HSM 210 First Exam

Part One

1. What factors would we look for in a country to see if their “healthcare system” is a real “system?”

   

1. Social and cultural beliefs and value

2. Physical environment

Political and Legal Climate

1. Who pays the costs, and for what do they pay

   

1. Government taxes. Private insurers, Employers, and individuals pay for

2. Private Insurers Public Insurance

3. Cost care iniatives

 

1. How costs are controlled

1. Control costs by limiting medical services they will pay for by making patients wait longer.

2. By rationing medical services/supply

   

1. How do doctors get paid

   

1. Salaries

2. Capitations

3. Performance-based initiatives

4. Fee Services

   

1. Who owns the hospitals?

   

1. Non-profit Organizations

2. Private Organizations.

3. Public Organizations

The differing emphasis between primary and specialist care

Specialists are specific conditions that require a specialized physician to provide care, Primary care is for those who need preventative care

1. The differing emphasis between public health and healthcare delivery

   

Private Healthcare focuses on treating an individual illness and Public focuses on prevention.

1. Medical Education

1. Varies in cost, funding, and specialization requirements across countries

2. Out-of-pocket contributions from patients

Out-of-pocket contributions from patients

1. systems may require co-pays, deductibles, or direct payments, while others fully cover costs.

 

1. The role of healthcare managers

 

1. Oversee hospital operations, policy implementation, and cost management

 

1. Accessibility

   

1. Not often accessible since the U.S system makes Insurance and Primary care cost unaffordable also being that the system forces those to delay treatment until the condition becomes severe. 

2. Measures how easily people. can get healthcare

 

1. Quality of care

   

1. Assessed by:

                                               i.     Providers Performance

                                             ii.     Patient Outcomes

                                           iii.     Safety Measure

 

Equity

1. Adequate distribution of healthcare resources

Differences in social determinants

1. Individual behaviors

   

 

1. diet, mental state, and smoking all impact health

1. Mental health:

   

1. Recognition,  funding, and accessibility

1. Obesity:

   

1.   Growing public health issue tied to diet, activity,  and policy

1. Environment:

 

1. Pollution,  sanitation, and climate affect public heal

1. Systemic prejudice:

   

1. Disparities in healthcare accessibility based on race,  gender,  and socioeconomic studies

1. Class structure:

1. Income inequality influences healthcare quality and access

The role of demographics

1. Aging population:

1. Older populations increase demand for healthcare and long-term care

   1. Develop. Chronic disease

E.  The “price/volume” dilemma

1. Moral hazard:

1. When insured individuals overuse healthcare because they don’t bear the full cost.

1. The role of “out of pocket” contributions: 

 

1. Cost sharing strategies to prevent overuse of service.

 

1. Sustainability:

   

1. Ensuring healthcare funds remain stable long-term

The different roles that the government plays in delivering and financing of healthcare

           

 

Regulation, financing, direct service provision, and public health initiatives

The role that employers play in the financing of healthcare

           

Employers often provide private insurance, particularly in the U.S

The role of societal values in structuring the healthcare system

Cultural beliefs shape policies, such as universal coverage vs. market-based systems

Three models for wealthy countries outside the US

 

1. Bismarck

1. Employer-based insurance with government regulations

2. Uses private health insurance plans which are financed through payroll deduction

3. Used in Germany, Japan, Switzerland, and some parts of Latin America 

1. National Health Service (Beveridge)

   

1. Government-funded and operated healthcare, financed by government tax payments. 

2. Low cost per capita, the government controls how much doctors can charge for there. Services

3. Used in the United Kingdom, and Spain

 

1. National health insurance

1. Publicly funded but privately delivered healthcare, has elements of both the Bismark and Beveridge models

                                               i.     Healthcare is private but the payer is a government-run insurance program that every citizen pays into.

Controls costs by limiting medical services they will pay for by making patients wait longer