HS 544: HEALTH CARE ECONOMICS

What is health? A complete state of mental, physical, and social well-being; not merely the absence of disease. What effects health? Lifestyle, genetics, diet, sleeping, stress, air, water, medical care, immunization Individual health can be measured by morbidity and mortality rate. What is quality? Meeting or exceeding the expectations of the customer. What is quality medical care? Diagnosis, outcome, equipment, service, customer care What is value? The amount of money you are willing to pay for something. What is managed care? An organization designed to manage care. Looking to keep cost down Appropriate amount of care for the appropriate cost.

Types of managed care? HMO - Health Maintenance Organization Physicians are salaried; meaning if they see one or the maximum amount of patients, they still get paid the same amount. Issue: People didnt feel they were receiving quality care. Was true in the beginning, because they worked out a deal with the physician to maximize profits. Meaning, find a way to give less treatment and they will give them a percentage of the profits. You must choose doctors, hospitals, and other providers in the HMO network. You will need a referral from your PCP to see a specialist (such as a cardiologist or surgeon) except in emergency situations. Your PCP also must refer you to a specialist who is in the HMO network. The only charges you should incur for in-network services are copayments for doctor's visits and other services such as procedures and prescriptions.

PPO - Preferred Provider Organization contracted to charge a certain amount You can choose doctors, hospitals, and other providers from the PPO network or from out-of-network. If you choose an out-of-network provider, you most likely will pay more. You do not need a referral to see a specialist. However, some specialists will only see patients who are referred to them by a primary care doctor. And, some PPOs require that you get a prior approval for certain expensive services, such as MRIs. In most PPO networks you will only be responsible for the copayment. Some PPOs do have an annual deductible for any services, in network or out of network.

POS - Point Of Service Social issues that affect health? How much are you willing to pay for others to have health care? Age - More willing to help a child, but not an elderly person. Income level Not willing to pay for someone who has a lot of money vs. someone who doesnt have any money. Education More educated people know when they need to go to the doctor. Will ing to help them because they can articulate their case better. Marital/family status Married couples tend to see the doctor more than an single person, because in the case of the men, the wife is making them a doctors appointment; otherwise, they are less likely to go. Also, parents are always taking their children to the doctor when they do not feel well. Members of a POS plan do not make a choice about which system to use until the point at which the service is being used.

Supply - how much the market can offer. The quantity supplied refers to the amount of a certain good producers are willing to supply when receiving a certain price. The correlation between price and how much of a good or service is supplied to the market is known as the supply relationship. Demand - how much (quantity) of a product or service is desired by buyers. The quantity demanded is the amount of a product people are willing to buy at a certain price; the relationship between price and quantity demanded is known as the demand relationship.

Changes in supply occur as a result of physician shortages or surpluses and a host of other factors. At some point in time however, the treatment plan is completed, the patient is satisfied, and additional services are not needed. This is known as market equilibrium.

Provider payment (how do we pay people?) Relationship between the patient (customer) and the agent (payer). Payments come from the customer and the insurance company. The insurer reimburses the provider for services rendered. Physician reimbursement 1. Fee-for-service - paid for the services rendered. 2. Per case reimbursement MD is paid a fixed rate for each type of case treated. (similar to DRG) 3. Resource based relative value unit classify cost incurred by the physical hospital in a competitive market strategy. 4. Hospital reimbursement - Prior to the 1980s, payments were retrospective

a. Prospective Billing Hospitals getting paid some money ahead of time; either from patients or part of premium. b. Per diem Based on an average cost of sending a patient somewhere. Fees share the risk between provider and payer. How does competition affect the market? Competing means price will down because you want that customer to buy their product from you. If there is no competition in your area, then you can charge whatever you want. a. Greater supply, lower price b. Higher demand, higher price c. Less supply, higher price Anti-trust is in place, because it allows for competition in the market; it forces the market to change/ improve. Monopoly there is only one seller of the product, so they can charge you whatever they want. Monopsony have one large buyer. Ex. McDonalds; in healthcare, government is an example. Medicare is the single largest health care system in the world. Once monopsony and monopoly reach equilibrium, then you have reached the optimal price of care.

