10 Characteristics the differentiate the US Health Care System 1. No central agency governs a system 2. Access is selective based on insurance 3.

Transcription

1 10 Characteristics the differentiate the US Health Care System 1. No central agency governs a system 2. Access is selective based on insurance 3. Health care offered under imperfect market activity 4. 3 rd party insurers are intermediaries between finance and delivery 5. Multiple payers are cumbersome 6. Balance of power, no domination 7. Legal risk affects practice behavior 8. New technology creates demand for its use 9. New service settings along a continuum (primary, preventive, long-term, acute, etc.) 10. Quality is achievable

2 Moral Hazard: use of health care services to a greater extent with insurance coverage compared to no insurance coverage National Health Insurance: (Canada) financed through taxes, delivered via private providers National Health System: (UK) financed and delivered via the government (providers employed by the government Socialized Health Insurance: (Germany) financed through government-mandated contributions (that money goes to private, NFP insurance companies), delivered by private providers Health is not just the absence of disease Theories of Equitable Distribution: Market Justice (the economic good) based on willingness and ability to pay Social Justice (a social good) central agency is responsible, collectively financed and universally available Prevention: 1. Primary prevent the disease 2. Secondary early detection and treatment of disease 3. Tertiary - rehabilitation Maldistribution: a shortage/surplus of physician types needed to maintain the health status of the population 1. Geographic (shortages outside of metropolitan areas (<50k) 2. Specialty(imbalance between primary and specialty care (59.2% are specialists) Projected health care expenditure:

3 Quad Function Model with cost control measures: Rand Health Insurance Experiment: Individuals randomized to health plans with different co-insurance levels Overall, those with lower co-insurance used more health care (Moral Hazard, Elastic Demand for health care) Manning, W. G., Newhouse, J. P., Duan, N., Keeler, E. B., & Leibowitz, A. (1987). Health insurance and the demand for medical care: evidence from a randomized experiment. The American economic review, Cost, Quality, Access *Coppola et al., in Kongstvedt, 2007

4 Reasons for cost escalation: 3 rd party payment, imperfect market, growth of technology, increase in elderly population, medical model (treatment, not prevention), multi-payer system (admin costs), defensive medicine, waste/abuse, practice variations Cost-shifting: the ability of providers to make up for lost revenues in one area by increasing utilization or charging higher prices in areas free of controls Health planning: (supply-side contracts), an example is Certificate of Need (CON) legislation Demand-side incentives: ex. Cost-sharing by patients Supply-side regulations: ex. Anti-trust provisions that prohibit price fixing, price discrimination

5 Access to Care: the ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely manner (Framework is Andersen & Newman: predisposing, enabling, need) Quality of Care: there is no common consensus among patients, providers, and payers on what quality is. Donabedian Model: Accountable Care Organizations (ACO) Financial incentives for doctors, hospitals, and other health care providers to work together to coordinate care for Medicare beneficiaries (must take responsibility for 5000 patients * 3 years) Triple Aim: Quadruple Aim:

6 Health Policy: *Longest, B. B. (2010). Health Policymaking in the United States (Fifth Ed). Health Admin Press: Chicaco, IL Health policies can be made outside of government ex. Coverage decisions made by insurance companies. Principal features of US health policy: 1. Government as subsidiary to the private sector 2. Fragmented, incremental, and piecemeal reform 3. Pluralistic and interest group politics 4. Decentralized role of the States 5. Impact of presidential leadership Attribution: All information adapted from course slides, available on BlackBoard on 28 APR 2015.