoid waste 

efficiency

 organization’s capacity, systems, & processes to provide high quality care

•Whether the organization uses electronic medical records

•Number or proportion of board-certified physicians

•Ratio of providers to patients

structure

what the organization does to maintain or improve patient health

•Percentage of people receiving flu vaccines

•Percentage of people with diabetes who had their blood sugar tested & controlled

process

 the impact of a healthcare service or intervention on patient health status

•Percentage of patients who die as a result of surgery

•Rate of hospital-acquired infections

outcome

•If a measurement is taken at several points in time or by various people, it will generally be **consistent**

• __Example__:  defining wait time as the interval between patient’s arrival at office and the time patient is first seen by doctor, vs. patient’s arrival at office and the time patient is seen by medical assistant 

reliability

• The extent to which a measure actually measures the concept (**accuracy**) 

•__Example__:  using electronic health records to measure hospital discharge times - the timestamp indicates that discharge has occurred, but the discharge be logged before __or__after patient departs

validity

•**Who and what?**

•Precise  

•Clear

•Plain language, avoid jargon

•Action verbs

specific

•**By how much?**

•Number/ \n percent used as reference point from which change can be monitored

•Direction you want to move or level you want to reach

•Tied to specific 

measurable

•**How?**

•What’s within reach, given available resources, knowledge, and time

achievable

•**Why?**

•Align with organization’s mission, vision, and values

•Achieve meaningful change for target population

relevant

•**When?**

•Realistic/ \n reasonable date

time-bound

•Doctor checks Joe’s height and weight to calculate his body mass index. 

process

•Doctor prescribes blood pressure medication & sends prescription to Joe’s pharmacy electronically.

structural

•Doctor checks Joe’s blood sugar levels.

process

•Nurse takes Joe’s blood pressure. 

outcome

•Nurse gives Joe a flu shot.

process

•Joe completes survey about his experience during his office visit

outcome

v The study of how people act within organizations

v How to create working conditions that foster employee effectiveness and organizational productivity 

organizational behavior

Influence of assumptions, perceptions & personality on behavior

individual

Teamwork, decision making, conflict

group

Influence of organizational culture, structure, authority, ability to adapt to change

organization

•**Our pre-existing knowledge & expectations serve as unconscious templates that we use to automatically filter and interpret new information**

•**Our thinking may be incomplete or inaccurate or distorted by unconscious biases**

mental representation

•**Most thinking is automatic – fast, unconscious, relies on mental representations**

•**Deliberate thinking is slow & conscious but often does not recognize underlying automatic thinking**

information processing

•**Tend to focus on evaluating options & choosing**

•**Less focus on defining the problem & its causes, generating options, assessing information needs**

decision making

•**Our perceptions of others are selectively filtered &  informed by our mental representations & emotions**

•**Tend to underestimate the role of external circumstances & attribute others’ behavior to their internal disposition**

social cognition

•Tendency to overestimate accuracy of our own judgments

overconfidence bais

•Tendency to unconsciously and selectively notice information that confirms our existing beliefs

confirmation bias

•Tendency to rely on the likelihood that information is true because it is easy to recall

availability heuristic

•Tendency to favor things we are familiar with

familiarity heuristic

•Tendency to underestimate the effect of situational factors and instead presume that personal factors cause behavior

fundamental attribution error

•Shared mental model  (perception/understanding)

•Clear roles & responsibilities

•Clear values & shared vision

•Optimized resources

•Strong leadership

•Regular feedback

•Strong sense of collective trust & confidence

•Mechanisms to cooperate & coordinate

•Ability to manage & optimize performance outcomes

characteristics of high-performing teams

•Inconsistent team membership 

•Lack of time

•Lack of information sharing

•Hierarchy 

•Defensiveness

•Conventional thinking

•Varying communication styles

•Conflict

•Lack of coordination & follow-up

•Distractions

•Workload

•Lack of role clarity

barriers to team performance

•the person assigned to lead and organize a team, establish clear goals, and facilitate open communication and teamwork among team members

designated leader

•any team member who has the skills to manage the situation at hand

situational leader

\-Knowing the current conditions affecting one’s work and ensuring that new or changing information is identified for communication & decision-making

\-Develop a common understanding and monitor performance

situation monitoring

v The ability to anticipate other team members’ needs and balance workloads

mutual support

•No individual firm controls market price

many small firms

•No individual or small group of buyers controls market price

many individual buyers

•Production & consumption decisions based on free will

freedom of market entry and exit

•Firm’s products are indistinguishable from competitors

homogenous products

•Sellers take price from market

price takers

•Buyers & sellers have equal information about production, price, &; buyers know all available choices; sellers have access to same tquantityechnology

perfect knowledge

•Transactions do not affect third parties

noexternalities

•Firms cover production & opportunity costs at equilibrium price

zero economic profit

•Only 1 seller –  \n power to influence quantity & price

monopoly

•2 sellers

duopoly

•A few sellers – low level cooperation, competition among the few

oligopoly

Compared to perfect competition, the amount of goods and services produced in a monopoly is _______, and price and profits are ________.