Health insurance risk pool Create a risk pool; this means you take a certain amount of risk (money) from everyone and put it together. Even if you dont use your insurance, a payment is due every month Insurance is a gamble Market demand for health insurance is increasing because healthcare cost is increasing. And if you dont have insurance, its going to cost you more to see a doctor. Have to have at least 80% in the risk pool at all times, if it goes below, then you are going to have to raise premiums to make that money back. With employer offered health insurance, you have to charge everyone the same price, regardless if they have a pre-existing condition or not.

One of the biggest differences is Medicaid cost is shared between federal government and individuals states and Medicare is funded totally by the federal governed. Until recently (2006), Medicare did not cover prescription drugs and under Medicaid, prescription drugs have always been covered. Medicare Medicare covers almost everyone 65 or older, certain people on Social Security disability, and some people with permanent kidney failure. Medicare is a federal program

4 parts of Medicare: - Part A: Hospitalization coverage - provides basic coverage for hospital stays and post hospital nursing facility and home health care. No premiums, but there is a 20% deductible. Medicare pays 80%

Some people use supplemental insurance to cover the other 20%. Ex. AARP drugs while in the hospital are covered. - Part B: Medical insurance - pays most basic doctor and laboratory costs, and some outpatient medical services, including medical equipment and supplies, home health care, and physical therapy. Its voluntary; you dont have to take it. Have a premium and a deductible. - Part C: Privately purchased supplemental insurance that provides additional services and through which all Medicare services offered by Part A and Part B can be accessed. Medicare Managed care program; Its a mechanism to help control cost. - Part D: Prescription drug coverage. They are covered up to a certain amount; once you reached that amount, you have reached the donut hole. This means you are responsible for Paying for your medicine for the duration of the year. Then if you reach a certain amount after you reach the donut hole, then Medicare will pay 100% of insurance for the duration of the year. Medicaid A federal program for low-income, financially needy people, set up by the federal government and administered differently in each state. (50% paid by government and 50% paid by state) Covers(non terminally ill) children and mother, low income older people who dont qualify for Medicare, blind, regardless of income Ran by the state

5 Goals of Medicare 1. 2. 3. 4. 5. Affordability is the entire program going to be affordable for the federal government Equity burden of Medicare would fall on a specific group of people. (i.e. Working class) Adequacy availability of care going to be adequate enough for people on Medicare Feasibility with a program the size of Medicare, is it feasible to implement changes? Acceptance how well will the consumer accept this program

Policy alternatives Because it has become so expensive, they have to make changes. Scope: age 65..why? Because life expectancy was between 65-69, which means they would only be using the service approximately 3 years. Now people are living longer, so they want to push it to 67. Add a premium, so there will be more money in the risk pool

How would you reform the system? Why do we need health care reform? Its about cost shifting; who can we get to pay for something. The purpose of the Health Care Reform Act is to end abuses by insurance companies and to allow access to health care by all Americans. The intention is also to curb the rising costs of health care

Anti-trust (Sherman/clayton act)

Deals with the concept of a monopoly there is only one seller of the product, so they can charge you whatever they want.

Sherman act 0f 1890 Dealt with changes in transportation and communication. Changing regional markets into national markets dealt with the railroads. to oppose the combination of entities that could potentially harm competition, such as monopolies or cartels Not to protect businesses from the working of the market; it is to protect the public from the failure of the market.

Clayton Act of 1914 Trying to keep thing from being in a monopolistic place. Allow competition and growth. Completion helps keep prices down; this works in favor of the consumer contained safe harbors for union activities

Policies effect the environment (genetics) Regulatory policies designed to influence actions. Ex. Government setting rates Social regulations deals with the ability to take people out of society. Ex. Sending criminals to jail Air & water regulations Behavior/Genetics smoking cigarettes, alcohol designed with age restrictions to keep it out of the hands of children.

