This is a basic table defining some of the major terms and issues in healthcare today. Great for someone who wants some basic definitions and a quick reference guide.

1. Critical
Issues
Final
Review
Sheet
Topic
Details
Medicare
-­‐
Federal
health
insurance,
65
and
over,
eligible
for
ss
disability
payment
and
indiv
who
need
kidney
transplants
or
dialysis
-­‐Part
A
–
(hospital
insurance)-­‐>
inpatient
care,
skilled
nursing
facility,
hospice,
home
health
care,
no
premium
required
-­‐Part
B-­‐
(medical
insurance)-­‐>
covers
medically-­‐
necessary
services
like
doctors’
services
and
outpatient
care/preventive
services
-­‐Part
C-­‐
(Medicare
Advantage
Plans)
–
combines
A,
B
and
D
-­‐>
managed
by
priv
ins
companies
approved
by
Medicare
-­‐Part
D-­‐
(Medicare
Prescription
Drug
Coverage)
helps
cover
prescription
drugs
Medicaid
-­‐
Federally
aided,
state-­‐operated
and
administered
program
-­‐>
low-­‐income
families
with
children,
elderly,
disabled,
blind
individuals
who
are
covered
by
SSI,
pregnant
women
whose
family
income
under
133%
of
poverty
level
Two
Models
of
Government
Health
Plans
Social
Insurance
=
Medicare
(only
those
who
have
paid
are
eligible)
Public
Assistance
=
Medicaid
(criteria
based
on
income
and/or
medical
condition)
-­‐>
those
who
contribute
may
not
be
eligible
SCHIP
-­‐
Cover
uninsured
children
up
to
age
19
from
families
who
made
too
much
$
to
qualify
for
Medicaid
Socioeconomic
Status
-­‐
Social
standing
or
class
of
an
individual
or
group
-­‐
Measured
as
a
combination
of
education,
income,
occupation
-­‐
Often
reveal
inequities
in
access
to
resources,
plus
issues
related
to
privilege,
power,
and
control
Gradient/Gap
-­‐
gradient
isn’t
just
about
“poor”
-­‐
every
rung
up
SE
ladder
people
w/in
society
tend
to
be
healthier
and
live
longer
the
higher
up
you
go
-­‐person-­‐level
unit
of
analysis
–
rigorous
evidence
of
a
strong
and
positive
association
between
absolute
SES
and
health
-­‐
health
is
affected
by
social
position
and
scale
of
soc/econ
diff
among
the
population
-­‐
in
terms
of
income,
relationship
is
with
relative
rather
than
absolute
income
levels

2. Epidemiologic
Transition
-­‐
poor
places
suffer
with
poorer
health
and
lower
life
expectancy
-­‐
economic
improvement
leads
to
improvements
in
health
and
life
expectancy,
but
only
to
a
point
Gini
Index
-­‐
“measurement
of
the
income
distribution
of
a
country’s
residents.
Number
ranges
from
0
to
1
and
is
based
on
residents’
net
inome,
helps
define
the
gap
between
the
rich
and
the
poor,
with
0
representing
perfect
equality
and
1
representing
perfect
inequality.
Pathways
for
SES
Relationship
to
Health
Social
Mobility-­‐
people
in
poor
social/econ
condition
because
of
poor
health
-­‐>
has
impact
on
social
mobility
but
too
small
to
account
for
health
diff
Behav/Cultural-­‐
Lack
of
self-­‐regulation,
poorly
developed
coping
skills,
external
locus
of
control,
discount
rates,
collection
of
learned
behaviors
w/in
a
community
Materialistic-­‐
Higher
income
affords
better
shelter,
food,
clothing,
more
education
-­‐>
safer,
less
phys
demanding
jobs,
wealthier
places
have
better
schools,
hospitals,
transportation
Pyschosocial
Mechanisms-­‐
Stress
of
trying
to
keep
up,
humans
well
designed
to
deal
w/
immediate,
short-­‐term,
actionable
stress
Policies
to
Decrease
SES
Health
Inequalities
-­‐
Income
redistribution
-­‐
Education
Promotion
-­‐
Social
Cohesion
PPACA
****Refer
to
the
document
Gardent
posted
that
describes
all
the
different
features
in
detail
1. Providing
Health
Care
to
All
Americans
2. Role
of
Public
Programs
3. Improving
quality
and
efficiency
of
health
care
4. Prevention
of
chronic
disease
&
public
health
5. Health
care
workforce
6. Transparency
&
program
integrity
7. Improving
access
to
innovative
therapies
8. Community
living
assistance
services
&
supports
9. Revenue
provisions
Individual
Mandate
Employer
Requirements
Health
Insurance
Exchanges

