HCD 303 Final Exam

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CoinsuranceSet percentage of the bill that must be paid at time of serviceDeductibleAmount that must be paid out-of-pocket annually before insurance coverage is appliedSickness Funds-130 sickness funds today -Covers 86% of country's population -Membership is mandatory -Must pay a legally mandated premium of 14.6% of income -Split between employer and employee -% of premium is determined by income -11% of population opts out of the SHI and opts for PHI -Percent of premium is determined by health assessment and is risk-adjustedSafety NetChildren under 18 yoa exempt from all cost-sharing -Adults: annual cap equal to 2% of household income -Annual cap lowered to 1% of household income for qualifying chronically ill people -Unemployed contribute to SHI in proportion to entitlementsCost SharingOutpatient prescriptions= $6.40-$12.70 Inpatient stay: $10/day -deductibles= vary by sickness fund plan -preventative services do not count towards deductibleSubsidyAny kind of government assistanceGeneralized ReciprocityPrinciple belief of giving to something knowing that the individual may not get an immediate returnSubsidiarityPrinciple belief that matter of government responsibility should be handled at the lowest level of government that makes operational senseSocial SolidarityPrinciple that governments have an obligation to ensure that every citizen has access to all social services including healthcareHealth FinancingThe function of a system that is concerned with the mobilization, accumulation, and allocation of money to cover the health needs of citizens individually and collectively, in the healthcare systemHealth Spending as % of GDP% of money spent on healthcare every year, in relation to the total amount spent throughout all industries in same yearFFSA payment model where all healthcare services, products, and prescriptions are unbundled and paid for separatelyPer DiemPayment model that reimburses organizations based upon the number of days treatment was givenPay-for-performancePayment model that reimburses healthcare organizations and physicians who achieve their performance on specified quality and cost measuresSalaryPhysicians are paid a predetermined salary based upon their level of expertise and experienceBundled PaymentsDRG= a prospective payment model in which hospitals are reimbursed with a fixed fee regardless of actual costs EDRG= bundled payment Reference Pricing= the payment amount now going to medical centers with high quality and low cost medical centers can charge more than reference priceCapitationProspective payment model where hospital/provider is paid a contracted rate per member per month, regardless of the number of services provided. Rates are typically risk-adjustedComponents of healthcare systemPeople Parts Inter-relationships CultureUS ranking in WHO37thUS rankings in Bloomberg54thUS rankings in commonwealth fund report11thGoals of a healthcare system1. high quality 2. low cost 3. easy accessHow do you measure various goals?1. life expectancy 2. quality of care 3. patient outcomes 4. patient safety 5. patient satisfaction 6. cost of care 7. access to careUS performance on quality, access, and costVaries throughout the country, but overall rankings are relatively poor throughoutHow does the US perform on life expectancyApproximately 80 yearsMedicareBeveridgeCivil servant, education -London -1942: wrote and released The Beveridge ReportBevanMinister of Health -Founder of NHS when it was passed into law in July 1948BismarckGermany's 1st Chancellor - "sickness funds" -1883: sickness insurance act passedLee Kwan YewPrime Minister of SingaporeUK modelDencentralizedGerman modelDelivery and sickness funds are: decentralized, privateSingapore modelCentralized, public/privateSystemSet of procedures according to which something is done. An organized scheme or method A set of connected things or parts forming a complex whole4 Components of a healthcare system1. people 2. parts 3. interrelationships 4. culture3 Goals of a healthcare system1. high quality 2. low cost 3. easy accessHow much does healthcare system actually impact the health of a population?10%How much do individual behaviors impact the health of a population?40%PremiumThe amount paid monthly for a health insurance planWhat type of health insurance programs became popular immediately after WW2?Employer-based insuranceGatekeeperWhen a health plan dictates that a patient must get referred by the PCP to see a specialist3 types of nudging1. economic 2. environmental 3. educationalWho is covered by Medicaid?1. pregnant women 2. disabled 3. low incomeWho is covered by Medicare?1. end-stage renal disease 2. elderly 3. disabledWhen did Singapore become an independent country?1965, freed from Great BritainProject ECHOCurrently being ran by ASU: 1. palliative care ECHO 2. end-stage liver disease ECHO 3. behavioral health integration ECHO 4. medication-assisted treatment ECHO 5. veteran community care ECHOProject ECHOA continuing medical education model where teams of specialists train primary care providers to treat complex patients in need of specialty care servicesSocial determinants of healthThey are extenuating circumstances, outside the control of individuals, that have substantial impacts on healthGlasgow EffectIt is the concept that neighborhood plays a very important role in our health and can change drastically, even within a small geographic area3 key aspects that are needed to accurately define a health or healthcare disparity1. risk factor 2. comparison population 3. measurable health of healthcare outcomeHealthcare disparitiesDifferences between two or more groups in health insurance coverage, access to and use of care, and quality of care receivedHealth disparitiesHigher burden of illness, injury, or mortality experienced by one population group relative to another groupWhat is agency?It is the capacity of individuals to act independently and have a voice in aspects impacting their lives. It is important when combating health disparities as it empowers citizens that have been traditionally marginalized.What is the goal of the HHS?Eliminate racial and ethnic health disparitiesIn the early 2000s the Surgeon General released two reports that ultimately led to the creation of which organization?National Center for Minority Health and Healthcare Disparities