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PUBHLTH 129: Study Guide
class III medical devices |
-support life
-requires premarket approval from the FDA |
cost sharing |
-spreads risk from individual to group
-helps avoid moral hazard |
how do managed care plans differ from traditional insurance |
-contract with certain providers |
medicare part A |
-hospital insurance
-covers inpatient services, hospice skiled nurse |
medicare B |
-financed by annual deductables
-physician services, outpatient, diagnostics |
medicare C |
-private health care insurance
-HMOs, PPOs |
medicare D |
-prescription drugs |
capitation |
-fixed monthly fee
-removes incentive for provider induced demand |
retrospective |
-actual price when provider delivers service
-need to do more to get more |
prospective |
-set price before
-no incentives to keep patients longer |
what incentives do providers have to do discounted fee arrangements |
-higher volume of patients |
when was the HMO act passed and how did it work |
-1973
-trend increased but slowed down in 80s |
why did managed care grow in 1980s |
-private businesses couldnt afford rising premiums, wanted control over cost to help profits |
main characteristics of HMO |
-use of gate keeping
-focus on prevention and primary care
-soem fee for service |
differences between HMO and PPO |
-PPO's you can go out of network
-PPOs use more specialty care before preventative
-no risk sharing with PPOs |
three meanings of cost |
-consumers + financers: physician bills
-national perspective
-providers perspective |
major factors contributing high costs |
-growth of tech
-increase in elderly
-abuse of medicare/caid |
PROs |
peer review organization
-assesses care |
2 competition based cost containment stradegies |
-demand side incentives: wants customers to be more conscious
-supply: wants health care organizations to be cost efficient |
implications of definition of quality
|
-doesn't include cost or access
-quality occurs on a continuum
-emphasis on desired health outcomes |
dimensions of quality micro macro |
-micro-services at point of delivery, quality of life, patient satisfaction
-macro- quality from population stand point, cost, access, population health |
new developments and improvements |
-clinical practice guidelines: a plan for managing clinical problem based on evidence
-cost efficient when benefits recieved are greater than cost incurred
-timeline that identifies planned medical interventions along with expected patient outcomes |