Availability affected by Money - cant afford to go to the doctor Location may live in an area where you have to travel far away to go to the doctor Physician shortage- which makes it hard to see a docotor ij a timely fashion.

Medicare as a social contract Family planning acts To provide adequate family planning services to all who want them but cannot afford them. Provides support and funding for family planning clinics that are vital to millions of young women and low-income individuals each year in this country who need access to reproductive health care. Designed to reduce the number of abortions Reduce the number of unwanted pregnancies For every single dollar spent on family planning, $4 - $8 was saved from public sector cost.

Family planning policies 1. Title V block grant given to states for maternal and child health. States are required to match federal funds; so if government gives 3, you have give 4. Give them funds to use on family planning already in process

 Allowed them to expand. Problem: since the funds werent regulated 2. Title X - similar to V, but the difference is funds were required to be spent on family planning only. 3. Title XX allowed dollars to be used for nay form of social services. Concept of federal block grants Large sum of money usually given to the state with a broad definition on how to spend it. An advantage of block grants is that they allow regional governments to experiment with different ways of spending money with the same goal in mind, though it is very difficult to compare the results of such spending and reach a conclusion. A disadvantage is that the regional governments might be able to use the money if they collected it through their own taxation systems and spend it without any restrictions from above.

Role of special interest groups Insurance companies, drug makers, hospitals, device and equipment manufacturers, doctors. Special interests groups are an association of individuals or organizations that attempts to influence public policy. They are usually concerned with one or a small range of issues. Their role is to link the governed with the government, allowing the group to politically participate in the public policy process. They often act as sources of technical and political information for policymakers. A

Political economy of Medicare An understanding of the political economy of Medicare is perhaps best achieved by thinking along three dimensions: (1) Medicare as redistributive politics; (2) Medicare as special-interest politics; and (3) Medicare as distributive politics.

Seeing the extent to which Medicare policies flow from these political processes makes clear that Medicare reform and broader political reform are, at some level, inseparable and indistinguishable. Redistributive policy Provider befits to the elderly and disabled by transferring income from working age people. 60% of Medicare revenue comes from payroll taxes. Benefits are distributed

Medicare payment policy Ensure elderly and disabled have access to and receive quality care. Payment system must establish rates that reflect competitive prices in the market.

HIPAA - Health Insurance Portability and Accountability Act

Designed to give people the right to carry insurance from place to place. People wanted to change jobs, but felt restricted, because they might not get the same coverage. Started because of pregnant women. May change jobs and not know they are pregnant. So they go to another job, the employee say they cannot cover the pregnancy because it was a pre-existing condition. HIPAA makes insurance portable; if you can show there is no break in credible insurance. Cannot exclude people with pre-existing conditions Privacy act came about because of HIPAA; you have the right to refuse to give employer your medical records. Put regulations in place that deal with employee sponsored group insurance policies. Make sure everyone pays the same premium, deductible, etc. Require all group insurance policies to open enrollment at least once a year; means you can change your policy, coverage, and add/subtract people Before HIPAA, outside of having a baby, that was the only time you could add someone.

Setting performance standards Licensure says you met certain standards. Why? So the state can make money Accreditation standards that must be met before you can do a job. Ex. JCAHO HCFA minimum of what you need to do Universal precaution came about because of HIV. Do the same thing to protect all doctors and patients.

Tobacco industry Public policy for healthcare Started by dealing with a regulatory review Juries have been reluctant in to hold tobacco companies liable because adults make their own choices Medicaid found out that second hand smoke was affecting the children, so they had to do something about it. It was costing them more money. Added a sin tax to cigarettes to recover that money.

Pros/cons using litigation Pros Cons Separation of power say litigation is inappropriate Procedural restraint Can hurt legislation through a perceived solving of the problem Litigation can be extremely expensive because of fees for filing court documents and paying attorneys. Depending on the case, litigation can drag out for months, or even years, extending these costs. Can be used when all else has failed Court can impose more damages May change public opinion

Although litigation proceedings may not be open to the public, they do give the public an awareness of the legal conflicts. This awareness is crucial to making decisions about affiliations and business partnerships. It allows the public to scrutinize each party carefully, which can get each party to play by operational and fairness rules.

