foundations intro slides (health care)

a person or place that is licensed to provide health care

ex. physician, nurse, hospital NOT INSURANCE COMPANY

provider

entity that assumes the risk of paying for medical treatments

ex. employer, commercial health, uninsured patient

payer

are these the top 5 PAYERS or PROVIDERS?

1. UnitedHealthGrouo

2. Elevance (Anthem blue cross blue shield)

3. Kaiser Permanente

4. Centene (Ambetter)

5. Humana

PAYERS

What are the 4 models of Health care with their nicknames

1. Beveridge (Socialized medicine)

2. Bismark (Social health insurance)

3. National Health Insurance

4. Out of Pocket Model

which model is referred to as socialized medicine?

beveridge

what model is referred to as social health insurance?

bismark

in which model is the government the SOLE provider AND payer (universal coverage)

how are costs in this model?

which aspect of this model does the US utilize?

government provider + payer = beveridge (english ppl nice so they take care of you) — socialized medicine

low costs because government controls how much doctors charge you

us - veterans administration (VA)

in which model is universal healthcare paid for by payroll taxes?

many providers and payers are in this model?

which aspect of this model does the us utilize?

Bismark (social health insurance)

Bismark = MANY providers and payers

us - US affordable care act (obamacare)

in which model are there multiple providers but government is ONLY PAYER

how is the service?

which aspect of this model does the us utilize?

• national health insurance model

• slow and not many doctors available since they are paid less to participate

• CMS (centers for medicare and Medicaid are funded by the government and there are different providers not just government)

in which model does no money = no service

what part of us use this model

out of pocket model

people are not “poor enough” to get medicaid but too poor to afford commerical health insurance

in order to recieve medicaid what condition must you be in?

when was this standard set?

less than or = 138% above the poverty line

made possible by affordable care act (obamaCare)

what is the most expensive cost for payers?

what comes close after?

hospital care

physician and clinical services

prescription drugs

private health insurance:

• most often provided by ___________ while 15 million purchase their own health insurance

are HEALTH MAINTENANCE ORGANIZATIONS (HMOs) or PREFFERED PROVIDER ORGANIZATIONS (PPOs) more expensive? why?

• employer

• Preferred provider organizations (PPOS) are more expensive because there are more options for physicians available

which Medicare covers hospital insurance?

medicare part A

which Medicare covers medical insurance

medicare part B

which medicare covers presciption drugs

medicare part D

uninsured children from families that earn too much for medicaid/too little to afford private insurance

SCHIP (state childrens health insurance program)

What are two government- sponsored (taxpayer-funded) insurance

1. Indian health services (IHS)

2. veterans health administration (VA)

Indian Health Services:

• american indians and ______ natives

• members of a federally- recognized tribe or group under federal supervision

• live on tax—_________ land or own restricted property

• Alaskan

• exempt

Veterans Health Administration (VA):

• military veterans who served ______ consecutive months or the full period of call-up to active duty except

  • discharged for ____________caused or exacerbated by active duty

  • discharged for hardship or “early out”

  • served prior to sept 7 _____

  • current or former reserves or national guard must have been called to active duty by ___________order and completed the full duty of active order

24

disability

1980

federal

Affordable Care Act:

how did the affordable care act reduce the number of uninsured Americans?

Private Insurance:

• tax credits that lower healthcare insurance costs for those with incomes _____- ____% of the federal poverty level

• REQUIRES employers to cover their workers who can and tax credits to small employers who cannot
  

• expanded government and private insurance

• 100- 400%

What is the healthcare ranking system called?

Organization for Economic Co-Operation and Development (OECD)

what are the 6 qualities that are ranked in OECD

is the US doing good in any of these?

why do we do so poorly?

1. obesity

2. maternal/ infant mortality

3. avoidable death

4. chronic illness

5. life expectancy

6. spending

WE FAIL EVERY SINGLE ONE

• health disparities based on race, socioeconomic, sexuality (less quality care for certain individual = more death)

• healthcare is seen as a business so it is expensive so a lot of people don’t get help
  

what is the leading cause of death in america?

heart disease

any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the healthcare professional, patient, or consumer?

medication error

patient harm from drug exposure

does there have to be a medication error involved?

adverse drug event (ADE)

no, pharmacist could do everything right, but the patient takes the wrong dosage on their own

what is a preventable ADE (adverse drug event)?

medication error that reaches patient and causes harm

medication error does not cause harm (didn’t reach patient or just good luck)

potential ade

side effect — non preventable ADE (no medication error, but patient still experienced harm from drug exposure)

adverse drug REACTION (ADR)

what is used to distinguish drugs that have similar names

tall man lettering

Which countries utilize the beveridge model?

United Kingdom and Cuba

Which countries participate is Bismarck model?

Netherlands, France, Germany, Japan

Which countries participate in National Heathcare?

South Korea and Canada

Which countries participate in the out of pocket model

China, India, south America