Health Policy Midterm

What is the paradox of excess

More is not always better; over treatment can lead to worse outcomes, more financial burden without benefit

What are some examples of excess care leading to worse outcomes

Frequent MRI for low-risk pain - increase cost, anxiety, and complications

Antibiotics - overprescribing develops resilience, future infections are harder to treat

How are procedure and complication rates related

Higher procedure rates lead to higher complication rates

What is low-value care

Delivery of medical services with little to no proven benefit to the patient; unnecessary imaging, excessive blood tests

What is over diagnosis and over treatment

The diagnosis and treatment of conditions that would have never caused symptoms or harm

What is wasteful spending

US has massive healthcare spending with little / negative ROI

What are access barriers to healthcare

Lack of insurance, inadequate coverage, high costs

What are health inequalities

Vulnerable and less outspoken patient groups have reduced access to care and needed services. Well-off people tend to receive expensive, sometimes unnecessary, care.

What are social determinants of health

conditions in which people are born, grow, live, work and age

US has low investment in social services like housing, education, and food security

What causes the paradox of excess

Fee for service models, medial culture, technology and industry, a fragmented system, and patient expectations

What are implications for patients and the system because of the paradox of excess

Physical and emotional harm, poorer outcomes, financial burden, erosion of trust

What is a policy

A set of rules, principles, or guidelines created by an organization, government, or institution to guide decisions and achieve rational outcomes

Who can make a policy

Private actors, governments, authoritative decision makers,

What is HIPAA

Protects privacy and medical records, secures sensitive data, patients have rights over their health information

What did thee ACA do

Expanded access to health insurance, prohibited denial of coverage due to pre-existing conditions, focused on preventive care and reducing costs

Why do polices matter

Ensure patient safety and quality of care, provide standards across organizations, protect patients rights, support ethical and legal decisions, and improve efficiency

What are some health trends in 2025

Focus on customer will improve outcomes, clinical excellence in women's health, generative AI is shaping strategy and growth

What is plagiarism

Using someone else work, copying directly, paraphrasing too close to the original, submitted someone else's work

Why is plagarism unethical

Violates academic integrity and honesty, undermines trust in scholarship, steal credit, and can lead to serious consequences

What are the types of plagarism

Direct, self, mosaic, and accidental

What is the trend of healthcare spending in the US

It has increased

How do people pay for healthcare

Out of pocket or individual private insurance/a third party

Who is eligible for Medicare part a

65 years old, paid social security for 10 years, those under 65 who are totally and permanently disabled

How is Medicare financed

Through the social security system

Who is eligible for Medicare part B

Those in Medicare part A who elect to pay the $164.90 per month premium

What are the consequences of being uninsured

Less preventative care and screenings, higher rates of uncontrolled chronic illness, more late-stage diagnosis, higher risk of death

Who are the uninsured

Low-income individuals in non-expansion states, small business employees, undocumented immigrants, racial and income disparities group

Does insurance = affordability

No

Does access to care guarantee good health

No

What are non financial barriers to health care

Cultural/language barriers, racial/ethnic disparities in treatment and timeliness, gender disparities, shortages of primary care

What is the fee for service model

Providers are paid on the amount of service they provide

What is capitation model of payment

Provides received a fixed amount per patient per month

What is the salary method of payment

Providers receive a fixed salary regardless of services provided

What are bundle payments

Single payment for all of the services related to an episode of treatment

What are pay-for-performance methods of payment

Providers are rewarded for better outcomes in their patients

What is value-based care payment

Focus on improving patient outcomes while controlling costs

What is primary healthcare

The tier of healthcare services that first comes into contact with a patient; responsible for preventative care

What is secondary healthcare

The patients having various abnormalities are referred to secondary healthcare facilities; responsible for curative healthcare

What is tertiary healthcare

When there are not enough facilities or specialized health care for the management of a particular patient they are referred to tertiary care; responsible for more advanced curative care

What are the two systems that healthcare can be organized into

Vertical and horizontal

describe horizontal healthcare systems

a

Goal - improve overall health through collaboration

Services - comprehensive primary care through public health systems

Features - improve coordination and communication between health services

Examples - general health services

Describe vertical health systems

Goal - treat specific diseases through targeted interventions

Services - provide disease-specific interventions, often through stand-alone programs

Features - improve quality of care through coordination and information sharing

Examples - mass campaigns to control communicable disease