Litigation the set of formal legal proceedings that enforce rights brings about new polices Many regulations come from this Can cause cost to go up because of attorney and court cost (extra cost that has nothing to do with healthcare)

Function of litigation Compensation people sue to get money. A way of making the person whole again Deference Accountability legal way to assign blame Equity jurisdiction when money is not enough to compensate for what happen; send person to jail

Social movements and how they affect health care A catalyst for policy change Ex. Smoking and guns Litigation made people aware of issues with second hand smoke Ideologies change over time Behavior change want to see how people react Attitude/beliefs begin to change once that happens is usually when public policy take effect. Society begins to judge based on if something is moral

Genetic privacy Right to be left alone Right to decide whether to receive info about themselves from a 3rd party Right to decide how to share information Right to prevent re-disclosure of info that was originally disclosed confidentially This approach to genetics policy is known as genetic exceptionalism, which calls for special legal protections for genetic information as a result of its predictive, personal and familial nature and other unique characteristics. Treat genetics like health care information Restrict any or certain parties (such as insurers or employers) from carrying out a particular action without consent. Laws in 17 states require informed consent for a third party either to perform or require a genetic test or to obtain genetic information. Twenty-seven states require consent to disclose genetic information. Alaska, Colorado, Florida, Georgia, and Louisiana explicitly define genetic information as personal property. Alaska also extends personal property rights to DNA samples.

Health Care Finance Administration

HS 541: Health Service System

What determines health? Demographics where you live Gender - single males are most affected, because they dont go to the doctor. When they get married, they will go more often, because wife is making the appointment. Age older people tend to use healthcare more Race & ethnicity difference races has different diseases that affect them. Ec. Sickle cell in African Americans Economic status low income areas access health care the least amount, because they dont have the money to go. Education the more educated you are, the more health care you Want to receive. Environment - water, air and pollution can affect your health. Service utilization effects how the system runs

Health: complete state of mental, physical and social well-being. Illness: not having all the areas of health in good standing. Social illness: someone who does not meet the norm. Medicine: not an exact science not every acts the same to medicine/treatment Access to health care Insurance if they dont have insurance cant afford to pay for health care Money dont have the money to pay for health care Geography where you live, would have to travel a long distance to see a doctor

FDA Food and Drug Administration Control approval and marketing of both prescription and over the counter drugs. Check on the safety of food, cosmetics testing, drug testing and medical devices. Does not get involved in herbal supplements because they are not considered drugs or food. Looks at data, and research before a product is approved. Its takes 5 to 7 years. Before you can do clinical trials, there are other processes you have to go thru. Last trial: animal clinical trials which is done on monkeys, because its the closet to human. It is very expensive.

Also approves medical equipment and durable medical equipment such as wheel chairs, crutches, prosthetics and surgical dressings. Also cosmetics

Comprehensive health planning act (1966) looks at the resources necessary on how we go forward with healthcare resources necessary for identified needs would be forthcoming consumer and provider could achieve a collaborative process which could be implemented. Participants would voluntarily abide by the plan created a state and local agencies charged with developing state wide, comprehensive plan for the delivery of health services in each state. Planning agencies included citizen representation Planning agencies had no authority to implement their plans

Health Planning Act of 1974 -Replaced Comprehensive health planning act 1966 - Required participation of consumer - Required states to have a 4-1,000 hospital ded to population ratio - Established the CON program What is health promotion? Usually based on lifestyle issues such as: Physical activity and fitness Nutrition Tobacco use Alcohol and drug use Family planning Mental health and mental disorder Violent and abusive behavior Education System is not organized and is very haphazard Usually based on individuals self-awareness which leads to looking for programs. Problem: not a very organized system, a lot of people are promoting things, advertising

Disease prevention Primary focus on agent causing the disease. Look at genetics and do health screenings to prevent Secondary early detection and treatment (pap smear, mammogram, colonoscopy) Tertiary reduce resulting issues when treatment is received. - reduce post op infection - prevent diabetes complications - HIV education

How is health services delivered?