3. Changes
to
Private
Insurance
Paying
for
PPACA
Societal
Approaches
to
Changing
Behavior
Individual
(medical
model)
-­‐
Convince
individuals
not
to
smoke,
drink,
eat,
ect
-­‐
Counseling
-­‐
Education
Population
(public
health
model)
-­‐
Broad
public
health
efforts
might
be
a
better
use
of
funds
-­‐
Change
social
structure
• Education
Campaign
(knowledge)
• Marketing/Advertising
(Fear/Promote)
• Social
Change
(make
it
socially
negative)
• Ban/Restrict
(limit
access)
• Tax
(make
it
more
costly)
Pauly
Article
–
Disruptive
Innovation
-­‐Using
cheaper,
simpler,
more
convenient
products
or
services
that
meet
needs
of
less
demanding
customers
-­‐
dominant
players
focused
on
improving
products/services
miss
more
convenient
and
less
costly
offerings
-­‐
A
little
less
quality
for
a
lot
less
money
-­‐
(think
of
the
flat
curve
of
spending
Hansen
referred
to
in
his
lecture)
Role
of
Pricing
in
HC
Costs
-­‐
is
supply
inducing
demand
or
is
demand
inducing
supply?
Economics
of
Employer
Mandate
-­‐
Making
employers
provide
costly
insurance
reduces
the
demand
for
labor
-­‐
If
insurance
is
part
of
the
package-­‐
the
supply
of
labor
also
increases
Consumer
Choice
and
Moral
Hazard
-­‐How
much
healthcare
will
people
demand
with
marginal
price
close
to
zero
-­‐
How
does
that
compare
to
what
we
would
demand
in
a
world
with
“perfect
insurance”
Hospital
Consolidation
-­‐
Increases
in
hospital
market
concentration
lead
to
increases
in
price
of
hospital
care
-­‐
Hospital
mergers
in
concentrated
markets
lead
to
significant
price
increases
-­‐
for
some
procedures
-­‐>
hospital
concentration
reduces
quality
-­‐
Hospital
competition
improves
quality
under
an
administered
pricing
system
-­‐
Competition
improves
quality
where
prices
are

4. market
determined,
although
the
evidence
is
mixed
Healthcare
Ethics
–
General
Principles
-­‐
Health
care
ethics
relates
to
national
policy/reform:
-­‐
access,
quality,
safety,
effective,
and
value
-­‐
Ethics
is
a
driver
for
health
care
change
Healthcare
Ethics-­‐
Healthcare
Organizations
-­‐
Ethics
defines
what
and
who
organization
is
at
its
core
-­‐
Serves
as
how
organization
will
fulfill
that
foundation
in
practice/culture
and
how
it
will
address
ethical
conflicts
Common
Morality
Respect
for
patients
(autonomy)
–
Promoting
self-­‐
determination
through
shared
decision-­‐making,
confidentiality,
truthful
communication,
promise-­‐
keeping
Promote
patients’
best
interests
(beneficience,
nonmaleficence)-­‐
promoting
beneficial,
evidence-­‐
based
care
w/in
rel
and
avoiding
actions
that
cause
harm
Distributive
&
Social
Justice
–
Allocating
resources
failry
and
providing
value
for
services
rendered
Ethical
Conflicts
in
Medicine
-­‐
Occurs
w/
uncertainty/conflict/question
regarding
competing
ethical
principles,
values,
or
professional/organizational
ethical
standards
of
practice
-­‐
When
one
considers
violating
an
ethical
principal,
personal
value,
or
organizational
standard
of
practice
=
an
ethical
conflict
-­‐
clinical
ethics
=
application
of
ethical
framework
to
individual
patient
care
issues
Research
Ethics
-­‐
Application
of
an
ethical
framework
to
the
design,
sponsorship,
review,
conduct,
and
dissemination
of
research
-­‐
Voluntary
consent
of
human
subject
=
essential
for
research
-­‐
Research
Ethics
Framework
=
social/sci
value,
scientifically
valid
design,
fair
subject
selection,
favorable
risk-­‐benefit
ratio,
independent
review,
informed
consent,
respect
for
enrolled
subjects
Quality
Improvement
Ethics
-­‐application
of
an
ethical
framework
to
the
design,
review,
conduct,
and
dissemination
of
QI
Organizational
Impact
of
Ethics
Conflicts
-­‐
Organizational
ethics
=
application
of
ethical
framework
to
system
of
care,
including
its
missions,
values,
structure,
culture,
and
practices
-­‐
Ethics
conflicts
have
impact
on
health
care
org