lower and higher

Reliance on advertising and sticky prices are characteristics of which market structure?

oligopoly

•Many sellers – each with small market share, no cooperation

monopolistic comp

more leverage when negotiating reimbursement rates with insurers; fewer entities providing services 

greater market power

costs of running business are shared among group of providers

economies of scale

for multi-specialty practices 

economies of scope

v  1 type of economic evaluation method to weigh pros and cons of alternatives 

v Costs are measured in dollars

v Outcomes/health status are measured in quality-adjusted life years (QALYs)

v Can be used to compare alternatives (for the same condition or 2 unrelated treatments) or identify programs that do or don’t make good use of scarce resources 

cost effective analysis

vDoes not address ethical dilemmas

v Only as good as the data used/available 

v Does not recommend whether an intervention should be implemented or is actually needed

critique of cost effective analysis

•How many years of living with a certain disability would you trade for a shorter number of years in perfect health? 

time trade off

•Imagine having a disability. Would you undergo a procedure that has a 50% chance of returning you to perfect health and a 20% chance of instant death?

standard gamble

•Supplemental unweighted measure of number of years of life extended using a particular treatment

•Intended to show if significant discrepancy between QALY vs. evLYG

equal value of life years gained (QALY alternative)

•Convert health outcomes into dollar amounts and subtract treatment costs

cost-benefit analysis (QALY alt.)

•Rank/weigh factors in terms of importance to decision maker (cost, clinical outcome, administrative burden)

•Score each treatment for each criterion & then generate single average weighted score to compare alternatives 

multi-criteria decision analysis (QALY alt.)

•Patients with the condition being treated define which treatments are of highest value & what high value means

•Patient preferences/goals are used to weigh & score factors:  treatment benefits/drawbacks vs. patient costs vs. evidence of clinical effectiveness

patient perspective value framework (QALY alt.)

v Rules that everyone __must__ follow to ensure order, safety, and fairness in society

v Established by government 

v Written and publicly available

v Violators may face civil fines or other penalties or criminal sanctions

the law

type of law that includes contracts and torts

civil law

types of law that is made up of felines and misdemeanors

criminal

•Action knowingly or deliberately causes harm to someone else

intentional torts

•Duty (e.g. standard of care)

•Breach (reasonably prudent person)

•Causation

•Damages

negligence

•Action harms someone else, regardless \n of intent or negligence

strict liability

•Performing the correct action incorrectly

misfeasance

•Performing an illegal action

malfeasance

failing to act

nonfeasance

v A professional’s improper or immoral conduct in the performance of duties, done either intentionally or through carelessness or ignorance 

malpractice

deliberately providing false information or misrepresenting information in order to gain a benefit

fraud

acting inconsistently with standard medical or business practices, whether intentionally or not

abuse

provider billing for services that were not provided or were not medically necessary

false claims

provider receiving compensation for referring patients to another physician

kickbacks

•Authorizes civil fines (per violation) and treble damages for providers who submit fraudulent claims to the federal government. 

•Allows whistleblowers to sue on behalf of federal government in exchange for share of money recovered. 

false claims act

•Prohibits anyone from knowingly offering, paying, soliciting, or receiving anything of value to encourage patient referrals, where healthcare services are reimbursed by the federal government. 

•Includes criminal fines and imprisonment, as well as civil fines, treble damages, and exclusion from Medicare/Medicaid. 

anti-kickback statute

•Prohibits physicians from referring patients to services in which the physician or a family member has a financial interest, where healthcare services are paid by the federal government (strict liability). 

•Refund obligation. For knowing violations

stark law

•Rules that everyone __must__ follow to ensure order, safety, and fairness in society

•Established by government (legislative, administrative, judicial action)

•Written and publicly available

•Violators may face civil fines or other penalties or criminal sanctions

law

•Guidelines for how people ideally __should__ act; used to decide what is morally right

•Established by individual or social norms; may be defined by licensing boards or professional organizations

•May be written or unwritten

•Violators may face social disapproval or loss of license or professional privileges 

ethics

•Autonomy (consent)

•Truth-telling

•Confidentiality

•Fidelity (providing care as promised)

respect for persons

•Doing the best one can for patients (duty to care)

beneficence

do no harm

nonmaleficence

fairness

justice

•Act with honesty, integrity, respect, fairness, & good faith

•Comply with laws & regulations

•Maintain competence

•Avoid improper exploitation of professional relationships for personal gain

•Disclose financial & other conflicts of interest

•Respect confidentiality

•Refrain from demeaning profession’s creditability & dignity

ACHE: profession

•Ensure culture of respect & dignity

•Build trust

•Ensure process to: 

• evaluate care safety, equity & quality

• fairly & equitably handle financial matters

•clearly & honestly advise patients of rights, opportunities,  \n responsibilities, & risks of available services 

•resolve conflicts between patients & providers

•ensure patient autonomy, confidentiality, & privacy

•review, develop, & implement evidence-based clinical practices

•Safeguard against discriminatory organizational practices

•Zero tolerance for any abuse of power that compromises patients

ACHE patients