Patient Find patient, make sure they are aware that they are patients, need patients in order to treat them. Providers Physicians, hospitals, etc. need enough providers In order to service patient needs. Payers someone has to pay for it. Ex. Insurance, government Political Government unit is in existence thru Medicare/Medicaid. They dont provide the care, but the insurance company pays for it.

Difference between Primary Care- 1st Contact with treatment system 1. Diagnosis & initial treatment 2. Episodic care for non-chronic illness 3. Prescription drugs 4. Routine dental care 5. Potentially serious conditions requiring prompt attention **where we see the largest issues such as access Secondary Care- ambulatory medical services and commonplace inpatient acute care. Generally chronic conditions. MDs are the predominant provider; chronic issues that require follow up ** access is often an issue; financial barriers are high; population needing care is large Long term care- continuous care for at least 90 days. People who have lost some capacity for independence. Tertiary Care highly specialized, costly complex care; in patient care. These are patients who had transplants Palliative/hospice care treat people who have terminal illnesses without trying to cure them; treating the pain Treat the pain Put them in a comatose state Letting the disease take its course

Mental illness People who are outside of what is considered normal. Mental illness is any disease or condition affecting the brain that influences the way a person thinks, feels, behaves and/or relates to others and to his or her surroundings. many of these conditions are caused by a combination of genetic, biological, psychological and environmental factors. One thing is for sure Many mental illnesses run in families, suggesting that the illnesses may be passed on from parents to children through genes. Some mental illnesses have been linked to an abnormal balance of special chemicals in the brain called neurotransmitters. Some mental illnesses may be triggered by psychological trauma suffered as a child, such as severe emotional, physical or sexual abuse; a significant early loss, such as the loss of a parent; and neglect. Certain stressorssuch as a death or divorce, a dysfunctional family life, changing jobs or schools and substance abusecan trigger a disorder in a person who may be at risk for developing a mental illness. Treated by psychiatrist, psychologist, therapist, counselor, social worker.

Over 15% of the population suffer from mental illness 66% of these people are physically disabled because of this. Ex. Depression, schizophrenia, bipolar

Health service workforce professionals. (who they are, how they become a Physician 4 years of college: earn a BS or BA degree, usually with a strong emphasis on basic sciences, such as biology, chemistry, and physics (some students may enter medical school with other areas of emphasis). 4 years of medical school: U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME) Residency program (graduate medical education): 3 to 7 years of professional training under the supervision of senior physician educators. The length of time depends on your medical specialty. For ex. family practice, internal medicine, and pediatrics, require 3 years of training; Fellowship: One to three years of additional training in a subspecialty is an option for some doctors who want to become highly specialized in a particular field, such as gastroenterology, a subspecialty of internal medicine and of pediatrics, or child and adolescent psychiatry, a subspecialty of psychiatry. Must obtain a license to practice medicine from a state or jurisdiction of the United States in which they are planning to practice. They apply for the permanent license after completing a series of exams and completing a minimum number of years of graduate medical education. The majority of physicians also choose to become board certified, which is an optional, voluntary process. Certification ensures that the doctor has been tested to assess his or her knowledge, skills, and experience in a specialty and is deemed qualified to provide quality patient care in that specialty.

