Policies Final Review

Good Luck Queen!!!!

Why should we care about healthcare spending?

It can increase the national debt if spending exceeds revenue.

What are the three perspectives of healthcare cost?

Hospital/physician, insurer, and patient.

What does cost mean to a hospital or physician?

Expenses such as electricity, water, and paying providers. (Dollar amount)

How is a charge calculated?

Cost + profit margin

What is reimbursement?

The actual money paid.

What is the difference between third-party payment and multiplayer system?

Third-party payment describes WHO pays, while a multiplayer system describes a healthcare system with MANY different payers.

What are the five things that increase healthcare costs?

Technology, elderly population, medical prevention, defensive medicine, and waste and abuse.

Why does new medical technology increase healthcare spending?

Once new technology is developed, it creates demand for its use.

How can medical prevention affect healthcare costs?

Prevention can increase short-term costs, but public health prevention can save money long-term.

What is defensive medicine?

Unnecessary tests or services performed to protect physicians from malpractice lawsuits.

Why do physicians practice defensive medicine?

To reduce legal risks and protect themselves from malpractice lawsuits.

What is healthcare waste and abuse?

Improper use of healthcare resources or insurance coverage for financial gain.

Who can contribute to healthcare waste and abuse?

Providers, hospitals, patients, and other parties.

What is cost shifting?

When hospitals or healthcare providers move costs to someone else to make up for financial losses.

How can hospitals use cost shifting?

They may lower workers' wages, lay off employees, or charge other patients and insurers more.

What is an example of cost shifting?

A hospital charges private insurance companies more to make up for lower payments from Medicaid.

What is health planning?

Planning and managing healthcare resources to reduce waste and control costs.

What is an example of health planning?

A community opens a new clinic in an underserved area instead of building an unnecessary expensive hospital.

What is peer review?

The process of having other healthcare professionals review a doctor's work, medical decisions, or treatments to make sure care is appropriate and effective.

How does peer review help control healthcare costs?

By identifying unnecessary tests, treatments, medical errors, and services that waste money.

What are competitive approaches?

When healthcare providers and insurance companies compete to attract patients and customers.

How can competition lower healthcare costs?

By encouraging providers to offer lower prices and better-quality services. AKA:Two hospitals compete by offering similar medical services at lower prices.

What is demand-side rationing?

Limiting healthcare based on a patient's ability or willingness to pay.

What happens with demand-side rationing?

Patients may not receive the care they need because they cannot afford it.

What is supply-side rationing?

Limiting healthcare based on the availability of services or decisions made by providers. So patients may not receive care because resources are limited or providers decide care isn't appropriate.

What does PCP stand for?

Primary Care Provider

What does MCO stand for?

Managed Care Organization.

What does ACO stand for?

Affordable Care Organization

Give an example of an ACO.

A group of doctors, hospitals, and specialists work together to treat patients and make sure they receive quality care while keeping costs down.

Give an example of an MCO.

An insurance plan requires you to choose a primary care doctor and get a referral before seeing a specialist.

What is an example of gatekeeping involving a PCP?

A patient must visit their primary care doctor and get a referral before seeing a specialist.

What is gatekeeping in healthcare?

When a person, provider, insurance company, or policy controls a patient's access to healthcare services.

What are the benefits of gatekeeping?

It reduces unnecessary healthcare spending and helps coordinate patient care

What are the disadvantages of gatekeeping?

It can delay treatment and make it harder for patients to access needed services.

What is a moral code?

A set of beliefs, values, and principles that guide a person's decisions about right and wrong.

What is an example of a moral code in healthcare?

A doctor believes it is wrong to treat patients unfairly based on income and provides fair treatment to everyone.

What is the difference between cost sharing and the RAND study?

Cost sharing is a way of paying for healthcare, while the RAND study examined how cost sharing affects people's use of healthcare.

What was the purpose of the RAND Health Insurance Experiment?

People who paid more out of pocket generally used fewer healthcare services.

What is the connection between cost sharing and the RAND Study?

Cost sharing is how patients pay for healthcare; the RAND Study examined how those payments affect healthcare use.

What is a disadvantage of cost sharing according to the RAND Study?

Patients may avoid necessary medical care because they don't want to pay.

What does it mean for a drug/device/tech/to be effective?

To accomplish the intended action they had in-mind

What is medical tech?

The application of science to create and use equipment and tools to diagnose, monitor, and treat medical conditions.

What are examples of medical technology?

Blood testing, laboratory equipment, X-rays, MRI machines, and ultrasounds.

What is HIT?

Health Information Technology: using computers and digital systems to manage healthcare information.

What are examples of HIT?

Electronic health records (EHRs), updating patient records, protecting confidential information, and managing billing systems.

What is the main difference between medical technology and HIT?

Medical technology focuses on diagnosing and treating patients, while HIT focuses on managing healthcare information.

What is telemedicine?

Providing healthcare services remotely through technology, such as video calls.

What is a major benefit of telemedicine?

It gives people access to healthcare professionals when they cannot physically visit a healthcare facility.

What are the controversies or disadvantages of telemedicine?

Privacy risks, inconsistent quality of care, unequal internet access, medication prescribing difficulties, and legal licensing issues.

Why is patient privacy a concern with telemedicine?

Patient information can be exposed through hacking, data breaches, or insecure platforms.

Why can the quality of telemedicine be a concern?

Doctors cannot always perform physical examinations through a screen.

Why is unequal access a problem with telemedicine?

Some patients do not have reliable internet access or the technology needed.

Why can prescribing medication through telemedicine be complicated?.

Providers may not be able to physically examine patients as they would during an in-person visit

What is a legal concern with telemedicine?

Some providers are not licensed to practice in every state, limiting where they can treat patients.

What does it mean for a drug, device, or technology to be effective?

It successfully accomplishes its intended purpose.

Why should we care about the efficacy of drugs, devices, and technology?

Because they cost money and affect patient safety. If they don't work, they waste time and resources.

What are the four categories of HIT?

Clinical information systems, administrative information systems, decision support systems, and internet/e-health technology.

What are clinical information systems?

Systems used to collect, store, and manage patient medical information.

What are administrative information systems?

Systems used to manage healthcare operations, scheduling, billing, and finances.

What are decision support systems?

Technology that helps make healthcare decisions and improve management.

What are the two types of decision support systems?

Managerial decision support and clinical decision support.

What is the difference between managerial and clinical decision support?

Managerial supports business and administrative decisions; clinical supports patient care and medical decisions.

What is internet and e-health technology?

Using the internet and digital tools to provide or manage healthcare services and information.

What is an EMR?

A digital medical record used within one healthcare practice.