ECON 170 Final

NP Trends

- huge growth rates (>7%)
- may overtake growth rate and actual amounts of MDs
- may lead to potential shortage of non-NP nurses

Path to Practice as a Physician

- degree
- certification by nat'l authority
- state licensure
- DEA number
- privileging by a healthcare org
- credentialing by managed care or other insurance entity

Graduate Medical Education

- state, fed, and local money used to help subsidize physician residency and education
- reforms include: Simpson-Bowles study to cut subsidies; expand the number of slots; redirect training to primary care; math funding to workforce needs; improve diversity and cultural competence

Physician compensation

Non-Cynical view
- intensity of training, work
- work length
- utility and requirements of practice
- surpluses of certain specialties

Cynical view
- taking advantage of reimbursement schemes
- pricing power due to specialty shortages

Backward Bending Supply Curve

- increased fees --> decrease physician services

Supplier Induced Demand

- physicians influencing patient's demand for care
- asymmetric info, agency issues, physician moral hazard?

Nursing Market

- subject to monopsony power (pricing power)
- have incentive to maintain market shortages
- keep control of patient care activities

Physician market

- far from economically competitive
- govt intervention (via edu subsidies) --> imperfections, with govt trying to fix
- NP market growing fast --> disrupting physician and nursing market

Compensation Models

Salary
- needs to compete w/ overall market

Fee for Service
- easier to see productivity incentives
- in capitation, incentives may reduce service utilization

Valued-Based Programs

- rewards providers and health systems that deliver better outcomes at lower costs
- difficult to implement since it's hard to track performance over time
- Medicare is beginning to take this reimbursement approach

Medicare Reimbursement Reform

- decreased FFS payments for surgeries and procedures
- increased payments for primary care
- paid regardless of patient outcome, so long as it met certain criteria

Malpractice and Torts

- over 400K deaths each year linked to medical errors
- 3.7% occur in hospitalizations
- few malpractices result in lawsuits
- costs around 2-5% of overall healthcare costs

Reimbursement Trends

- pay for performance model gaining steam in public and private markets
- Medicare 4 All raises prospect of normalizing salaries
- tort reform has been longed ignored

Firearm Injury Trends

- 60% of gun-related deaths are suicides (w/ white men particularly affected)
- women gun-death primarily result of partner violence
- men gun deaths spike in young adult years (w/ Black men particularly affected)
- approx. 400M guns in the US (true count unknown due to spotty data, black market and ghost guns)

Gun Death Solutions

- using a public health approach (gathering data, IDing risk and protective factors, developing and evaluating interventions, implementation)
- lack of research for gun violence
- very little data on protective risk factors
- safe gun storage areas
- firearm owner groups (to encourage gun safety and bystander intervention)