Dentist Complete a Bachelor's Degree: earn a BS or BA degree, usually with a strong emphasis on basic sciences, such as biology, chemistry, and physics (some students may enter medical school with other areas of emphasis). However no specific major is required all candidates, no matter the major, need to complete prerequisites in physics, biology, chemistry, biochemistry and statistics. Pass the Dental Admission Test: All dental schools require applicants to complete the Dental Admission Test (DAT), administered by the American Dental Association (ADA). Dental schools use DAT scores, GPAs and letters of recommendation to make admittance decisions. Complete Dental School: To become a dentist, individuals must earn a DDS at a 4-year dental school certified by the Commission on Dental Accreditation. Take the National Board Dental Examination All prospective dentists must pass the National Board Dental Examination (NBDE) to obtain a state license. The ADA administers the 2-part exam. Part one covers basic health topics, such as physiology, gross anatomy, dental anatomy, biochemistry and occlusion. Part two tests candidates' knowledge in specific dental areas, including pediatric dentistry, oral diagnosis, pharmacology and operative dentistry. Additionally, most states administer their own practical and written exams that individuals must pass to obtain a state license, though some award licensure to candidates who pass the NBDE. Start a Practice or Join a Partnership: The U.S. Bureau of Labor Statistics (www.bls.gov) reports that the majority of dentists are general practitioners who work in private practices. These dentists are commonly partners in or sole proprietors of their practices and may employ a small number of associates or assistants.

History of hospitals Originated in the 17th century Before the 17th century when people got sick, they were isolated, because they had no cure. Ex. Leprosy People would open up their houses and take in sick people. sick house were considered poor houses because they couldnt afford physicians. Were sent there to die Sick houses help advance healthcare today. They were like laboratories. People were experimented on in hopes of finding a cure. Edwards hospital in Naperville started as a sick house. A women treated her husband Edward in her house until he died. Then she converted it into a hospital. 1890s for profit hospitals came about; turned hospitals into a business 1920s it changed because of the great depression Lot of health care businesses went under Government set up tax breaks, so religious groups could create poor houses to help people

Hill Burton Act 1946: Also known as the Hospital Survey and construction act of 1946 Designated to construct hospitals in rural areas by making funds and resources available. In later years, it was modified to fund replacement facilities. Ambulatory coast centers, nursing homes, rehab centers, center for chronic disease. Modification of existing hospital, especially MD educational centers Originally dealt with hospitals and remodeling. Changed to a vertical integration; does not have anything to do with horizontal integration.

Dr. Ernest Codman (1869-1940) A Surgeon Got involved at looking at post opt infections Known for Establishing end results based medical care. He set in motion the idea of measuring outcomes

Finance How do we finance the health care system? Health insurance has been the major financing mechanism for quite some time. After WWII, insurance covered more than just work related injuries. Insurance is designed to protect against unpredictable loss Public and privately funded 70% privately covered 1/3 federal government coverage 1/3 funds non Medicare 12% state government

Health insurance risk pool

Create a risk pool; this means you take a certain amount of risk (money) from everyone and put it together. Even if you dont use your insurance, a payment is due every month Insurance is a gamble Market demand for health insurance is increasing because healthcare cost is increasing. And if you dont have insurance, its going to cost you more to see a doctor. Have to have at least 80% in the risk pool at all times, if it goes below, then you are going to have to raise premiums to make that money back. With employer offered health insurance, you have to charge everyone the same price, regardless if they have a pre-existing condition or not. Claims are paid from the risk pool and premiums are paid into the risk pool.

Forms of Insurance Blue Cross Established in 1929 It was first created for teachers Prepaid insurance for groups of people Paid for hospital stay Issue: covered hospitals and not doctors.

Blue Shield Established in 1939 Covered the doctors

Medicare Medicare covers almost everyone 65 or older, certain people on Social Security disability, and some people with permanent kidney failure. Medicare is a federal program

4 parts of Medicare: - Part A: Hospitalization coverage - provides basic coverage for hospital stays and post hospital nursing facility and home health care. No premiums, but there is a 20% deductible. Medicare pays 80% Some people use supplemental insurance to cover the other 20%. Ex. AARP drugs while in the hospital are covered. - Part B: Medical insurance - pays most basic doctor and laboratory costs, and some outpatient medical services, including medical equipment and supplies, home health care, and physical therapy. Its voluntary; you dont have to take it. Have a premium and a deductible.