5. -­‐
Ethical
conflicts
have
sig
cost
implications
-­‐
Theoretical
correlation
between
ethical
conflicts
and
organizational
costs
-­‐>
impact
org
performance,
including
wages,
efficiency,
and
price
IOM
Six
Aims
for
Improvement
1.
Safe
2.
Effective
3.
Patient-­‐centered
4.
Timely
5.
Efficient
6.
Equitable
Health
Workforce
Planning
-­‐
Do
we
have
shortage
of
clinicians?
How
does
regional
supply
of
clinicians
affect
population
utilization
and
outcomes?
How
should
hc
org
rethink
clinician
workforce?
-­‐
“easier
to
add
capacity
than
take
capacity
away”
-­‐
“healthcare
economics
=
imperfect
market
-­‐>
shapes
pattern
of
care”
Physician
Shortage
Concerns
Concerns
1.
Growing
population
(elderly)
2.
Increase
in
age-­‐specific
utilization
rates
3.
Econ
expansion
-­‐>
“GDP
is
destiny”
4.
“demand”
increasing
rapidly
-­‐>
failing
to
anticipate
“demand”
w/
more
phys
=
shortage
5.
Assumes
demand
=
patient
needs
&
preferences
Desirable
Population
Outcomes-­‐
Investing
in
Medical
Workforce
Access
–
to
care
when
it
is
wanted/needed
Quality
–
care
that
is
technically
excellent
and
matches
patients’
preferences
Outcomes
–
care
that
improves
health
and
well
being
of
patients
and
populations
Costs
–
care
that
is
affordable
to
the
patient
and
to
society
ð if
these
outcomes
are
agreed
upon,
what
are
effective/efficient
ways
to
achieve
these
ends?
ð Evidence
that
acces/quality/outcomes
are
sensitive
to
physician
supply?
ð Understand
why
technical
quality/patient
satisfaction
is
not
necessarily
better
with
more
physicians
-­‐
With
similar
outcomes,
must
be
noted
that
many
health
care
systems
deliver
care
w/
far
fewer
physicians
(think
about
WHY
this
is,
what
FACTORS
affect
this,
and
how
to
INCREASE
efficiency)
-­‐
“good
care
trumps
care
&
clinician
quantity”
Clinician
Workforce
Planning
w/in
Health
Care
Organizations
-­‐
Improve
patients
health
&
wellbeing
-­‐
Optimize
organizational
by
strengthening:
1.
Secure
valuable
referrals
(PCP
networks)
2.
Build
capacity
in
high
margin
specialties
3.
Assume
fee-­‐
for-­‐service
revenues
will
flow
unimpeded
-­‐
Current:
Add
clinician
capacity
to
organizations

6. does
not
reliably
lead
to
better
outcomes
-­‐
Future:
fee-­‐for-­‐service
will
be
supplanted
by
capitated
payments
Scenarios
in
Organizational
Workforce
Planning
1.
Regional
Per
Capita
Supply
of
Physicians
vs
Proportion
employed
by
a
health
system
-­‐
Evaluate
proportion
of
highly
effective
care
High
Regional
per
capita
supply
+
high
health
syst
proportion
of
regional
supply
=
near
regional
monopoly
within
possible
over
capacity
region,
high
organizational
gain
–
high
risk,
questionable
patient
benefit
High
Regional
per
capita
supply
+
low
health
system
proportion
of
regional
supply
Modest
surgeon
share
w/in
possible
over
capacity
region,
high
organizational
gain
–
moderate
risk,
uncertain
patient
benefit
Direction
of
Workforce
capacity
w/in
organization
Depends
on:
1.
Regional
workforce
environment
2.
Proportion
of
workforce
environment
that
is
“owned”
by
the
organization
3.
Proportion
of
current
care
that
is
highly
effective
in
relation
to
patient
needs
and
preferences
Economics
of
the
Employer
Mandate
**Make
sure
to
review
the
graphs
in
Hansen’s
lecture
and
understand
them
-­‐
Making
employers
provide
costly
insurance
reduces
the
demand
for
labor
but
if
insurance
is
part
of
the
package,
the
supply
of
labor
also
increases
-­‐
With
marginal
price
close
to
zero
-­‐
Flat
of
the
curve
spending
–
if
we
are
near
flat
of
the
curve
and
we
increase
co-­‐pays,
what
should
happen
to
the
health
of
the
insured
population??
NO
CHANGE
-­‐
Expenditure
=
price
x
quantity
-­‐
Understand
the
role
of
prices
and
choice
in
competition
(think
of
chemotherapy
example,
Alaska
colonoscopy
example,
medical
tourism
industry
and
how
that
affects
competition,
insurance
companies
encouraging
patients
to
seek
cheaper
care)
-­‐
lack
of
competition
(market
power)
can
be
destructive
-­‐
consolidation
and
creation
of
market
power
is
happening
(new
york
hospitals
combining
and
forming
giant
hospitals)
-­‐
Insurers
are
able
to
create
demand
elasticity
=>
Demand
elasticity
measures
the
rate
of
response
of
quantity
demanded
due
to
a
price
change,
used
to

7. see
how
sensitive
the
demand
for
a
good
is
to
a
price
change
(higher
price
elasticity,
more
sensitive
consumers
are
to
price
changes)