HSA 6114
Terms
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- a psychological state, person’s own perception / experience of being sick
- Illness
- a bio-physiological phenomenon manifested by changes / malfunctions in human body – determined by a professional evaluation
- Disease
- State of complete, physical, mental, functional, and social well-being and not merely the absence of disease or injury. Extent to which person able to maintain normal level of functioning within his/her social context. Optimum capacity for an individual f
- Health
- is the cost of providing care the best use of the money? How much does it cost to treat the illness of 1 individual patient
- cost-analysis
- Identifying health problems and causative factors – collect, assemble, analyze, and disseminate info, monitoring health status of the community, diagnosing / investigating health problems
- Assessment
- Developing strategies to address problems – developing public policy that uses scientific knowledge in decision making e.g. 1) Mobilizing community partnerships 2) Developing policies and plans 3) Informing, education, empowering individuals about
- Policy Development
- Making sure strategies are implemented and goals achieved. Services necessary to achieve public health goals are provided. e.g. Enforcing laws / regulations; linking people to HC services; assuring competent workforce; evaluating effectiveness, access
- Assurance
- Activities of LPHAs
- • Frontline of public health agencies • Responsible for direct delivery of services • Carry out activities under authority delegated by state/local jurisdictions • Two thirds states extend “home rule†authority to local govt’s so they can: o Adopt their own local constitutions o Exercise governmental powers (e.g., taxation) –Alachua/Gilchrist county tax rates differ
- PH Operating Divisions
- ⬢ National Institutes of Health (NIH) - $28 M Budget ⬢ Food and Drug Administration (FDA) ⬢ Centers for Disease Control & Prevention (CDC) ⬢ Agency for Toxic Subs. & Disease Registry (ATSDR) ⬢ Indian Health Service (IHS) ⬢ Health Resources & Services Admin. (HRSA) ⬢ Substance Abuse & Mental Health Services Administration (SAMHSA) ⬢ Agency for Healthcare Research & Quality (AHRQ) - $300M Budget
- Federal Agencies with PH Responsibilities
- ⬢ Department of Health and Human Services (DHHS) ⬢ Environmental Protection Agency (EPA) ⬢ Department of Education ⬢ Department of Agriculture ⬢ Department of Labor ⬢ Department of Housing and Urban Development ⬢ Department of Transportation ⬢ Department of Veterans Affairs ⬢ Department of Defense
- include costs and benefits in quantitative terms
- Economic Evaluation
- Empowerment Evaluation
- an approach that examines a programs ability to: ⬢ take stock of their existing strengths and weaknesses, ⬢ focus on key goals and program improvements, ⬢ develop self-initiated strategies to achieve these goals ⬢ determine the type of evidence that will document credible progress.
- utilizes statistical methods and other evaluation tools on an ongoing basis to assure accountability for public health programs and to improve performance.
- Performance Evaluation
- father of vaccination
- Edward Jenner
- father of epidemiology
- John Snow
- father of the sanitary movement
- Edwin Chadwick
- father of germ theory of disease
- Louis Pasteur and Robert Koch
- with a defined budget, which of the possible programs should be invested in?; How do we best use our resources ($) to put toward patient treatment, How many lives can we save?
- cost-effectiveness(CEA)
- uses quality of life years to determine various benefits of different programs; Preventing death vs. improving life; try to use same denominator so treatments more easily compared
- cost-utility (CUA)
- $ - object $$ analysis of cost vs. benefits, To put in to dollar terms; comparison based solely on $ value difference, i.e. How much does it cost to save a life?
- cost-benefit(CBA)
- Major achievements in PH
- 1. Vaccinations 2. Motor-vehicle safety 3. Safer workplaces 4. Control of infectious diseases 5. Decline in deaths from coronary heart disease and stroke 6. Safer and healthier foods 7. Healthier mothers and babies 8. Family planning 9. Fluoridation of drinking water 10. Recognition of tobacco use as a health hazard
- Perfect Competition
- -Sufficient info -Large # of buyers/sellers -satisfactory substitutes for competitors
- Government seeks to ensure equitable distribution of resources
- Public Interest Theory of Government
- Seeks to make burdens/benefits equal among all
- Social Justice Theory
- Political markets no different than economic ones
- Economic Theory of Regulation
- Medical Errors (IOM)
- 44,000-98,000 deaths annually, $17-29B in costs
- Reasons for Rising Health Care Costs
- -Third party payment/moral hazard -Technology growth -Increased length of life -Admin costs -Fraud/abuse
- fit between service capacity and individual requirements
- Availability-Dimensions of Access
- fit between location of the provider and the location of the patients
- Accessibility-Dimensions of Access
- ability to pay
- Affordability-Dimensions of Access
- fit between the manner in which services are organized and an individual’s ability to take advantage of that arrangement; convenience, ex. Hours of operating, disability
- Accommodation-Dimensions of Access
- attitudes of patients and providers towards each other, is there a disconnect?
- Acceptability-Dimensions of Access
- Having health insurance increases the demand of HC because the patient is cushioned from the cost of the services received.
- Moral Hazard
- an amount of money that must be paid before the insurance policy becomes active
- Deductible
- paid as the beneficiary uses the insurance
- Co-Payment
- some insurance plans pay a percentage of the cost; patient is responsible for the remaining amount
- Co-Insurance
- insurance plan experiences a higher number of claims than would be expected under a random basis.
- Adverse Selection
- bases premiums on demographic characteristics or actual experience of the group to be insured
- Experience Rating
- bases premiums on the wider geographic area
- Community Rating
- 4 Major Control Knobs of International Health
- 1. Financing 2. Payments 3. Organization 4. Regulation
- General revenue/public financing, social insurance, private insurance, self-pay Ex. NHS – National Health Service (through taxes, run by department of health)
- Financing-International Health
- FFS, Salary (plus bonus), Capitation, Global Budget, Case Mix (DRG)
- Payments-International Health
- Public, Private (not for profit), Private (for profit)
- Organization-International Health
- Correct Mkt Failures, Control provider, induced demand, counteract monopolies
- Regulation-International Health
- Utilization Review-Cost Control Mechanism
- looking at how patients are actually using: 1. prospective review 2. concurrent review 3. retrospective review ï‚— Ex. Emergency Procedures
- Providers working for HMO on salary + bonus, provide service only to HMO patients; services not provided internally will be paid for out of network
- Staff Model-HMO
- contracts with multi-specialty group of physicians and hospitals at negotiated rates
- Group Model-HMO
- Similar to group model, but provide services at multiple sites to many groups thereby expanding geographical area
- Network Model/IPA-HMO
- Issues W/ Managed Care
- 1. Physician Autonomy 2. Consumer Choice 3. Consumer Satisfaction
- What do policy makers think is the largest problem with policy reform?
- Fragmentation of the system.
- Types of LT CARE
- 1. Nursing Homes 2. Home based care 3. Adult Day Health 4. Hospice 5. Assisted Living Facilities