- Part C: Privately purchased supplemental insurance that provides additional services and through which all Medicare services offered by Part A and Part B can be accessed. Medicare Managed care program; Its a mechanism to help control cost. - Part D: Prescription drug coverage. They are covered up to a certain amount; once you reached that amount, you have reached the donut hole. This means you are responsible for Paying for your medicine for the duration of the year. Then if you reach a certain amount after you reach the donut hole, then Medicare will pay 100% of insurance for the duration of the year. Medicaid A federal program for low-income, financially needy people, set up by the federal government and administered differently in each state. (50% paid by government and 50% paid by state) Covers(non terminally ill) children and mother, low income older people who dont qualify for Medicare, blind, regardless of income Ran by the state They are required to make payments to hospitals at least once a year Goals of Medicare Affordability is the entire program going to be affordable for the federal government Equity burden of Medicare would fall on a specific group of people. (i.e. Working class) Adequacy availability of care going to be adequate enough for people on Medicare Feasibility with a program the size of Medicare, is it feasible to implement changes? Acceptance how well will the consumer accept this program

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HIPAA - Health Insurance Portability and Accountability Act Designed to give people the right to carry insurance from place to place. People wanted to change jobs, but felt restricted, because they might not get the same coverage. Started because of pregnant women. May change jobs and not know they are pregnant. So they go to another job, the employee say they cannot cover the pregnancy because it was a pre-existing condition. HIPAA makes insurance portable; if you can show there is no break in credible insurance. Cannot exclude people with pre-existing conditions Privacy act came about because of HIPAA; you have the right to refuse to give employer your medical records. Put regulations in place that deal with employee sponsored group insurance policies. Make sure everyone pays the same premium, deductible, etc. Require all group insurance policies to open enrollment at least once a year; means you can change your policy, coverage, and add/subtract people Before HIPAA, outside of having a baby that was the only time you could add someone.

Revenue Where it comes from, where its spent Spent Bulk spent on hospitals MD services Home health Drugs nursing care research and construction

Access, cost, Quality If we increase access, cost will increase because of the volume of care being provided. This in turn will decrease quality of care. If we decrease cost, quality of care will decrease, and access will also decrease because cant afford doctors to service patients. If we increase quality, cost will increase, and access will decrease, bercause patients are spending a lot of time with patients. Patients based quality of care on: appointment time amount of time doctor spend with them cleanliness how they are treated food quiet tv works outcome; did they get well

TQM Total Quality Management Functions on the premise that the quality of products and processes is the responsibility of everyone who is involved with the creation or consumption of the products or services offered by an organization. Capitalizes on the involvement of management, workforce, suppliers, and even customers, in order to meet or exceed customer expectations.

CQI- Continuous Quality Improvement An approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems: it focuses on "process" rather than the individual; it recognizes both internal and external "customers"; it promotes the need for objective data to analyze and improve processes.

Focus on process Structural problem solving Cross functional teams Employer empowerment Focus on customer

JCAHO measures quality; its a standard to follow, but it doesnt mean your way is wrong. PSRO - Professional Standards Review Organization Originally designed to see how physicians treated their patients. (what drugs they use, etc.) Like physicians grading physicians Problem: Physicians were reluctant to report problems. No protection for physicians with often resulted in lawsuits for slander.

PRO Peer Review organization Designed to be an educational piece. PIM process Improvement methodology (same as TQM and CQI) Technology (assessment, development) Assessment Process of examining medical technology used in care giving and reporting properties such as safety, efficacy, feasibility, indication for use of cost, cost effectiveness as well as social and ethical consequences.

Effect health care An increased use of something until it is almost over used can now treat diseases that was once untreatable diagnosis what we are not able to cure

Stages/development promising reports - going in a direction were we see something helpful professional organization looking over reports official randomized clinical trials paid studies; look for people with disease and treat them for free. Standard procedure - something that will be accepted and paid for by insurance. Public acceptance see advertisement to make people want to buy it. Professional discredidation consider old technology because something new has come out and work better. Market erosion anything done with id discredited. Lot of equipment and drugs we no longer use.